Open Sourc e VistA Developer Toolkit (Working title: VistA Novo)
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Transcript of Open Sourc e VistA Developer Toolkit (Working title: VistA Novo)
© 2013 The MITRE Corporation. All rights reserved.Approved for Public Release; Distribution unlimited. 13-3623
OverviewPresentation for OSHERA Architecture Working Group5 Nov 2013
Technical Team: Andy Gregorowicz, Dave Hill, Andrew Hubley, Salim Semy
Outcome Leads: Mary Pulvermacher, Mike Dowe
Task Outcome: Technical contributions to accelerate open source VistA’s ability to successfully serve our nation and share information with entities that do not use VistA
Open Source VistA Developer Toolkit(Working title: VistA Novo)
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
Outline
VistA Novo Conceptual Overview– Problem– Key Principles– Using VistA Novo– Deploying a VistA Novo based
app– Key Technical Principles– VistA Novo Developer Toolkit
Unified Architecture– VSA – VistA Novo Relationship– Unified Architecture: The Big
Picture– Unified Architecture Value
VistA Novo Proof of Concept– Proof of Concept Use Case– Blood Pressure Use Case– VistA Novo Use Case
Architecture– Use Case Sequence with Test
Stub– Planned Implementation– Security Approach– Planned Products– Schedule
Conclusion– Anticipated Results– Summary
© 2013 The MITRE Corporation. All rights reserved.Approved for Public Release; Distribution unlimited. 13-3623
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Vi s t A N o v o C o n c e p t u a l O v e r v i e w
VistA Novo Overview
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
Problem
VistA is a robust software product, but daunting to beginners– Development environment and interfaces are obscure– Often frustrates potential new users before they can see VistA’s potential
The current VistA environment hinders a healthy open source ecosystem– Simply setting up an instance of VistA and adding a patient can take hours to days for a novice
user MUMPS skills are difficult to find
– Developers and organizations typically don't know MUMPS and new developers are reluctant to invest in MUMPS
– Recent pushes for everyone to learn to code, from places like Code Academy, are creating a new wave of developers in modern, scripting languages
Current technologies offer a wealth of tools and services advantages not available with MUMPS– Automated testing and support for Behavior Driven Development (BDD)
Including the ability to track the exact code covered by the tests– Performance tuning– Rich open source library and tool ecosystem
Support for health standards, newest web technologies
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
Key Principles
Make VistA an attractive project for open source developers– Most open source projects have a way to let new users get something up and running in less than 30
minutes– Open source developers have their choices for EHR systems
OpenMRS, OpenEHR and others– A healthy open source ecosystem will benefit the VA, iEHR and the nation
Allow for the creation of new capabilities in VistA using current software development languages and tools– Leverage current talent pool and modern software tools and services to create a healthy open source
ecosystem Use what is available
– Don’t reinvent the wheel– Leverage projects that are working on incorporating current development tools into the MUMPS/VistA
environment Keep it Open
– All code and documentation must be open to allow a community to function– Dependencies on commercial software inhibit newcomers and low resource parties
Be Transparent– Transparently share to invite ideas, advice, support and contribution– Leverage collective intelligence of the open source community
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
Using VistA Novo
Work with the VistA Novo Test Stub to create your test health data
Build your application in JavaScript
Work with clinical data using FHIR services
Test using Jasmine to follow Behavior Driven Development (BDD) best practices
Use tools like HRCov for code coverage and NewRelic for performance tuning
Technology Details
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
Deploying a VistA Novo based app
Create your application using
VistA Novo
Package the application
Deploy the stand alone application• Communicates with
an existing VistA installation using VistA based services
Share stand alone application
with OSS community
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
Key Technical Principles
Robust test suites enable correctness, confidence, and software evolution – All software should have robust, automated, repeatable testing.– This enables change in software. Developers more confidently
make changes if they are provided with some assurance that they haven’t broken other pieces of the software.
Keep it Simple – Create the most simple implementation possible. Do not implement a feature until it is required.
Use Design Patterns – Create software solutions that follow well accepted patterns. This will increase familiarity for developers.
Developers First – Modern toolkits hide mundane code/tasks from developers. This toolkit should focus on developer convenience, leading toward greater productivity.
