Taming Feral Systems With APIs in Region Östergötland’s Digitalisation Platform
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Caregivers often have many “unofficial” healthcare IT-related systems and a growing number of external apps that meet important business needs but have vulnerable management or limited (sometimes non-existent) integration that lead to double documentation and make coordination difficult. The phenomenon is called “feral systems”. Even for health care providers with a strategy of trying to collect patient data into a few centrally decided and managed systems, we believe it is better to find ways to “tame” the feral systems than to try to eradicate hunting. The lecture shows how we want to support businesses that see a need for tailor-made solutions for things that are not adequately addressed by the main systems, with the help of various parts of the Östergötland Digitalisation Platform (RÖD).
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Taming Feral Systems With APIs in Region Östergötland’s Digitalisation Platform
- 1. Taming Feral Systems With APIs in Region Östergötland’s Digitalization Platform Nordic APIs 2019 Platform Summit 23 October 2019 Kimmo Ulltjärn, IT-Architect kimmo.ulltjarn@regionostergotland.se
- 2. Region Östergötland • 4th largest in Sweden • 463 000 inhabitants • Health care • 3 Hospitals • ~40 Health centres • Dental care • Public transport • Regional development It’s not Rocket ScienceOh wait, it’s way more complex
- 4. Starting point for the Digitalization Platform ? IT-Strategies: What and why How can IT do this? What capabilities are needed to implement the strategies? Political strategy – a new direction for healthcare • Early efforts • Closer to our citizens
- 5. Strategic IT capabilities Digitalization Platform API:s, accessible via internet, modern technology and open established standards Security Core responsibility established capabilities Integration Contracts Lose coupling Storage Unstructured data (VNA) Structured data (openEHR) Databases Files Management Monitor Manage Publish Economy Core Business Services based on functional requirements of the core business and capabilities of source systems
- 6. Goals System 5System 3 System 2 System6 System 5 System 4 System 3 System 2 System 1 Mode 1 Stable ”Backstage” Mode 2 Agile ”Frontstage” Technical Infrastructure Core business och citizens Functional Requirements Quality Requirements Digitalization platformIntegration Security Rules and policies openEHR VNA Dev portal Nationella tjänsteplattformen
- 7. Storage, standards and APIs • Storage • Files • Databases • Structured healthcare data (openEHR) • Unstructured data (VNA) • openEHR • Open • Established • Makes cooperation a lot easier • Empower healthcare professionals Intraoperability Common clinical data models API-model Input Persistency Interoperability API-model Output 80/20 principle mentioned in the 1st keynote Low code / no code
- 9. What is a feral system anyway? • In addition to the core systems • Often internal development projects by clinicians • Bypasses decided architecture • Solves real problems for the core business • 100’s in a large hospital • Reflex: Do away with them • …but they are really useful Source: http://lemurkat.blogspot.com/2011/12/return-of-giraffezebraelephant-thingy.html Feral systems ERP systems
- 10. Feral systems Advantages • Make daily life easier • Knowledge • Research and innovation • Business-driven development • Fast development (initially) Disadvantages • Technical debt • Integration debt • Information silos • Security risks • Legal risks • Management risks Business - Can’t live without them IT - Can’t manage or replace them ”My colleague has retired and left a few systems behind…”
- 11. Tame feral systems • Goal • Keep advantages of feral systems • Research today, Clinical everyday life tomorrow • Remove disadvantages • Shorten development times: Less code for storage, security, integration etc • How • Stepwise • Inform about advantages with the platform • Provide education and support in informatics • Freedom: • Develop what you want • Only one requirement – The digitalization platform is to be used Source: https://www.ebay.com/itm/ANIMAL-SELFIE-PHOTO-ELEPHANT-LION-HIPPO-GIRAFFE- DEER-EMU-ZEBRA-METAL-PLAQUE-1212-/262966426169
- 12. Back in the days – How it was •Digitalization started early •Overlapping functionality •Integration debt •Information silos •Expensive and unmanageable
- 13. Back in the days – The goal •One core system •…or at least a few •Monolithic •ERP (EHR system) Core system LAB PACS RIS
- 14. The result Core system LAB PACS RIS
