Healthcare It Ehr Platforms
Following a comment yesteryear Vince Kuraitis regarding EHR modules below, I stance it would hold upward helpful if nosotros expanded a fleck on the notion of "Platform" inward the context of EHR software technology.
Roughly speaking in that location are iii kinds of "platforms":
(1) Hardware Platforms similar the figurer y'all are reading this on or an iPhone
(2) Operating System (OS) Platforms similar Windows vii or Linux or iPhone OS
(3) Software Platforms similar salesforce.com or IBM Websphere Portal
We should perish on inward heed that some OS platforms, peculiarly everything made yesteryear Apple, are tied to a hardware platform. For example, y'all cannot install the iPhone OS on a Motorola mobile phone. You tin laissez passer the sack nevertheless install Windows vii or Linux on a Dell machine or a Sony laptop.
So which "platform" are nosotros referring to when nosotros hash out EHR modules that are plug-and-play?
Until really recently, best of breed EHR modules, peculiarly inward Hospital settings, could hold upward assembled yesteryear users on diverse hardware platforms in addition to fifty-fifty diverse OS platforms. The integration of such modules was achieved yesteryear interfacing the modules, that is, creating a platform independent connection betwixt the modules in addition to streaming information across. There are good established information technology standards for this class of communication (TCP/IP, FTP) in addition to every OS platform is capable of supporting them. The integration of such modules occurs purely on a data-exchange level. Each module, to a greater extent than probable total blown application, is completely self-contained when it comes to functionality in addition to information storage.
For instance let's facial expression at the most mutual integration inward HIT: an EMR interfaced to a Practice Management (PM) system. Both the EMR in addition to the PM are maintaining split upward databases of patients demographics. Both comprise dissimilar code to implement such functionalities every bit searching for patients, registering in addition to updating demographics, creating users in addition to privacy in addition to safety measures. When a user changes information inward 1 application, the information is updated inward the other application through interfaces (data-exchange).
This procedure is complex, expensive, requires information technology professionals to laid upward in addition to hold in addition to is prone to failure. If the modules are developed yesteryear dissimilar vendors, the coordination of software releases in addition to versions is a really fragile process. From a software evolution perspective, this organisation is also really tiresome in addition to wasteful, since each vendor has to reinvent the bike in addition to programme all features in addition to functionality from scratch. This dilemma is non unique to Healthcare IT.
The software world's response to the work was twofold, but the underlining stance was the same. Create reusable modest full general functionality in addition to larn inward available to other programs every bit a service. Thus the term Web Services was coined, along alongside Service Oriented Architecture (SOA). Web Services, for a piece the holy grail of modularity, proposed consummate vendor, linguistic communication in addition to OS neutrality. Application would facial expression for, abide by in addition to employ, services deployed all over the web. So y'all could locate in addition to utilisation a service providing conditions forecasts inward your region, or drug-to-drug interactions, or recommendations for immunization schedules for a salubrious 6 yr old. This is really much similar holler for the spider web a elementary question, champaign of report to elementary parameters, in addition to receiving a elementary response. Theoretically, 1 could get together a large application built on this paradigm, but, at to the lowest degree for Healthcare, the complexity of the domain coupled alongside the lack of fiscal drivers, express the utilisation of Web Services for anything to a greater extent than than replacement for erstwhile fashioned (TCP/IP) interfaces.
SOA on the other manus is widely practiced yesteryear developers edifice applications on an internal basis. It breaks downwardly large modules of software into small, reusable service chunks that dissimilar teams tin laissez passer the sack utilisation without the demand to rewrite code. For example, in that location are many places inward an EHR where y'all demand to search for patients, or display medication lists. An SOA architected application would brand these functions available every bit a service to those writing lab modules in addition to those writing billing modules in addition to therefore on. It saves evolution fourth dimension in addition to makes the software much easier to maintain.
Within an SOA architected software platform (here's that discussion again), disparate evolution teams tin laissez passer the sack create functional software modules guaranteed to piece of work together, since they are all using the same services edifice blocks. My favorite analogy is a large bucket of Lego blocks. Each Lego stand upward for a service. Developers pick Legos from the bucket according to specifications documents in addition to get together large software constructs. As y'all larn improve at this, y'all create to a greater extent than sophisticated in addition to specific Lego blocks for your developers (like adding the Lego Star Wars kits to your erstwhile bucket).