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
VistA Novo Developer Toolkit
An open source toolkit for building VistA-based applications using mainstream development environments– Initially JavaScript (node.js); Other environments (e.g., Ruby
(Rails), Python (Django)) could be added later Run-time features
– Health data standards support (CCDA, FHIR) Design-time features
– VistA service testing stub utility to mock prospective behavior of new services that don’t yet exist, allowing parallel application development
CCDA = Consolidated Clinical Document ArchitectureFHIR = Fast Health Interoperable Resource
© 2013 The MITRE Corporation. All rights reserved.Approved for Public Release; Distribution unlimited. 13-3623
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U n i f i e d A r c h i t e c t u r e
VistA Novo Overview
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
VSA – VistA Novo Relationship
VSA Wizard
Internal VA Services
External Authoritative Services
Vista Based ServicesGenerates
Uses
Vista Novo
VistA Service Assembler (VSA)– Provide utilities to build VistA Based Services as authoritative
services for use by other systems and technologies VistA Novo (Open Source VistA Developer Toolkit)
– Proof-of-concept open source toolkit for building VistA-based applications using mainstream development environments
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
VistA
Non-VistA System
VSA Wizard
Generates
FHIR
MITRE developing VistA Novo and VSA Service test
stub based on blood pressure use case
VSA team developing VSA Wizard tool
* VistA Novo will start as an open source project;VistA Novo = Open Source VistA Developer Toolkit
Unified Architecture: The “Big Picture”
SOAInfrastructure
VistA-Based Service
Mobile App VistA Novo*
App could call VistA-Based Services directly
Legend
App developer
Service dev
VA
MITRE
Other systemOptional
FHIR
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Unified Architecture Value
Stakeholder Potential Value
Veteran• New tools for patient empowerment• Increased access to their own health data• Broader network of “connected” providers
Clinician
• Increased access to computable patient health data
• Tighter feedback loop to adjust care plan• Easier to collect, share and use health data
meaningfully• Better care at lower cost
Developer
• VistA innovation open to larger community• Ability to leverage mainstream technologies to
increase developer efficiency and decrease sustainment costs
• Better data interoperability via open standards
© 2013 The MITRE Corporation. All rights reserved.Approved for Public Release; Distribution unlimited. 13-3623
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Vi s t A N o v o P r o o f o f C o n c e p t
VistA Novo Overview
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
VistA Novo Proof of Concept Use Case
Tests Unified Architecture Concepts– Selected to test key concepts of a unified architecture that combines an Open Source
VistA Developer Toolkit, VistA Based Services to access VistA data, and services to access other patient generated data (PGD)
Proposes Simple Blood Pressure Use Case– Simple proof-of-concept implementation– Use case proposed by VHA Office of Informatics & Analytics Patient Generated Data
(PGD) Connected Health Team in June 2013– Helps VA explore PGD topics
Serves up consolidated data using FHIR and simple CRUD interfaces– Reduces risk on use of FHIR (Fast Health Interoperable Resources), a fast emerging
health data exchange standard– Uses mobile friendly RESTful approach
Resources identified by URLs Uses standard set of stateless services (Create, Read, Update, Delete) to interact with resources Small learning curve
Demonstrates use of a test stub to mock the VistA Based Services allowing coordination on the interface to those access services
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
Blood Pressure Use CaseNotional Summary
Caveat: Notional summary for proof of concept implementation only; actual business processes and rules for Patient Generated Data (PGD) data to be defined by Veterans Health Administration (VHA)
Goals– Clinician: Demonstrate clinical value of access to PGD– Veteran: Motivate engagement in their own health– Technical: Inform cross-platform data standardization and
interoperability efforts Steps
– Veteran enters PGD data Veteran monitors blood pressure (BP) at home Veteran enters BP data using VA mobile subscription service to populate PGD
database; Data saved to PGD store with sharing allowed
– Clinician (e.g., Nurse) pulls PGD data as needed– Clinical team makes treatment decision
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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
ServiceInvocation
Data Storage
FHIRServices
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
PGD Service
VistABased
Service*
Other Services
FHIR
FHIR
FHIR
VistA Novo
*VistA Based Services may be generated using VistA Service Assembler (VSA)
VistA Novo Use Case Production Architecture
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
Mobile Apps
Open Source
Services
Things we haven’t
thought of
VistA Based Applications
ServiceInvocation
Data Storage
FHIRServices
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
FHIR
FHIR
FHIR
VistA Novo
VistA Novo Use Case Design Time Architecture
Test Data
Test Stub
Test Data Creation
User Interface
Mock Services
User enters syntheticblood pressure
readings for testing
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ServiceInvocation
Data Storage
FHIRServices
Test Data
Test Stub
Test Data Creation
User Interface
Mock Services
VistA Novo
1
234
5 6 7
Data Storage checks for data & invokes
a service toretrieve observations
FHIR Services check Data Storage for observation
External application requests
observations via FHIR
Test Stub returns synthetic BP
readings
Synthetic BP readings are cached in Data Storage
Observations are served through
the FHIR interface from Data Storage
User enters synthetic
blood pressure readings for testing
Blood Pressure (BP) Use Case Sequencewith VistA Novo Test Stub
