The KIS Architectural Framework Gordon Raup, CTO Datuit, LLC

Started from a business need Build software to make the PCMH work Found cross provider collaboration is difficult, time- consuming and expensive with current technology Goals A single Electronic Chart for the Patient that all vendors use Allow provider to modify EHRS without vendor assistance Current Status Provisional Business Process Patent was filed May 2010 Changed companies to accelerate progress Currently working on the prototype and finalizing the patent

Data is stored in Silos No single database schema can meet all needs Databases dont scale up well for large volumes of data Provider is dependent on the Vendor Only the Vendor can change the system Very expensive to change Vendors Innovation is expensive Must either be done by or coordinated with the vendor or done in a different silo

Interfaces required to link silos Requires agreement between two vendors and the provider Fragile and expensive Cross-Provider collaboration is difficult Data from different providers must be viewed separately or translated Translation is expensive and risky Vendors pursuing a winner take all strategy Health Reform Difficult with Database Model Accountable Care Organizations and Medical Homes require high level of cross-provider collaboration

All permanent storage is done in documents Context always kept with data Use only published standards for which conformance can be tested Continuity of Care Document (CCD) Clinical Document Architecture (CDA) Use only documents conformant with the HL7 Reference Information Model (RIM) Use Logic Apps to extract and combine data from multiple documents

Store Documents in Specially designed data centers – Data Keeps Every patient has Primary Data Keep where all Documents are stored, regardless of vendor. Multi-level storage: Permanent layer, BigTable-like layer, RAM layer Fierce Protective Shield – Gate Server Patient identification, User ID & Role authentication, validation of User Permissions, Session Authentication and Termination, Encryption and decryption. Document Masking per Patient Consent.

Accelerator Apps inside Gate Server Tightly integrated with the BigTable layer Purpose is to have data end user needs before it is asked for Predictive modeling based on knowledge of health system, patient health status and user past practices. Interchangeable – Diabetes Center may want different Accelerator than Cardiac Rehab Data Agents outside Gate Server Viewer Agent, Communication Agent, Logic Agent Tightly integrated with end user browser session Purpose is to prepare new screens before browser action generates request for them

Apps are Nested Four types of Primitives: Action Elements, List Elements, Data Widgets, Page Definitions Four Levels of Nesting: Page Sets, Solution Sets, Packages, and Applications Tightly integrated with Viewer Agent Apps have Defined Roles and Services Med List App must be able to supply meds in a standard format for other apps to use. Office Visit App must have all of the required elements of an Office Visit Requirements are usually a constraint on underlying document standard

Single Electronic Chart for each Patient All Data for the patient in one place – No interoperability required. EPC instead of EHR Avoids the cost, speed delays, and translation risk of HIE The tight care coordination needed for Medical Homes and Accountable Care Organizations wont be realized unless each provider can see all of the data quickly, whenever they want it. Allows all Providers to be in the same silo Because all documents must conform to published industry standards all vendors can reliably read and interpret the data. Documents posted by one provider are immediately available and usable by other providers – and their Data Agents.

Fosters innovation in care delivery Technically-aware healthcare providers or their IT departments can create their own page sets, data widgets, and KIS packages without technical training by using KIS BUILDER Such innovators can sell their IP with little effort and investment and automatically have proceeds deposited in their bank account each month. Reduces Health IT costs substantially By allowing provider organizations to compete with vendors, overall IP costs will be reduced By using simple interchangeable parts, the system will be cheaper to maintain and adjust By moving to a Utility Computing model health IT infrastructure costs will be substantially reduced.

Supports Open Source without the challenges Developer organizations can provide KIS apps to others at no charge or for a small fee. KIS Organization will ensure system reliability and enhancements. Makes FDA Quality Standards Practical KIS breaks software apps into small chunks that can be separately tested to higher standards. Allows true Provider-Patient Collaboration Different KIS apps tailored to consumers can display the same data as recorded by healthcare providers – no importing. Patients can add data to the EPC just like any other provider

Response Time Database technology was developed to improve response time, but is not scalable. KIS will use small independent distributed Data Agents to provide real time data and services to end users Data Agents will use in-memory fast-response data structures such as NOSQL, and modern search algorithms such as web crawlers and predictive modeling to provide fast response time. It is anticipated that when fully built out, response times will be better than comparable database response times.

Choosing Document Standards Not all types of documents have published standards that are widely accepted. Different document standards will be required in different countries and in different industry segment Industry is now rapidly coalescing around preferred standards A common marketplace of supported standards as implemented in the KIS platform will accelerate this process Ensuring Privacy and Security Robust Identity Management and Privacy Consent Management will be critical to widespread adoption. The Health IT industry has struggled with both of these electronic management challenges. Both are substantially easier to lock down with a consistent system. KIS provides vendors such a consistent system while providing a level playing field on which to compete.

Gordon Raup, CTO Datuit, LLC