- 15. New goal: Tame feral systems Digitalization Platform Security Integration Storage Management Core systemLAB PACS RIS • Technical debt • Integration debt • Information silos • Disconnected • Unmanageable • Ecosystem • Connected • Manageable
- 17. Production planning Digitalization Platform Security Integration Storage Management Core system Vendor C Vendor B Customer B Customer C Region Östergötland GOLIConnect • Vendor neutral solution • No vendor HW/SW on premise Goli Database GOLI Capacity Web Server Web browser (clients) Web browser (clients) Web browser (clients) HTTPS
- 18. Pathology Breastcancer - PoC openEHR archetypes Clinical data models Max-datasets, cover many use cases International. Translated openEHR template Specific use case Often national/local openEHR & snomedCT pathology response Business driven development Input: Unstructured structured data Research & healthcare – synergy http://liu.diva-portal.org/smash/get/diva2:1343958/FULLTEXT01.pdf
- 19. Burn injury unit – in development
- 20. Health data from Google Fit - PoC Digitalization platform Provide services with structured data to healthcare professionals Provide services with structured data to citizens open EHR • Same design pattern – Citizen provides health data – Patient provides healthcare data • Different laws • Region Östergötland provides back-end Security
- 21. Telehealth, monitoring – under procurement Digitalization platform Provide services with structured data to healthcare professionals Provide services with structured data to citizens open EHR Security Monitoring •Status •Alarms Patient administration •Patient type •Thresholds •Care plan Communication •Chat/messages •Phone •Video Forms •Editor Electronic Medical Record Measurements Forms Chat / Messages Bookings Video Patient Patient equipment from other vendor Clinical Decision Support, AI and stuff from other vendors Core system
- 22. Conclusions • Already reaping the benefits of API:s and common functions in the Digitalization Platform • Security • Integration • Storage • Management • Open established standards matter • Structured healthcare data based on openEHR • Reduced complexity, low code/no code • Empower healthcare professionals It’s not Rocket Science It’s way more complex. We’re making it easier.
Notas del editor
- Me: enterprise architect at Region Östergötland 4th largest organizational entity within the public sector in Sweden that provides Health care Dental care Public Transport Regional development A few other things Rocket science… ”Not many people know this – but they all agree that it is more complex…”
- Let me introduce you to our Digitalization Platform
- Political strategy Early efforts – preventing is better than curing Closer – better to provide care at home than at hospitals IT-strategies; what/why Digitalization. Many of them both national and local level How is todays topic!
- Platform with 4 strategic capabilities - standardization Security Integration Storage Management Accessible Internet API:s Open established standards Securtiy – OAuth2, OpenID connect Storage – something we will look into What matters: Ability to provide services Core business needs. Purpose of platform, make this easier and faster by providing functions that you will always need
- High level architecture view Legacy, technical infrastructure …Delivers services to core business and citizens …How? Through the digitalization platform. Where? Hospitals, at home etc Mix of modern apps using api:s and legacy systems Gartner: Bi modal IT Mode 1: Stability, efficiency Mode 2: Agility, speed. Lose coupling needed to avoid the slower pace. Functional requirements from core business/citizens Quality requirements responsibility of IT Rules/Policies about Digitalization Platform usage
- Storage 4 kinds Establishing: Structured Health Data Standards Heard about FHIR… Want to draw your attention to openEHR slightly different take Want to exploit Low code/no code Standard storage component in the platform to use
- Ad-hoc systems for specific purposes
- Solution: One system to rule them all
- …the ad-hoc special purpose systems didn’t go away!
- Moving one system at a time From: Unmanageable To: Manageable, part of ecosystem Rember: This is often fast moving research in a university hospital
- Not really a feral system. More traditional use case where we expose data to partners With the ususal advantages Technical stuff: 2 weeks
- I really like this! They were so happy!
- Just a LoFi Using same technolgy as the Pathology ”app”
- Only a small web app had to be developed. In matter of weeks. Again. Mode 2!
- Potential feral system – information silo if done the wrong way. Patient equipment EMR Patient eq. from other vendor CDS/EMR from other vendor. AI stuff maybe? Even the old core system at some point.