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When Providing a Health Service, the Infrastructure Behind the API is Equally Important

Posted on May 2, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

In my ongoing review of application programming interfaces (APIs) as a technical solution for offering rich and flexible services in health care, I recently ran into two companies who showed as much enthusiasm for their internal technologies behind the APIs as for the APIs themselves. APIs are no longer a novelty in health services, as they were just five years ago. As the field gets crowded, maintenance and performance take on more critical roles in offering a successful business–so let’s see how Orion Health and Mana Health back up their very different offerings.

Orion Health

This is a large analytics firm that has staked a a major claim in the White House’s Precision Medicine Initiative. Orion Health’s data platform, Amadeus, addresses population health management as well as “considering how they can better tailor care for each chronically ill individual,” as put by Dave Bennett, executive vice president for Product & Strategy. “We like to say that population health is the who and precision medicine is the how.” Thus, Amadeus can harmonize a huge variety of inputs, such as how many steps a patient takes each day at home, to prevent readmissions.

Orion Health has a cloud service, a capacity for handling huge data sets such as genomes, and a selection of tools for handling such varied sources as clinical, claims, pharmacy, genetic, and consumer device or other patient-generated data. Environmental and social data are currently being added. It has more than 90 million patient records in its systems worldwide.

Patient matching links up data sets from different providers. All this data is ingested, normalized, and made accessible through APIs to authorized parties. Customers can write their own applications, visualizations, and SQL queries. Amadeus is used by the Centers for Disease Control, and many hospitals join the chorus to submit data to the CDC.

So far, Orion Health resembles some other big initiatives that major companies in the health care space are offering. I covered services from Philips in a recent article, and another site talks about GE. Bennett says that Orion Health really distinguishes itself through the computing infrastructure that drives the analytics and data access.

Many companies use conventional relational database as their canonical data store. Relational databases are 1980s-era technology, unmatched in their robustness and sophistication in querying (through the SQL language), but becoming a bottleneck for the data sizes that health analytics deals with.

Over the past decade, every industry that needs to handle enormous, streaming sets of data has turned to a variety of data stores known collectively as NoSQL. Ironically, these are often conceptually simpler than SQL databases and have roots going much farther back in computing history (such as key/value stores). But these data stores let organizations run a critical subset of queries in real time over huge data sets. In addition, analytics are carried out by newer MapReduce algorithms and in-memory services such as Spark. As an added impetus for development, these new technologies are usually free and open source software.

Amadeus itself stores data in Cassandra, one of the most mature NoSQL data stores, and uses Spark for processing. According to Bennett, “Spark enables Amadeus to future proof healthcare organizations for long term innovation. Bringing data and analytics together in the cloud allows our customers to generate deeper insights efficiently and with increased relevancy, due to the rapidity of the analytics engine and the streaming of current data in Amadeus. All this can be done at a lower cost than traditional healthcare analytics that move the data from various data warehouses that are still siloed.” Elastic Search is also used. In short, the third-party tools used within Orion Health are ordinary and commonly found. It is simply modern in the same way as computing facilities in other industries–così fan tutte.

Mana Health

This company integrates device data into EHRs and other data stores. It achieved fame when it was chosen for the New York State patient portal. According to Raj Amin, co-founder and Executive Chairman, the company won over the judges with the convenient and slick tile concept in their user interface. Each tile could be clicked to reveal a deeper level of detail in the data. The company tries to serve clinicians, patients, and data analysts alike. Clients include HIEs, health systems, medical device manufacturers, insurers, and app developers.

Like Orion Health, Mana Health is very conscious of staying on the leading edge of technology. They are mobile-friendly and architect their solutions using microservices, a popular form of modular development that attempts to maximize flexibility in coding and deploying new services. On a lark, they developed a VR engine compatible with the Oculus Rift to showcase what can creatively be built on their API. Although this Rift project has no current uses, the development effort helps them stay flexible so that they can adapt to whatever new technologies come down the pike.

Because Mana Health developed their API some eighteen months ago, they pre-dated some newer approaches and standards. They plan to offer compatibility with emerging standards such as FHIR that see industry adoption. The company recently was announced as a partner in the Commonwell Alliance, a project formed by a wide selection of major EHR vendors to pursue interoperability.

To support machine learning, Mana Health stores data in an open source database called Neo4j. This is a very unusual technology called a graph database, whose history and purposes I described two years ago.

Graphs are familiar to anyone who has seen airline maps showing the flights between cities. Graphs are also common for showing social connections, such as your friends-of-friends on Facebook. In health care, as well, graphs are very useful tools. They show relationships, but in a very different way from relational databases. Graphs are better than relational databases at tracing connections between people or other entities. For instance, a team led by health IT expert Fred Trotter used Neo4J to store and query the data in DocGraph, linking primary care physicians to the specialists to which they refer patients.

In their unique ways, Mana Health and Orion Health follow trends in the computing industry and judiciously choose tools that offer new forms of access to data, while being proven in the field. Although commenters in health IT emphasize the importance of good user interfaces, infrastructure matters too.

Big EMR Vendors Agree To Interoperability Scheme

Posted on March 6, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

John’s Comment: See my coverage of the CommonWell announcement on EMR and HIPAA.

Could it be that real interoperability between vendors is on the way? Five big EMR vendors — including three hospital-oriented giants and two doctor-focused players — have come together during HIMSS to announce plans to create common standards for health data sharing, reports Forbes.

Cerner, McKesson, Allscripts, athenahealth and Greenway Medical Technologies have joined to create a new non-profit called the CommonWell Health Alliance. (As most wags have noted, Epic is conspicuously absent from the mix.)

The partners haven’t disclosed a lot of detail as to how they plan to achieve interoperability amongst themselves, but the scheme seems to rely on creating a unique national ID. “Without a national ID and the ability to create true data that can be safely and securely sent between individuals, we are going to introduce new systemic risk back into the system,” Neal Patterson, founder, chairman and chief executive of Cerner told Forbes.

Patterson, public citizen that he is, said that the CommonWell Alliance isn’t a commercial effort but “an obligation.”  That certainly sounds lovely, but with five hyper-competitive public companies forming up this effort, I’m skeptical to say the least. Besides, if it’s an obligation, why isn’t Epic so obligated?

John Halamka, Chief Information Officer of Beth Israel Deaconness Medical Center in Boston, has probably sniffed out more of partners’ true motivation. “They’re thinking of it as an enabler for new technologies,” Halamka suggests to Forbes, a move which can “raise the tide for all boats.”

Whether it raises any boats or not, creating interoperability links between these vendors certainly can’t hurt. After all, the more data sharing the better, particularly by major players with significant market share.

That being said, there’s still the matter of Epic being out of the picture, not to mention other major EMR players. How much of a practical difference the CommonWell Health Alliance can make is very much in question.