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
VistA Novo Proof of ConceptPlanned Implementation VistA Novo Framework
– JavaScript Implementation Data Storage and FHIR Services generated with the help of HL7
tooling– JSON representations of resources
Ease of creation in JavaScript environment XML representation is out of scope
Test Stub for Proof of Concept Use Case (BP Service)– Ruby on Rails application– Mock implementation of BP service
RESTful service with JSON payload– Web-Based User Interface
Enter/edit patient demographics and BP readings Can incorporate new data models with minimal effort (rails_admin)
VistA Based Application – out of scope– No client development– Will simulate using HTTP utilities
Test Data Creation
User Interface
Mock Services
Test Data
ServiceInvocation
Data Storage
FHIRServices
Mobile Apps
Open Source
Services
Things we
haven’t thought
of
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
ServiceInvocation
Data Storage
FHIRServices
Test Data
Test Stub
Test Data Creation
User Interface
Mock Services Mock Service Calls
CRUD FHIR calls on patient data
Web User InterfaceUse to enter synthetic BP readings for testing
VistA Novo BP Use CasePlanned Implementation Graphic
Mock Authoritative VistA Based Services• Get BP (RESTful API)
• VistA or PGD data• Set BP (RESTful API)
• PGD dataUse 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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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 creates and donates back to HL7
Delphimodule
JavaScript module
Javamodule
To be built
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
VistA Novo Proof of ConceptSecurity Approach Summary
– Using simplistic approach for proof of concept Defer security implementation Use security component of underlying VistA Based Services
– Consider features of future RESTful approach Proof of Concept Approach
– Send authentication information to VistA Based Service– Assume Patient id is a string that can be used as a FHIR identifier and VistA Record IEN/SID– Use HTTP Basic Authentication to authenticate services for now– Assume that authorization will happen at the data source
Test stub assumes that authentication is equal to authorization Possible future RESTful approach
– Secure communications using https– Use proven open standards for identity management as well as user and service authentication
OpenID Connect for distributed identity management and user authentication OAuth 2 for service to service authentication
– Enforce privacy at the provider location at the time the information is requested– Leverage approach profiled by RESTful Health Exchange (RHEx) wiki.siframework.org/RHEx
Original proof of concept sponsored by ONC Federal Health Architecture (FHA) Endorsed by ONC Health IT Standards Committee, 19 June 2013
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Planned Products
Open Source VistA Community Engagement Artifacts– Proof of concept source code on GitHub– Developer documentation on Wiki– Online discussions on mailing lists– WebEx presentations
Proof-of-Concept Source Code– Pathfinder capabilities for an open source VistA developer toolkit
Sufficient source code to verify the toolkit approach viability Not all features will be complete
– FHIR Services to expose VistA data– A backend that can invoke VistA-based services to populate FHIR-
based data models– A testing stub to simulate the VistA Based Services
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
VistA Novo Schedule
AugSept Oct
NovDec
Jan
Create service invocation framework
Test Stub feature complete
Open Source VistA Services Collab Session
VistA Novo Release 1.0
Build FHIR generator in Java using HL7 tools
FHIR support feature complete
VistA Novo Demo
Create mock BP service
Create framework for building new stubs
Create UI for setting test stub data
Test Stub Development
FHIR Development
10/11
11/8
11/15
11/22
11/15
12/6
12/201/14
12/138/21
© 2013 The MITRE Corporation. All rights reserved.Approved for Public Release; Distribution unlimited. 13-3623
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C o n c l u s i o n
VistA Novo Overview
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
Anticipated Results
Evidence on Open Source VistA Developer Toolkit viability– Founded on actual experience– Demonstrating the use of mainstream development technologies
Proof-of-concept open source developer toolkit software Risk reduction on the use of FHIR: a rapidly emerging HL7 standard Easier extension and modification of the VistA Platform
– Avenue for innovative applications using VistA data & business logic– Greater utilization of VistA’s vast feature set by the community– Easier integration through tooling for Health IT standards
Greater participation in the VistA community from new developers– Lower barrier to entry especially for small and resource constrained
organizations– Ability to leverage community innovation & dominant IT skills available
Significant step toward VA ASD targeted outcomeTargeted Outcome: Technical contributions to accelerate open source VistA’s ability to successfully serve our nation and share information with entit ies that do not use VistA
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
Summary
VistA Novo is a VA ASD sponsored proof-of-concept for an open source VistA developer toolkit– Built open– Using open source perspective– Using mainstream development technologies
Intended to demonstrate the viability of a unified architecture that tests and uses authoritative VistA Based Services
Including excellent partnership with OSEHRA to engage and encourage broader Open Source VistA community involvement
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© 2013 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution unlimited. 13-3623
More Information
Mailing List: [email protected] Code Repositories:
– Test Stub: https://github.com/OSEHRA/vista-novo-test-stub– FHIR Implementation: https://github.com/OSEHRA/vista-novo-fhir
Wiki: http://wiki.osehra.org/display/VN/VistA+Novo+Home Issue Tracking: http://issues.osehra.org/browse/VN