PROPOSED AWG LETTER TO OSEHRA BOARD

 

Per discussion at last week's AWG, attached is Jack Taylor's draft letter to OSEHRA board.

I am working on issue slides to present to IPO, which I will post this weekend for review and comment..

REQUESTED ACTION: Please provide suggestions for improvement.

Steve Hufnagel

DRAFT

To:         OSEHRA BOARD

Subject: iEHR and OSEHRA – Increasing collaboration

Date:     17 July 2012

1. The OSEHRA Architecture Work Group (AWG) has been assembled and active since September of 2011, and now has 127 engaged participants from VA, DoD and industry. The AWG has produced relevant documentation in architecture to its schedule including the VistA OpenSource migration progression, and compiled an extensive library of related documentation to OSEHRA, the related VA-DoD integrated Electronic Health Record (iEHR), and the Virtual Lifetime Electronic Record (VLER).

2. The AWG has been briefed by the iEHR SOA-ESB program manager, Dr. Patrick Pearcy on the essentials of that critical project and has conducted discussions within the AWG on that project and on the additional, more recent Requests for Information (RFI) for the iEHR capabilities. The discussions in the AWG have focused upon the appropriate architectural aspects of these RFIs and there is a concern that the content and value of these discussions, by recognized experts in the field is not being brought into the analysis and decision processes of the iEHR under the Integrated Program Office (IPO).

3. Individual members of the AWG do attend some of the iEHR related IPO meetings and some are participating in the meetings of the Interagency Clinical Informatics Board (ICIB) where iEHR capability prioritization is established and Capability Integrated Product Teams (CIPT) are chartered and engaged to the definition of specific requirements, business functional architecture documentation and architectural/technical feasibility is assessed.

4. The AWG has concerns about the open-source communities ability to  participate in iEHR. The AWG would like to propose a briefing to be provided back through the IPO with specific insights from the OSEHRA perspective on both the overall approach and on a capability by capability basis ongoing.  We feel this will “instantiate” the relationship of OSEHRA to the iEHR and VLER as depicted in the graphic below.

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Comments

PROPOSED AWG LETTER TO OSEHRA BOARD

Mary-Anne Wolf's picture

Minor typo in:

The AWG has concerns about the open-source communities ability to participate in iEHR.

Either one community or multiple communities. Either one ability or multiple abilities.
Maybe need an apostrophe or reorder the phrase. No extra space in "to participate".

I would be inclined to
The AWG has concerns about the abilities of open-source communities to participate in iEHR.
(This implies that different communities may have different impediments,
which I suspect to be true.)

This paragraph begs the question about what the concerns are and what remedy is suggested, but I am not sure about the strategy of saying anything about that in this letter. I will be very interested to see your slides.

Mary-Anne

----- Original Message -----
From: "Stephen.Hufnagel" <HufnagelS@OSEHRA.org>
To: "Architecture" <architecture@groups.osehra.org>
Sent: Tuesday, July 17, 2012 3:36:24 PM
Subject: [architecture] PROPOSED AWG LETTER TO OSEHRA BOARD

 

Per discussion at last week's AWG, attached is Jack Taylor's draft letter to
OSEHRA board.

I am working on issue slides to present to IPO, which I will post this
weekend for review and comment..

REQUESTED ACTION: Please provide suggestions for improvement.

Steve Hufnagel

DRAFT

To:         OSEHRA BOARD

Subject: iEHR and OSEHRA – Increasing collaboration

Date:     17 July 2012

1. The OSEHRA Architecture Work Group (AWG) has been assembled and active
since September of 2011, and now has 127 engaged participants from VA, DoD
and industry. The AWG has produced relevant documentation in architecture to
its schedule including the VistA OpenSource migration progression, and
compiled an extensive library of related documentation to OSEHRA, the related
VA-DoD integrated Electronic Health Record (iEHR), and the Virtual Lifetime
Electronic Record (VLER).

2. The AWG has been briefed by the iEHR SOA-ESB program manager, Dr. Patrick
Pearcy on the essentials of that critical project and has conducted
discussions within the AWG on that project and on the additional, more recent
Requests for Information (RFI) for the iEHR capabilities. The discussions in
the AWG have focused upon the appropriate architectural aspects of these RFIs
and there is a concern that the content and value of these discussions, by
recognized experts in the field is not being brought into the analysis and
decision processes of the iEHR under the Integrated Program Office (IPO).