Now let's accept a saltation of organized faith in addition to imagine that a vendor who built such SOA architected product, decides to issue a listing of all the services available along alongside a manual on how to utilisation them, in addition to to transcend it off it makes a examine surroundings available to the public, therefore they tin laissez passer the sack elbow grease edifice their ain bundles of functionality in addition to examine their creations. salesforce.com did that for the CRM marketplace position in addition to a flurry of piffling modules to get upward or supersede the master salesforce.com production parts rapidly emerged. These independent developers could sell their novel software to other salesforce.com customers, or larn inward freely available to all. There is entirely 1 affair they couldn't do. They couldn't utilisation their modules without subscribing to salesforce.com in addition to they couldn't run their software on some other vendor's platform. For salesforce.com, opening its software platform to exterior developers made proficient fiscal sense.
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So when nosotros verbalize well-nigh EHR modules in addition to platforms, what just are nosotros talking about?
If nosotros are talking well-nigh modules interacting through Web Services, in addition to therefore yes, nosotros could subscribe to a diverseness of vendor independent modules in addition to create an entire EHR that way. However, in that location are no Web Services out there, correct now, that would allow such integration out of the box. The most mutual module that is available inward this fashion is electronic prescribing, but y'all cannot purchase an e-Prescribing service in addition to await your other EHR modules to simply piece of work alongside it. Usually the EHR vendor performs the necessary tasks for such integration, including testing, in addition to e-Prescribing services are non interchangeable. There is really piffling fiscal incentive for software vendors to create full general services inward this fashion in addition to fifty-fifty less incentive for large vendors to allow consumption of such tertiary political party services. If the fiscal ROI is non there, similar it was for salesforce.com, inward most likelihood it volition non happen.
How well-nigh the salesforce.com model then? The Software Platform. Will it piece of work for Healthcare IT? The response is a resounding yes. Last calendar week Eclipsys Corporation announced that it is opening its Microsoft powered Helios enterprise platform to software developers everywhere, much similar salesforce.com did a few years ago. What does this mean?
It way that modest vendors tin laissez passer the sack utilisation the Helios services (Lego bucket) to prepare plugins for the Eclipsys Sunrise product. It way that medium size vendors tin laissez passer the sack prepare modules to supersede some Sunrise modules, in addition to it way that large vendors tin laissez passer the sack twine their ain applications inward code that volition allow seamless integration alongside Eclipsys Sunrise. And Eclipsys is taking the responsibleness to test, validate in addition to guarantee that all these modules from dissimilar companies volition indeed piece of work together. Securely.
The caveat is of course of didactics that y'all must perish an Eclipsys client to taste all these choices of EHR modules, because Eclipsys is the platform owner.
I believe nosotros volition encounter to a greater extent than large vendors taking this approach inward the nigh future.
We tin laissez passer the sack also accept the software platform notion 1 footstep further. What if a generic Healthcare platform was built that offered no EHR in addition to entirely really few basic services, similar security, communications in addition to other OS related functionality, such every bit printing in addition to scanning? What if software vendors could hold upward convinced to build modular EHR services in addition to also brand them available to other users of this platform? What if such platform were gratis to prepare on in addition to gratis to the consumer? Not necessarily opened upward source, simply free. Would that work? Would that attain vendor independent, plug in addition to play EHR modularity that would lower costs in addition to improve quality?
There is entirely 1 possible response to this: Not really.
First, software platforms, every bit their cite indicates are made of software. Software needs to hold upward maintained, updated in addition to fixed. This costs money.
Second, inward guild to ensure truthful integration, mortal has to examine all these modules in addition to their interaction, in addition to validate information integrity in addition to proper functionality. This also costs money.
In other words, whatsoever software platform requires governance. Without governance, a platform is entirely useful every bit an opened upward source tool for professional person developers. And governance costs money.
IBM Websphere Portal is 1 such software platform. By EHR pricing standards, Wesphere is really expensive. The entirely way, I tin laissez passer the sack see, to create in addition to hold a Healthcare information technology opened upward software platform is for the Government to offering 1 to vendors in addition to providers for a nominal price, which way that Earth is paying for the necessary governance.
EHRs are really complex transactional pieces of software. They are the ultimate challenge inward enterprise software. It is non a trivial chore to build an EHR in addition to it is non a trivial chore to get together 1 from prebuilt modules either. There is really piffling error tolerance. EHRs tin laissez passer the sack improve efficiency in addition to character of care, if done right, but they tin laissez passer the sack also impairment patients if done wrong.
While I tin laissez passer the sack encounter patients, or consumers, assembling on the wing iGoogle pages alongside diverse widgets to assist hold wellness in addition to mange health, I cannot envision the same mightiness for a infirmary responsible for millions of patient records, hundreds of integrated electronic devices, thousands of staff members in addition to several hundreds of human lives, at whatsoever given moment. For them the EHR is Mission Critical Software, in addition to that requires a much dissimilar criterion than iGoogle.
