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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.

How Do We Achieve Continuous Healthcare Interoperability?

Posted on February 2, 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 had a really interesting chat about healthcare interoperability with Mario Hyland, Founder of AEGIS. I’m looking at a number of ways that Mario and I can work together to move healthcare interoperability forward. We’ll probably start with a video hangout with Mario and then expand from there.

Until then, I was struck by something Mario said in our conversation: “Healthcare interoperability is not a point in time. You can be interoperable today and then not be tomorrow.

This really resonated with me and no doubt resonates with doctors and hospitals who have an interface with some other medical organization. You know how easy it is for your interface to break. It’s never intentional, but these software are so large and complex that someone will make a change and not realize the impact that change will have across all your connections. As I wrote on Hospital EMR and EHR, API’s are Hard!

Currently we don’t even have a bunch of complex APIs with hundreds of companies connecting to the EHR. We’re lucky if an EHR has a lab interface, ePrescribing, maybe a radiology interface, and maybe a connection to a local hospital. Now imagine the issues that crop up when you’re connecting to hundreds of companies and systems. Mario was right when he told me, “Healthcare thinks we’re dealing with the complex challenges of healthcare interoperability. Healthcare doesn’t know the interoperability challenges that still wait for them and they’re so much more complex than what we’re dealing with today.”

I don’t want to say this as discouragement, but it should encourage us to be really thoughtful about how we handle healthcare interoperability so it can scale up. The title of this post asks a tough question that isn’t being solved by our current one time approach to certification. How do we achieve continuous healthcare interoperability that won’t break on the next upgrade cycle?

I asked Mario why the current EHR certification process hasn’t been able to solve this problem and he said that current EHR certification is more of a one time visual inspection of interoperability. Unfortunately it doesn’t include a single testing platform that really tests an EHR against a specific interoperability standard, let alone ongoing tests to make sure that any changes to the EHR don’t affect future interoperability.

I’ve long chewed on why it is that we can have a “standard” for interoperability, but unfortunately that doesn’t mean that EHR systems can actually interoperate. I’ve heard people tell me that there are flavors of the standard and each organization has a different flavor. I’ve seen this, but what I’ve found is that there are different interpretations of the same standard. When you dig into the details of any standard, you can see how it’s easy for an organization to interpret a standard multiple ways.

In my post API’s are Hard, the article that is linked talks about the written promise and the behavioral promise of an API. The same thing applies to a healthcare interoperability standard. There’s the documented standard (written promise), and then there’s the way the EHR implements the standard (behavioral promise).

In the API world, one company creates the API and so you have one behavioral promise to those who use it. Even with one company, tracking the behavioral promise can be a challenge. In the EHR world, each EHR vendor has implemented interoperability according to their own interpretation of the standard and so there are 300+ behavioral promises that have to be tracked and considered. One from each company and heaven help us if and when a company changes that behavioral promise. It’s impossible to keep up with and explains one reason why healthcare intoperability isn’t a reality today.

What’s the solution? One solution is to create a set of standard test scripts that can be tested against by any EHR vendor on an ongoing basis. This way any EHR vendor can test the interoperability functionality of their application throughout their development cycle. Ideally these test scripts would be offered in an open source manner which would allow multiple contributors to continue to provide feedback and improve the test scripts as errors in the test scripts are found. Yes, it’s just the nature of any standard and testing of that standard that exceptions and errors will be found that need to be addressed and improved.

I mentioned that I was really interested in diving in deeper to healthcare interoperability. I still have a lot more deeper to go, but consider this the first toe dip into the healthcare interoperability waters. I really want to see this problem solved.