3. Individual members of the AWG do attend some of the iEHR related IPO
meetings and some are participating in the meetings of the Interagency
Clinical Informatics Board (ICIB) where iEHR capability prioritization is
established and Capability Integrated Product Teams (CIPT) are chartered and
engaged to the definition of specific requirements, business functional
architecture documentation and architectural/technical feasibility is
assessed.

4. The AWG has concerns about the open-source communities ability to 
participate in iEHR. The AWG would like to propose a briefing to be provided
back through the IPO with specific insights from the OSEHRA perspective on
both the overall approach and on a capability by capability basis ongoing. 
We feel this will “instantiate” the relationship of OSEHRA to the iEHR
and VLER as depicted in the graphic below.

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PROPOSED AWG LETTER TO OSEHRA BOARD

Jack Taylor's picture

This is the intent - to edit to accuracy and impact - please proceed! Am out of office on travel but will try to dial in from the car.
JAck

-----Original Message-----
From: Apache [mailto:apache@groups.osehra.org] On Behalf Of Mary-Anne Wolf
Sent: Tuesday, July 17, 2012 3:46 PM
To: architecture@groups.osehra.org
Subject: Re: [architecture] PROPOSED AWG LETTER TO OSEHRA BOARD

Minor typo in:

The AWG has concerns about the open-source communities ability to participate in iEHR.

Either one community or multiple communities. Either one ability or multiple abilities.
Maybe need an apostrophe or reorder the phrase. No extra space in "to participate".

I would be inclined to
The AWG has concerns about the abilities of open-source communities to participate in iEHR.
(This implies that different communities may have different impediments, which I suspect to be true.)

This paragraph begs the question about what the concerns are and what remedy is suggested, but I am not sure about the strategy of saying anything about that in this letter. I will be very interested to see your slides.

Mary-Anne

----- Original Message -----
From: "Stephen.Hufnagel" <HufnagelS@OSEHRA.org>
To: "Architecture" <architecture@groups.osehra.org>
Sent: Tuesday, July 17, 2012 3:36:24 PM
Subject: [architecture] PROPOSED AWG LETTER TO OSEHRA BOARD

Per discussion at last week's AWG, attached is Jack Taylor's draft letter to OSEHRA board.

I am working on issue slides to present to IPO, which I will post this weekend for review and comment..

REQUESTED ACTION: Please provide suggestions for improvement.

Steve Hufnagel

DRAFT

To: OSEHRA BOARD

Subject: iEHR and OSEHRA – Increasing collaboration

Date: 17 July 2012

1. The OSEHRA Architecture Work Group (AWG) has been assembled and active since September of 2011, and now has 127 engaged participants from VA, DoD and industry. The AWG has produced relevant documentation in architecture to its schedule including the VistA OpenSource migration progression, and compiled an extensive library of related documentation to OSEHRA, the related VA-DoD integrated Electronic Health Record (iEHR), and the Virtual Lifetime Electronic Record (VLER).

2. The AWG has been briefed by the iEHR SOA-ESB program manager, Dr. Patrick Pearcy on the essentials of that critical project and has conducted discussions within the AWG on that project and on the additional, more recent Requests for Information (RFI) for the iEHR capabilities. The discussions in the AWG have focused upon the appropriate architectural aspects of these RFIs and there is a concern that the content and value of these discussions, by recognized experts in the field is not being brought into the analysis and decision processes of the iEHR under the Integrated Program Office (IPO).

3. Individual members of the AWG do attend some of the iEHR related IPO meetings and some are participating in the meetings of the Interagency Clinical Informatics Board (ICIB) where iEHR capability prioritization is established and Capability Integrated Product Teams (CIPT) are chartered and engaged to the definition of specific requirements, business functional architecture documentation and architectural/technical feasibility is assessed.

4. The AWG has concerns about the open-source communities ability to participate in iEHR. The AWG would like to propose a briefing to be provided back through the IPO with specific insights from the OSEHRA perspective on both the overall approach and on a capability by capability basis ongoing. We feel this will “instantiate” the relationship of OSEHRA to the iEHR and VLER as depicted in the graphic below.

