Open Sourc e VistA Developer Toolkit (Working title: VistA Novo)

1. Open Source VistA Developer Toolkit(Working title: VistA Novo) Overview Presentation for OSHERA Architecture Working Group 5 Nov 2013 Technical Team: Andy Gregorowicz, Dave Hill, Andrew Hubley, SalimSemy 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

2. 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

3. VistA Novo Overview VistA Novo Conceptual Overview

4. 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

5. 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 currentsoftware 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 currentdevelopment 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

6. Using VistA Novo Technology Details

7. Deploying a VistA Novo based app

8. 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.

9. 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 Architecture FHIR = Fast Health Interoperable Resource

10. VistA Novo Overview Unified Architecture

11. VSA – VistA Novo Relationship VSA Wizard Vista Based Services Uses Internal VA Services External Authoritative Services Generates 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

12. Unified Architecture: The “Big Picture” FHIR FHIR • VistA Novo* Non-VistA System Mobile App MITRE developing VistA Novo and VSA Service test stub based on blood pressure use case Legend • SOA • Infrastructure App developer Service dev VA MITRE Other system Optional • VistA-Based Service Generates VSA Wizard App could call VistA-Based Services directly VSA team developing VSA Wizard tool VistA * VistA Novo will start as an open source project; VistA Novo = Open Source VistA Developer Toolkit

13. Unified Architecture Value

14. VistA Novo Overview VistA Novo Proof of Concept

15. 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

16. 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

17. VistA Novo Use Case Production Architecture • Simple CRUD interface allows for easy development and surprisingly sophisticated applications • Pluggable back end that can be adapted to other services • Only used for caching • Mobile Apps • PGD Service • FHIR • PGD Database • VistA • Based • Service* • Open Source Services Service Invocation • Data Storage • FHIR • Services • FHIR • VistA • Other Services • FHIR • Things we haven’t thought of • VistA Novo • Other Data Sources • VistA Based Applications • Data Sources • *VistA Based Services may be generated using VistA Service Assembler (VSA)

18. VistA Novo Use Case Design Time Architecture • Simple CRUD interface allows for easy development and surprisingly sophisticated applications • Pluggable back end that can be adapted to other services • Only used for caching User enters synthetic blood pressure readings for testing • Mobile Apps • FHIR Test Data Creation User Interface Mock Services • Open Source Services Service Invocation • Data Storage • FHIR • Services • FHIR • FHIR • Things we haven’t thought of • VistA Novo • Test Data • VistA Based Applications • Test Stub

19. Blood Pressure (BP) Use Case Sequencewith VistA Novo Test Stub User enters synthetic blood pressure readings for testing 1 • Data Storage checks for data & invokes • a service to • retrieve observations • FHIR Services check Data Storage for observation • External application requests observations via FHIR 3 4 2 Test Data Creation User Interface Mock Services Service Invocation • Data Storage • FHIR • Services • VistA Novo • Test Data • Observations are served through the FHIR interface from Data Storage • Test Stub returns synthetic BP readings • Synthetic BP readings are cached in • Data Storage 5 6 7 • Test Stub

20. 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 • Open Source Services • Mobile Apps Test Data Creation User Interface Mock Services Service Invocation • Data Storage • FHIR • Services • Things we haven’t thought of • Test Data

21. 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 data Web User Interface Use to enter synthetic BP readings for testing Use HTTP utility, such as cURL, Poster, etc. to invoke FHIR service and view results Test Data Creation User Interface Mock Services • Mock Service Calls • CRUD FHIR calls on patient data Service Invocation • Data Storage • FHIR • Services • VistA Novo Framework • FHIR Services • Get Observation (RESTful API) • Set Observation (RESTful API) • Test Data • Test Stub

22. VistA Novo Technical Architecture Test Stub VistA Novo Framework HL7 FHIR Code Generator generates Service API: FHIR Mock Service API Java module Web UI: Rails Admin HTTP Client: Restlet C# module Runtime:JavaScript Web Framework: Delphi module Database: Runtime: Ruby JavaScript module App Server: Database: DB Tools: Mongoose MITRE creates and donates back to HL7 To be built

23. 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

24. 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

25. VistA Novo Schedule Open Source VistA Services Collab Session Test Stub Development VistA Novo Release 1.0 Test Stub feature complete VistA Novo Demo Create mock BP service Create framework for building new stubs 11/22 1/14 11/15 12/20 Create UI for setting test stub data 11/8 10/11 8/21 12/13 FHIR support feature complete 12/6 11/15 Create service invocation framework FHIR Development Build FHIR generator in Java using HL7 tools Jan Nov Sept Dec Oct Aug

26. VistA Novo Overview Conclusion

27. 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 outcome Targeted 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

28. 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

29. More Information • Mailing List: vistanovo@groups.osehra.org  • 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