Roughly speaking in that location are iii kinds of "platforms":
(1) Hardware Platforms similar the figurer y'all are reading this on or an iPhone
(2) Operating System (OS) Platforms similar Windows vii or Linux or iPhone OS
(3) Software Platforms similar salesforce.com or IBM Websphere Portal
We should perish on inward heed that some OS platforms, peculiarly everything made yesteryear Apple, are tied to a hardware platform. For example, y'all cannot install the iPhone OS on a Motorola mobile phone. You tin laissez passer the sack nevertheless install Windows vii or Linux on a Dell machine or a Sony laptop.
So which "platform" are nosotros referring to when nosotros hash out EHR modules that are plug-and-play?
Until really recently, best of breed EHR modules, peculiarly inward Hospital settings, could hold upward assembled yesteryear users on diverse hardware platforms in addition to fifty-fifty diverse OS platforms. The integration of such modules was achieved yesteryear interfacing the modules, that is, creating a platform independent connection betwixt the modules in addition to streaming information across. There are good established information technology standards for this class of communication (TCP/IP, FTP) in addition to every OS platform is capable of supporting them. The integration of such modules occurs purely on a data-exchange level. Each module, to a greater extent than probable total blown application, is completely self-contained when it comes to functionality in addition to information storage.
For instance let's facial expression at the most mutual integration inward HIT: an EMR interfaced to a Practice Management (PM) system. Both the EMR in addition to the PM are maintaining split upward databases of patients demographics. Both comprise dissimilar code to implement such functionalities every bit searching for patients, registering in addition to updating demographics, creating users in addition to privacy in addition to safety measures. When a user changes information inward 1 application, the information is updated inward the other application through interfaces (data-exchange).
This procedure is complex, expensive, requires information technology professionals to laid upward in addition to hold in addition to is prone to failure. If the modules are developed yesteryear dissimilar vendors, the coordination of software releases in addition to versions is a really fragile process. From a software evolution perspective, this organisation is also really tiresome in addition to wasteful, since each vendor has to reinvent the bike in addition to programme all features in addition to functionality from scratch. This dilemma is non unique to Healthcare IT.
The software world's response to the work was twofold, but the underlining stance was the same. Create reusable modest full general functionality in addition to larn inward available to other programs every bit a service. Thus the term Web Services was coined, along alongside Service Oriented Architecture (SOA). Web Services, for a piece the holy grail of modularity, proposed consummate vendor, linguistic communication in addition to OS neutrality. Application would facial expression for, abide by in addition to employ, services deployed all over the web. So y'all could locate in addition to utilisation a service providing conditions forecasts inward your region, or drug-to-drug interactions, or recommendations for immunization schedules for a salubrious 6 yr old. This is really much similar holler for the spider web a elementary question, champaign of report to elementary parameters, in addition to receiving a elementary response. Theoretically, 1 could get together a large application built on this paradigm, but, at to the lowest degree for Healthcare, the complexity of the domain coupled alongside the lack of fiscal drivers, express the utilisation of Web Services for anything to a greater extent than than replacement for erstwhile fashioned (TCP/IP) interfaces.
SOA on the other manus is widely practiced yesteryear developers edifice applications on an internal basis. It breaks downwardly large modules of software into small, reusable service chunks that dissimilar teams tin laissez passer the sack utilisation without the demand to rewrite code. For example, in that location are many places inward an EHR where y'all demand to search for patients, or display medication lists. An SOA architected application would brand these functions available every bit a service to those writing lab modules in addition to those writing billing modules in addition to therefore on. It saves evolution fourth dimension in addition to makes the software much easier to maintain.
Within an SOA architected software platform (here's that discussion again), disparate evolution teams tin laissez passer the sack create functional software modules guaranteed to piece of work together, since they are all using the same services edifice blocks. My favorite analogy is a large bucket of Lego blocks. Each Lego stand upward for a service. Developers pick Legos from the bucket according to specifications documents in addition to get together large software constructs. As y'all larn improve at this, y'all create to a greater extent than sophisticated in addition to specific Lego blocks for your developers (like adding the Lego Star Wars kits to your erstwhile bucket).