Images

ipo_governance_model.jpg [1]

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Group sticky:

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[3]
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Need for iEHR engagement

Rafael Richards MD, MS's picture

I am unable to see the graphic.  Could you re-post?

Are the AWG's efforts, advice, and input ignored in the design of the future EHR system, of which OSEHR is a  major component?  The consequence of this are unknown, but this would seem to add certain and considerable risk to the iEHR project.  Is this the message?

It is important to add that to be successful, RFIs regarding the OSEHR codebase needs to incorporate lessons learned from the past from what has worked, and what hasn't. OSEHR  is an integrated system that has been in continuous use and evolution for 30 years, and has been providing the highest care to its patients compared to all other healthcare sectors in the United States.  What is it about OSEHR Architecture has made it so successful?  Members of the AWG have this insight.  A key point is to not break something that is working.

Rafael Richards MD

 

http://www.washingtonmonthly.com/features/2005/0501.longman.html

http://www.amazon.com/Best-Care-Anywhere-Health-Better/dp/0977825302/ref=cm_cr_pr_product_top

 

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Graphics for the Letter To OSEHRA Board

Peter Li's picture

If you are referring to the ipo_governance_model.jpg, the url is: 

http://www.osehra.org/sites/default/files/ipo_governance_model.jpg

Steve Hufnagel is working on issue slides this past week.  The issue slides should speak to the your comments on the risks to the current iEHR approach and the need to incorporate the lessons learned from the past 30 years of continuous use and evolution of VistA architecture.

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IPO Governance Model - recommendation

Rafael Richards MD, MS's picture

Thank you.   If one interprets the arrows in the IPO Governance Model as representing management decisions and information flow,  the IPO Governance Model figure shows the following:

http://www.osehra.org/sites/default/files/ipo_governance_model.jpg

On the left hand side of the figure (yellow) representing  JEC and the functional requrirements.  The JEC has two feedback arrows exiting:  one managing and direcing the IPO Advisory Panel,  and one managing and directing the IPO itsself. It also has an arrow directing its internal functions.   

On the right hand side of the figure (green) is OSEHR, representing the VA and VistA community. It has no feedback arrows.   It has no input back into the IPO Adisory Panel, and it has no input back to the IPO itsself.  It is simply an informational end point. 

While there is an administrative connection between the DoD and VA at the top of the figure, there is no bidirectional flow of information or input opportunity by OSEHRA to any entity.  Instead, all information flow and management decisions as designated by arrows, point in only one direction, making it a one-way, top-down, waterfall design, with no opportunity for feedback:

       JEC (DoD)   ==>    

                      [ IPO ]  ==>   

                                   OSEHR (VA)

The IPO clearly sees the success of VistA, and obstensibly wants to build on its success.  VistA has been successful for over thirty years because of its continuous evolution and innovotion,  contributed by its end user physician community and developers,  by transparency, sharing, and testing code throughout its network of hospitals continously.  The VA has been practicing the "open-source model"  more than twenty years before the term was invented.

A requirements-driven approach may work for architecting rigid structures that are not meant to be changed, such as ships or aircraft. Software is different, particularly in the complex and rapidly changing fields of healthcare, computer science, internet technology, medical technology, and constantly changing requirements, regulations, and evidence-based medical practice.  A rigid top-down waterfall approach leaves little to no room for evolution or innovation.  It is survival negative.  What were the lessons learned from the AHLTA architecture?  Is the iEHR architecture any differnt?

A Governance Model that  considers these factors might be more inclusive and balanced:

       JEC   ==>   [ IPO ]  <==  OSEHR

Or alternatively:

      JEC   <==>    OSEHR   ==>  [ IPO ]

In the second model, functional requirements would be formulated by JEC in consultation with the OSEHR architecture group. This process would assure that the current architecture and functionality of OSEHR is taken into consideration.  If a package exists, it would be refactored and enhanced to meet requirements without breaking any current functionality. Each package forming the core 'gold' system would be systematically reviewed, refactored, and enhanced, evolving the system in a controlled, scientific fashion with continous releases and feedback from end users.

I believe a letter should address the root cause for why there is no input into the IPO by the VA and VistA community, as represented by OSEHR, and make the request that this IPO Governance Model be amended as above.

 

 

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Request for balanced input from OSEHRA

Rafael Richards MD, MS's picture

see above

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