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Sansoro Hopes Its Health Record API Will Unite Them All

Posted on June 20, 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://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.

After some seven years of watching the US government push interoperability among health records, and hearing how far we are from achieving it, I assumed that fundamental divergences among electronic health records at different sites posed problems of staggering complexity. I pricked up my ears, therefore, when John Orosco, CTO of Sansoro Health, said that they could get EHRs to expose real-time web services in a few hours, or at most a couple days.

What does Sansoro do? Its goal, like the FHIR standard, is to give health care providers and third-party developers a single go-to API where they can run their apps on any supported EHR. Done right, this service cuts down development costs and saves the developers from having to distribute a different version of their app for different customers. Note that the SMART project tries to achieve a similar goal by providing an API layer on top of EHRs for producing user interfaces, whereas Sansoro offers an API at a lower level on particular data items, like FHIR.

Sansoro was formed in the summer of 2014. Researching EHRs, its founders recognized that even though the vendors differed in many superficial ways (including the purportedly standard CCDs they create), all EHRs dealt at bottom with the same fields. Diagnoses, lab orders, allergies, medications, etc. are the same throughout the industry, so familiar items turn up under the varying semantics.

FHIR was just starting at that time, and is still maturing. Therefore, while planning to support FHIR as it becomes ready, Sansoro designed their own data model and API to meet industry’s needs right now. They are gradually adding FHIR interfaces that they consider mature to their Emissary application.

Sansoro aimed first at the acute care market, and is expanding to support ambulatory EHR platforms. At the beginning, based on market share, Sansoro chose to focus on the Cerner and Epic EHRs, both of which offer limited web services modules to their customers. Then, listening to customer needs, Sansoro added MEDITECH and Allscripts; it will continue to follow customer priorities.

Although Orosco acknowledged that EHR vendors are already moving toward interoperability, their services are currently limited and focus on their own platforms. For various reasons, they may implement the FHIR specification differently. (Health IT experts hope that Argonaut project will ensure semantic interoperability for at least the most common FHIR items.) Sansoro, in contrast can expose any field in the EHR using its APIs, thus serving the health care community’s immediate needs in an EHR-agnostic manner. Emissary may prevent the field from ending up again the way the CCD has fared, where each vendor can implement a different API and claim to be compliant.

This kind of fragmented interface is a constant risk in markets in which proprietary companies are rapidly entering an competing. There is also a risk, therefore, that many competitors will enter the API market as Sansoro has done, reproducing the minor and annoying differences between EHR vendors at a higher level.

But Orosco reminded me that Google, Facebook, and Microsoft all have competing APIs for messaging, identity management, and other services. The benefits of competition, even when people have to use different interfaces, drives a field forward, and the same can happen in healthcare. Two directions face us: to allow rapid entry of multiple vendors and learn from experience, or to spend a long time trying to develop a robust standard in an open manner for all to use. Luckily, given Sansoro and FHIR, we have both options.

My Prediction for the Epic App Store

Posted on March 5, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I was talking with a healthcare IT vendor which really needs to integrate deeply with an EHR to be valuable. Without that integration the product is not nearly as useful for doctors. Therefore we started talking about their current EHR integration and the potential for future EHR integrations. At that point he asked me what I thought about the coming Epic App Store (officially called the Epic App Exchange).

In case you missed it, I wrote about the Epic App Store over on Hospital EMR and EHR. I cover what’s been said about the Epic App Store (not much from Epic itself) and make some predictions. However, today’s conversation solidified my predictions.

Epic has always been open to working with their customers and a tech partner to integrate something with Epic. Basically, the customer is king and so if the customer wants the integration, Epic will provide the SDK that’s needed for the integration and make it possible for the customer to do what they need. Everyone’s known that if you want to integrate with Epic, then you need to work through a customer.

With this in mind, I believe the Epic app store is a way for Epic to allow for distribution of these apps that have been created by their customers (often with a tech partner) to other Epic customers.

Basically, this is in line with Judy’s focus on the customer. Some might say that this focus is great. Hard to argue with Epic’s success. However, this approach misses out on the opportunity of the Epic app store facilitating entrepreneurial innovators to build something on top of Epic that their customers didn’t even know they wanted yet.

