What is a healthcare IT platform?

1. What is a healthcare IT platform? By Shahid N. Shah(based on Marc Andreeson’s definitions)

2. Who is Shahid? • 20+ years of software engineering and multi-site healthcare system deployment experience • 12+ years of healthcare IT and medical devices experience (blog at http://healthcareguy.com) • 15+ years of technology management experience (government, non-profit, commercial) • 10+ years as architect, engineer, and implementation manager on various EMR and EHR initiatives (commercial and non-profit) Author of Chapter 13, “You’re the CIO of your Own Office”

3. Next-generation health IT needs platforms

4. First came healthcare services centralization… Source: Jason Hwang, Innosight, via Jeff Selberg of IHI

5. …then comes decentralization and disruptive innovation Source: Jason Hwang, Innosight, via Jeff Selberg of IHI

6. Which leads to adaptive business model innovation… Viability Models Source: Ian Morrison, The Second Curve, via Jeff Selberg of IHI

7. …and means the full patient record is in various places that must connect Source: Jeff Selberg, IHI

8. Conclusion: we need real platforms

9. What is a Health IT Platform?

10. Definition according to Marc Andreesonfounder of Netscape & Opsware A "platform" is a system that can be programmed and therefore customized by outside developers -- users -- and in that way, adapted to countless needs and niches that the platform's original developers could not have possibly contemplated, much less had time to accommodate....The key term in the definition of platform is "programmed". If you can program it, then it's a platform. If you can't, then it's not.

11. Most health IT systems are apps, not platform – be careful what you’re buying • Remember: if youcan program it, then it's a platform. If you can't, then it's not. • In this case “you” is not the developers but people outside the original development team. This is crucial – if only the original developers can add to a system, it’s not a platform. To verify if something is a platform, ask the developers a simple question: “can I, without your help or being on your server, create software that connects to your system and allows me to extend it?” If the answer is no, it’s not a platform. Period.

12. A real platform’s power curve High-value Platform Value as a platform Platform Application Number of ecosystem partners, community size, integration points

13. The Ideal Healthcare Platform • Offers Type 1 connectivity through REST that can be consumed by third-parties. • Offers Type 2 connectivity through Java, .NET, PHP or other language plugins that can be developed by third parties. • Offers Type 3 execution capabilities by hosting 3rd party code in a cloud environment.

14. Platform Type 1: Access API Marc Andreeson writes that Type 1 is the kind of Internet platform that is most common today. This is typically a platform provided in the form of a web services API -- which will typically be accessed using an access protocol such as REST or SOAP.Architecturally, the key thing to understand about this kind of platform is that the developer's application code lives outside the platform -- the code executes somewhere else, on a server elsewhere on the Internet that is provided by the developer.Examples: PracticeFusion, eBay, Paypal, Flickr, Delicious • The entire burden of building and running the application itself is left entirely to the developer • The easiest kind of Internet platform to create

15. Platform Type 2: Plug-In API This is the kind of platform approach that historically has been used in end-user applications to let developers build new functions that can be injected, or "plug in", to the core system and its user interface.In the Internet realm, the first Level 2 platform was the Facebook platform followed by LinkedIn, OpenSocial, and others.

16. Platform Type 2: Facebook Example Marc Andreeson writes that when you develop a Facebook app, you are not developing an app that simply draws on data or services from Facebook, as you would with a Level 1 platform. Instead, you are building an app that acts like a "plug-in" into Facebook -- your app literally shows up within the Facebook user experience, often as a box in the middle of a page that Facebook otherwise defines, such as a user profile page. • The third-party app itself lives outside the platform • The entire burden of building and running a Level 2 platform-based app is left entirely to the developer • Unlike a Level 1 platform where the burden of exposing the app to users is also placed on the developer, Level 2 Internet platforms -- as demonstrated by Facebook -- will be able to directly help their developers get users for their apps • Level 2 platforms are significantly harder to create than Level 1 platforms

17. Platform Type 3: Runtime Environment In a Level 3 platform, the huge difference is that the third-party application code actually runs inside the platform -- developer code is uploaded and runs online, inside the core system. For this reason, in casual conversation Marc Andreeson refers to Level 3 platforms as "online platforms".A Level 3 platform will also superset Level 2 and Level 1 -- i.e., a Level 3 platform will typically also have some kind of plug-in API and some kind of access API.A Level 3 platform's developers upload their code into the platform itself, which is where that code runs. As a developer on a Level 3 platform, you don't need your own servers, your own storage, your own database, your own bandwidth, nothing... in fact, often, all you will really need is a browser. The platform itself handles everything required to run your application on your behalf.

18. Platform Type 3: The Future • Level 3 platforms are much harder to build than Level 2 platforms. • The level of technical expertise required of someone to develop on your platform drops by at least 90%, and the level of money they need drops to $0 • The Level 3 Internet platform approach is much more like the computer industry's typical platform (PC) model than Levels 2 or 1. Level 3 platform examples include: Ning , Salesforce.com, Amazon.com

19. The Ideal Health IT Platform Provides

20. Comparison with legacy applications Designed for transaction processing and documentation Designed for patient / provider engagement

21. Comparison with legacy applications

22. Modern Platform Connectivity IHE-compliant health information exchange components that currently support: • Patient identity cross referencing (PIX v2/v3) • Patient demographics query (PDQ v2/v3) • Multi-patient query (MPQ) • Cross-community patient discovery (XCPD) • Cross-enterprise document sharing (XDS, XDS-I, XDS-MS, XDS-LAB, XDS-SD) • Cross-community Access (XCA) • Cross-enterprise user assertion (XUA) • Document subscriptions (DSUB) • Shared Value Sets (SVS) • Audit Trails and Node Authentication (ATNA) • Basic Privacy and Patient Consent (BPPC)

23. Thank You