Now let's accept a saltation of organized faith in addition to imagine that a vendor who built such SOA architected product, decides to issue a listing of all the services available along alongside a manual on how to utilisation them, in addition to to transcend it off it makes a examine surroundings available to the public, therefore they tin laissez passer the sack elbow grease edifice their ain bundles of functionality in addition to examine their creations. salesforce.com did that for the CRM marketplace position in addition to a flurry of piffling modules to get upward or supersede the master salesforce.com production parts rapidly emerged. These independent developers could sell their novel software to other salesforce.com customers, or larn inward freely available to all. There is entirely 1 affair they couldn't do. They couldn't utilisation their modules without subscribing to salesforce.com in addition to they couldn't run their software on some other vendor's platform. For salesforce.com, opening its software platform to exterior developers made proficient fiscal sense.
- - - - - - - - - - - - - - - -
So when nosotros verbalize well-nigh EHR modules in addition to platforms, what just are nosotros talking about?
If nosotros are talking well-nigh modules interacting through Web Services, in addition to therefore yes, nosotros could subscribe to a diverseness of vendor independent modules in addition to create an entire EHR that way. However, in that location are no Web Services out there, correct now, that would allow such integration out of the box. The most mutual module that is available inward this fashion is electronic prescribing, but y'all cannot purchase an e-Prescribing service in addition to await your other EHR modules to simply piece of work alongside it. Usually the EHR vendor performs the necessary tasks for such integration, including testing, in addition to e-Prescribing services are non interchangeable. There is really piffling fiscal incentive for software vendors to create full general services inward this fashion in addition to fifty-fifty less incentive for large vendors to allow consumption of such tertiary political party services. If the fiscal ROI is non there, similar it was for salesforce.com, inward most likelihood it volition non happen.
How well-nigh the salesforce.com model then? The Software Platform. Will it piece of work for Healthcare IT? The response is a resounding yes. Last calendar week Eclipsys Corporation announced that it is opening its Microsoft powered Helios enterprise platform to software developers everywhere, much similar salesforce.com did a few years ago. What does this mean?
It way that modest vendors tin laissez passer the sack utilisation the Helios services (Lego bucket) to prepare plugins for the Eclipsys Sunrise product. It way that medium size vendors tin laissez passer the sack prepare modules to supersede some Sunrise modules, in addition to it way that large vendors tin laissez passer the sack twine their ain applications inward code that volition allow seamless integration alongside Eclipsys Sunrise. And Eclipsys is taking the responsibleness to test, validate in addition to guarantee that all these modules from dissimilar companies volition indeed piece of work together. Securely.
The caveat is of course of didactics that y'all must perish an Eclipsys client to taste all these choices of EHR modules, because Eclipsys is the platform owner.
I believe nosotros volition encounter to a greater extent than large vendors taking this approach inward the nigh future.
We tin laissez passer the sack also accept the software platform notion 1 footstep further. What if a generic Healthcare platform was built that offered no EHR in addition to entirely really few basic services, similar security, communications in addition to other OS related functionality, such every bit printing in addition to scanning? What if software vendors could hold upward convinced to build modular EHR services in addition to also brand them available to other users of this platform? What if such platform were gratis to prepare on in addition to gratis to the consumer? Not necessarily opened upward source, simply free. Would that work? Would that attain vendor independent, plug in addition to play EHR modularity that would lower costs in addition to improve quality?
There is entirely 1 possible response to this: Not really.
First, software platforms, every bit their cite indicates are made of software. Software needs to hold upward maintained, updated in addition to fixed. This costs money.
Second, inward guild to ensure truthful integration, mortal has to examine all these modules in addition to their interaction, in addition to validate information integrity in addition to proper functionality. This also costs money.
In other words, whatsoever software platform requires governance. Without governance, a platform is entirely useful every bit an opened upward source tool for professional person developers. And governance costs money.
IBM Websphere Portal is 1 such software platform. By EHR pricing standards, Wesphere is really expensive. The entirely way, I tin laissez passer the sack see, to create in addition to hold a Healthcare information technology opened upward software platform is for the Government to offering 1 to vendors in addition to providers for a nominal price, which way that Earth is paying for the necessary governance.
EHRs are really complex transactional pieces of software. They are the ultimate challenge inward enterprise software. It is non a trivial chore to build an EHR in addition to it is non a trivial chore to get together 1 from prebuilt modules either. There is really piffling error tolerance. EHRs tin laissez passer the sack improve efficiency in addition to character of care, if done right, but they tin laissez passer the sack also impairment patients if done wrong.
While I tin laissez passer the sack encounter patients, or consumers, assembling on the wing iGoogle pages alongside diverse widgets to assist hold wellness in addition to mange health, I cannot envision the same mightiness for a infirmary responsible for millions of patient records, hundreds of integrated electronic devices, thousands of staff members in addition to several hundreds of human lives, at whatsoever given moment. For them the EHR is Mission Critical Software, in addition to that requires a much dissimilar criterion than iGoogle.
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