Epics current strategy is more in line with staying the entrenched incumbent. Real transformation comes when you provide a platform for innovation that goes beyond yourself and your customers. I hope one day Epic sees this vision and really roles out an open app store. Until then, the Epic connected customer applications are going to have a bit of a monopoly selling their add on services to Epic customers.

Epic API, EMR Market Saturation, and Faith in Clinical Decision Support

Posted on September 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


Vince asks a good question. I wrote a little bit previously about the Epic User Group Meeting where they announced the Epic API. I definitely think there’s still a lot of missed opportunity for the announced Epic API, but hopefully what they’ve released is successful so it encourages them to open up their API much more.


I’ve been writing a lot lately about the changing EMR marketplace (see Golen Age of EHR Over). This prediction offers a new insight I hadn’t covered. The market could decrease because many of the larger purchases are already done. So, that could slow the EHR spending.


I wish I could find this talk. I’m really interested in how properly implemented clinical decision support can save lives. That’s what this should be about anyway, no?

EpicUGM Insights, Announcements (Epic API), and Pictures

Posted on September 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week has been the annual user group for Epic EHR users, otherwise known as Epic UGM. @VinceKuraitis aptly noted that the Epic user conference had 15k attendees and yet it only produced 188 tweets the first day of the conference. I’m not sure if this is a reflection of Epic users view of social media or Epic users fear of sharing what’s happening. The limited tweets aside, there were still a number of interesting tweets and pictures coming out of the event. Plus, some interesting quotes from the Madison paper I think you’ll enjoy.


Look at the crowds for registration. I wonder when Epic will outgrow Madison and need to move the event to Las Vegas. We’d certainly welcome them here. Although the local paper said that the event is the second biggest tourism engine in the area (World Dairy Expo beats it out).


Deep Space was the theme of the conference and also is the name of the enormous 11,400 seat underground auditorium on Epic’s campus. More pictures of the auditorium below. It’s also worth noting that Judy did the keynote dressed as a Na’vi from the movie “Avatar.”

Now for some tweets with pictures of the auditorium:


Soon the Epic conference will pass HIMSS on attendance. Not likely, but it is interesting that there were only 297 healthcare organizations. I wonder how many people organizations like Kaiser brought to the event.


This is a really interesting tweet. First, it’s interesting that Judy is talking about meaningful use stage 4. Does this mean there will be an MU stage 4? Second, what happened to MU stage 2? I’m pretty sure most aren’t worried much beyond MU stage 2 right now.


This likely deserves a blog post of its own. Although, this comment is really interesting in the context of Epic. Does this mark a fundamental shift in the products that Epic develops?

What I think will be the biggest announcement coming out of Epic UGM 2013 is the new Epic API. While it definitely falls short of what most of us would love to see Epic do with an API, at least it’s a start. The focus of the API seems to all be around getting all of the various health and wellness app data into the EHR. Here’s a good description of who they want to use the Epic API:

Are you a manufacturer of a consumer-facing monitoring device? We have an API for that.

Have you developed a health or wellness-related tracking app or portal? Clinicians need that information.

We’ve designed open.epic to make it gosh-darn simple to integrate the data you collect into your patients’ medical records. Interested?

I believe this will be a great opportunity for many developers. We’ll see how it plays out long term. I’m a little surprised that the Epic API doesn’t include interoperability which Epic is doing more and more. I guess they see it as a separate initiative.

The local newspaper covered the Epic UGM event as well and offered a few other insights into what was said at the conference:

“We’ve just gone over the 51 percent mark. You take care of a little over half of the patients in this country,” Faulkner said. Worldwide, nearly 2.4 percent of the population is covered by electronic health records created by Epic.

I’m sure we’ll be hearing Epic users quote this 51% number a lot more.

Epic, with $1.5 billion in 2012 revenue and 6,800 employees, will keep growing as its customers grow, Faulkner said, adding that clients are loyal. “To us, it’s a lifetime relationship,” she said.

I think Judy might be right for many Epic customers. The lock in to Epic for many of these large organizations is strong.

I guess the 15,300 attendee number is interesting when you think that 6,800 of them could be employees. Although, no doubt it is a really important and interesting event in the healthcare IT world. Judy seems to be softening on media coverage of Epic. It seems like Judy and Epic have decided to start becoming a larger part of the conversation. I wonder if a blogger could attend the event next year.