By Seong K. Mun, PhD
The 8th Annual OSEHRA Summit, Open SaaS – Open Source in the Cloud, is really all about transition and interoperability. Healthcare information technology is mirroring mainstream IT in a rapid migration to the cloud and the use of Software as a Service (SaaS). Moreover, the Healthcare segment is using this transition to address a critical lack of data sharing and interoperability that is impacting the quality of patient care and the ability to manage population health. With the support of our Conference Sponsor, Perspecta, the OSEHRA community of organizational and individual members is coming together both to discuss the challenges of transition, and to showcase what has been accomplished to date.
As one might expect, the Department of Veterans Affairs (VA), the nation’s largest Healthcare provider, is the most visible example of Healthcare IT in transition. VistA (VA’s Electronic Health Record system) will be around for many more years as VA converts to a commercially developed system and migrates many of its key applications to the cloud. Since VistA has also been implemented as an open source EHR solution at sites around the world, there is great community interest in how VA will manage the transition. With that in mind, the Summit will begin with a panel discussion that includes several VA executives, aptly titled “VistA in Transition.” A back-to-back second panel will be comprised of experts from OSEHRA organizational members, offering industry perspectives on VistA transition issues.
As the world’s premier open source EHR, VistA continues to be an important resource even while in transition. Since many attendees are current or future users of VistA, the Summit has multiple track sessions on VistA and related enhancements. One of the perennial issues in working with VistA is that its internal database is unique and not compatible with many current SQL-based tools. On Monday, July 8, one of our organizational members, YottaDB LLC, is conducting a pre-Summit training course called SQL Reporting of VistA Data, which will present an open source tool that permits a relational view of VistA data. Adding SQL access to VistA enables the use of statistical analysis tools that can help to get even more value from the data.
VA is far from alone in confronting Healthcare modernization challenges. The Department of Health and Human Services (HHS) itself is an excellent example. They have responsibility for the Indian Health Service (IHS), a uniquely complex healthcare system that serves hundreds of sovereign tribes. The HHS CTO office has commissioned a study on the future strategy for IHS, and the afternoon begins with a progress update for the open source community. We expect this session will be an excellent example of how open community engagement can inform a government agency’s strategic planning process as well as promote innovation.
While relatively few Government agencies are Healthcare providers, all of them are subject to the Federal Open Source Policy, and all are grappling with cloud strategies. We decided to reprise our Federal Agency panel this year to update the community on the state of open source activity in agencies such as Department of Homeland Security and National Security Agency, as well as programs such as code.gov. This year’s panel will be moderated by Roger Baker, who will bring his experience as CIO of the Commerce Department and of the Department of Veterans Affairs to what will be a wide-ranging discussion with a lively Q&A session.
One of the most frequently used (and misused) terms in IT strategic planning is “interoperability.” In the context of Healthcare, one facet of interoperability is the elimination of artificial boundaries imposed by proprietary data formats and the general inability of major EHR systems to share clinical information. The afternoon session on July 9 with feature a blue-ribbon interoperability panel called Care Without Boundaries. Panelists will include former American Medical Association President Robert Wah, MD and Charles Jaffe, MD, PhD, the CEO of Health Level 7 International. The panel will be moderated by LTG (ret.) James Peake, MD, the former Secretary of Veterans Affairs.
After what promises to be a broad and informative interoperability discussion, we once again turn to our organizational members for an industry perspective. There will be discussions and demonstrations of a powerful platform containing both proprietary and open source software that can move data seamlessly from one system to another based on implementation of FHIR®-based capabilities. Attendees will get a look at how community collaboration can address even issues as large and complex as Healthcare interoperability.
Another example of an open source interoperability solution is a new package called the Omnibus Care Plan (OCP). The Substance Abuse and Mental Health Agency (SAMHSA) developed this state-of-the-art health IT platform for patient-centered care coordination and care management specifically for patients with substance abuse and mental health illnesses. Designed from inception as an open source project, OCP exemplifies best practices in software design and a flexible open source license (the Apache License Version 2.0). A commercial product has already been successfully fielded based upon OCP, demonstrating the viability of a derivative open source model. A special demonstration session will cover both OCP and the associated commercial product.
Another much-anticipated demonstration will be provided by InterSystems Corporation as they present their HealthShare product to the open source community. HealthShare is being used by many organizations nationally, and by VA as the foundation of their Veterans Data Integration and Federation (VDIF) Enterprise Platform. This will be the first opportunity for the community to see how this proprietary package is being integrated with VistA to normalize and federate VA’s heath record data.
The final session of this year’s Summit will be of great interest to developers of Healthcare software. As cloud migrations and SaaS development accelerate, so will the associated testing requirements. Lack of realistic patient data has been a persistent problem in the healthcare software community. In today’s privacy-sensitive environment, even de-identified data can feel risky. Using Synthea™ (an open source synthetic patient data generator developed by The MITRE Corporation) as a starting point, the OSEHRA Community has developed a data generating utility and data loader that can generate thousands of patients spanning many years of medical history. The data generation can be tailored to focus on a specific disease model such as anemia or other chronic illness. The current data loader is currently set up for VistA, and is being tested inside VA. Members of OSEHRA’s Synthetic Patient Data Open Source Project Group will close the 2019 Summit with a roundtable discussion covering development strategies, disease modeling, and possibilities for porting data to other EHR systems. We believe that the widespread availability of synthetic patient data will have a profound impact on advancing health informatics.
Our Summit conferences have always been about informing our community, sharing perspectives, and driving innovation. This year’s event continues the tradition, with multiple government and industry panels, a rich selection of track presentations, and insights into key open source initiatives. The role of open source in healthcare continues to evolve with technology and improvements in patient care, and the open source community continues to set the standard for collaboration and innovation.
For more information on the 2019 OSEHRA Summit, visit summit.osehra.org.