VistA on FHIR with VistA Novo

© 2014 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623, 13-1012, 12-2797, 12-2251

D a ve H i l l , T h e M I T R E C o r p o r a t i o n d w h i l l @ m i t r e . o r g

VistA on FHIR with VistA Novo

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Overview

VistA Novo VistA Novo is a foundational piece Other existing open source technologies to build VistA-based

applications – Security – Mobile – Clinical Quality Measures

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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623

wiki.osehra.org/display/VN/VistA+Novo+Home

http://wiki.osehra.org/display/VN/VistA+Novo+Home



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Purpose

Demonstrate VistA Novo – a proof of concept – Sponsored by VA ASD – Open source OSEHRA project

Show value of simple Patient Generated Data (PGD) use case – Using realistic patient scenario – Leveraged through MITRE’s Patient Toolkit project Working with Kathy Frisbee, VHA Research project focused on PGD Kristina Sheridan, MITRE Project Lead

Simulate Patient Scenarios to: – Show value to Veterans of clinician access to both VistA and PGD

data


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What VistA Novo Provides

Open Standards Support – Open standard, RESTful API to VistA Based Services – Fast Healthcare Interoperability Resources (FHIR) standard data format Data interoperability, across internal VA systems and external systems Uses the automated FHIR code generator with new JavaScript module

Potential army of innovators, reviewers, and quality assurance help Using mainstream technologies

A Test Stub to accelerate innovation – Simplifies testing, particularly corner cases and error conditions – Apps can be developed in parallel with service development Test Stub provides simulation before real service is available

Underpinnings for better care at lower cost – Get healthcare “off the mainframe”1 – More empowered patients

1E. Dishman, “Take health care off the mainframe,” TEDMED 2009.


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Mobile Apps

Open Source

Services

Things we haven’t

thought of

VistA Based Applications

PGD Database

VistA

Other Data Sources

Data Sources

Service Invocation

Data Storage

FHIR Services

Simple CRUD interface allows for easy development

and surprisingly sophisticated applications

Only used for caching

Pluggable back end that can be

adapted to other services

Patient-Generated Data (PGD) Service

VistA Based

Service*

Other Services

FHIR

FHIR

FHIR

VistA Novo

*VistA Based Services may be generated using the VistA Service Assembler (VSA)

VistA Novo Production Architecture


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Service Invocation

Data Storage

FHIR Services

Test Data

Test Stub

Test Data Creation

User Interface

Mock Services Mock Service Calls

CRUD FHIR calls on patient data

Web User Interface Use to enter synthetic BP readings for testing

VistA Novo Development Architecture

Mock Authoritative VistA Based Services • Get Vitals (RESTful API)

• VistA or patient-generated data • Set Vitals (RESTful API)

• Patient-generated data

Use HTTP utility, such as cURL, Poster, etc. to

invoke FHIR service and view results

FHIR Services • Get Observation

(RESTful API) • Set Observation

(RESTful API)

VistA Novo Framework


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Synthetic BP readings are cached in Data Storage

Test Stub returns synthetic BP

readings

User enters synthetic

blood pressure readings for testing

Service Invocation

Data Storage

FHIR Services

Test Data

Test Stub

Test Data Creation

User Interface

Mock Services

VistA Novo

Data Storage checks for data & invokes

a service to retrieve observations

FHIR Services check Data Storage for observation

External application requests

observations via FHIR

Observations are served through

the FHIR interface from Data Storage

Blood Pressure (BP) Scenario with VistA Novo Test Stub

1

2 3 4

5 6 7

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generates

VistA Novo Technical Architecture

Test Stub VistA Novo Framework

DB Tools: Mongoose

Runtime: JavaScript

HTTP Client: Restlet

Database:

Service API: FHIR

Runtime: Ruby

Database:

Web UI: Rails Admin

HL7 FHIR Code

Generator

Mock Service API

C# module

App Server:

Web Framework:

MITRE created and donated back to HL7

Delphi module

JavaScript module

Java module


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The Future Is Bright

VistA Novo is a foundational first step Building block for passive data collection instead of active data

collection – Leverage open standards in VistA Novo with mainstream

technologies – Mobile sensors provide patient-generated data automatically – Fewer data errors – Easier for the patient

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Patient “Black Box”

Smartphones – Mobile sensor hub Scales Blood pressure cuffs Sleep monitors Vitals monitors Diabetes monitors Fitness monitors

– More engaged patient – Better communication

Computable Patient Record – Faster diagnosis and

treatment – Better care, lower cost

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Data Is Medicine

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Blue Button Plus blue-button.github.io/blue-button-plus-pull/

http://blue-button.github.io/blue-button-plus-pull/

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RESTful Health Exchange wiki.siframework.org/RHEx


http://wiki.siframework.org/RHEx

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Safeguarding Access to Health Information Use same trust model as Direct but implemented with Web

Technologies Communications secured with https Use proven, open standards

– OpenID Connect for distributed Identity management and user authentication

– Oauth 2 for service-to-service authentication Privacy is enforced at the provider location at the time the

information is requested – Provides information needed for authorization determination E.g., Extends standard profile information to add clinical role

for use in enforcing access control


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Content

Security

Transport

Encryption in Transit

Interface

Layer Purpose

Identity & Authentication

Content Payload

TLS/SSL

HTTP

Standards

CCDA

OpenID OAuth

HL7 V2 C32

HTML DICOM …


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hreader.org

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© 2012 The MITRE Corporation All rights reserved

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project-imas.github.io

http://project-imas.github.io/

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iMAS - iOS Mobile Application Security Problem iOS is considered secure, but out of

the box security is not enough Simple device passcodes enable

easy compromise of applications and data

Solution Veteran empowerment with secure

mobile Additional security controls beyond

Apple Reduce iOS app attack surface Extends security with or without

MDM and commercial solutions Open source available

project-imas.github.com Raise iOS app security levels -

closer to the Art of the Possible

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Data Is Medicine


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More Information

Mailing List: [email protected]

VistA Novo Code Repositories:

– Test Stub: https://github.com/OSEHRA/vista-novo-test-stub

– FHIR Code: https://github.com/OSEHRA/vista-novo-generated-fhir

– FHIR HL7 Generator: https://github.com/OSEHRA/vista-novo-fhir

Includes JavaScript FHIR generator module

– Demo applications: https://github.com/OSEHRA/vista-novo-demos

Wiki: http://wiki.osehra.org/display/VN/VistA+Novo+Home

Issue Tracking: http://issues.osehra.org/browse/VN

Blue Button Plus REST API: http://blue-button.github.io/blue-button-plus-pull/


mailto:[email protected]

https://github.com/OSEHRA/vista-novo-test-stub

https://github.com/OSEHRA/vista-novo-generated-fhir

https://github.com/OSEHRA/vista-novo-test-stub

https://github.com/OSEHRA/vista-novo-fhir

https://github.com/OSEHRA/vista-novo-demos

https://github.com/OSEHRA/vista-novo-fhir


http://issues.osehra.org/browse/VN



http://issues.osehra.org/browse/VN

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hreader.org

wiki.siframework.org/RHEx

projectpophealth.org

http://project-imas.github.io

wiki.osehra.org/display/VN/VistA+Novo+Home

Dave Hill

[email protected]


Documents

VistA on FHIR with VistA Novo