Appnovation Accelerate Conference - November 18, 2015 Presenters: Kristen Wilson-Jones & Gil Flamino Hurry up and Wait! Has anyone heard that before? The healthcare industry is an ever-evolving, dynamic and highly regulated one. The ability to respond to the new “new thing” along with balancing to a longer-view strategy is critical. To make it more challenging, healthcare is highly fragmented and what appears to be a “healthcare system” is in reality 1000’s of small businesses. This presents barriers everywhere you turn: data, organizational, workflow, time, applications, etc. In this session we will discuss how Sutter R&D is approaching these challenges utilizing open source to build their HIT Innovation Plecosystem, coined Maestro. We will also be conducting a live build-an-app-on-the-fly that demonstrates the promise of open source and how we’ve put into practice.

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Hurry Up and Wait !
Leveraging Open Source Technology to Fuel
Sutter’s HIT Innovation Plecosystem
Kristen “KWJ” Wilson-Jones, CTO Sutter Health, RD&D
Gil Flamino, Sr. Solutions Architect Sutter Health RD&D

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Introduction
RD&D Technology Vision
Transform the scale,
Pace and adoption of
HIT innovations
API driven
Federated / Mashup
Lean / Agile
Smart people

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Barriers to Innovation
“People do not “live” in e-HRs. They
go to multiple locations, see multiple
caregivers over varying periods of
time. Their data ends up in multiple
applications and databases and are
used by multiple people, patients
included.”
-KWJ

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• EPIC e-HR as core
• Portfolio > 3000 apps
• No different than the
ERP “era”
4
One Size does NOT fit all

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• EPIC e-HR as core
• Over 18,000 HL7
Interfaces
• 28 million HL7
messages day
• 68k SFTP day
5
Data Going Everywhere

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Barriers to Innovation in HIT
EPIC, Midas, Allscripts, MisysLab,
Breeze PFT, Survey Tools, HIE, etc.
Over 100 communities in Northern
California, 7500+ physicians in SMN, 26
hospitals, 5 other LOB, Utah Call Center,
over 5 million patients
Real-time instant access via APIs vs.
HL7, ETL, SFTP, or batch file processing
Applications /
System
Single encounter to a long journey of
episodes of care spanning a lifetime
Organizational
Data
Time
Maestro
is a suite of open
source integrated
platforms that serve as
a digital health
Orchestration
Plecosystem that
breaks through these
barriers
Workflow
Multiple logins, multiple user interfaces,
multiple handoffs, Excel, sticky notes
silo’d data

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The Maestro Healthcare
“Plecosystem”

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Interoperability the “Traditional Way” (HL7 Integration)
Traditional way of “Integration”
via HL7 interface
● Each system would interface via HL7 connectors individually
with each other
● The receiving system would take the incoming information,
disseminate it, and map to its own proprietary fields
● Data mismatch due to lack of consistency across proprietary
designs, definitions, formats, and framework
● Data flow is not real time, may impact decision making
● Singular, message-based transaction (no history)
● Requires data persistency in a new “data pile”
● There is ZERO workflow orchestration or context
● Average end-to-end build/test time 4 months
● Extensive support costs = high TCO

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The Maestro Healthcare Plecosystem at Sutter Health
AngularJS
NodeJS
Socket.io
Java
ORM
MuleSoft
Activiti
PostgreSQL
RESTful APIs
JSON
● APIs built once and
exposed through Maestro
Data Services
● Enables mash-up
development without the
need to store data
● Business logic Layer
massaging; retains all
context
● Data flow is instant, real-
time to back end systems
● Can access history
● Average end-to-end
build/test time less than 1-2
weeks

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Maestro @ Work
Case Studies

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RED Program: Workflow Enrollment Dashboard
● 3 sources
● 5 APIs
● Launch
Workflow

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RED Program: Workflow Visualization
● 3 sources
● 3 APIs
● Interactive
Drilldown

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RED Program: Workflow Task Interaction
● 2 sources
● 3 APIs
● Interactive Task
details
● Ability to capture
additional information

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Chronic Care Management
● Single Source
● 8+ APIs
● 2 yr look-back

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Chronic Care Management
● Single Source
● Data “assembler”
● Word procesing-
like formatting
● PUT to EPIC

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RheumSHARE

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RheumSHARE
● 3 Sources
● 5+ APIs
● Reusable
interactive object
● Data correlations
between 2
● Look back history
and trending

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RheumSHARE
● 3 Sources
● Progress Notes
Assembler
● PUT into EPIC

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Cardiometabolic

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The Demo Story
What you are about to see is “REAL WARE”
• Dr. KWJ will create a simple patient questionnaire
• Patient Kristen will take the questionnaire
• Developer Gil will expose the interface that connects to the
questionnaire (let’s see what’s behind this!)
• Developer Gil will enhance an existing dashboard to add the patient
captured data

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Where’s the “So What” ?
• So…we can innovate and develop new applications at least an order of magnitude faster
than a traditional “buy application and HL7 interface”
• So… we now have a way to experiment and fail fast and fail cheap on numerous innovative
ideas.
• So… we can iterate rapidly and applications can be optimized for the end-users total
experience and needs vs. forced into a user-interface box or multiple boxes
• So… we can easily deploy on any device: web, tablets, mobile
• So… we can provide insights that are just not visible or completely absent today
• More importantly… we can actually have a true understanding of all of the interactions we
have with patients in a holistic view and actually improve the patient experience.