Session Abstract

In this talk, Mr. Calco will discuss the use of HL7 FHIR® as a data

exchange format to (i) facilitate federated data domain reconciliation,

(ii) support usable, discreet interfaces at the point-of-care and (iii)

empower new business intelligence (BI) strategies.

This is accomplished in part utilizing Apex’s ForeverDB™, a powerful

knowledge management platform based on a new information model

in which data is immutable, schema is “just data,” and the dimensions

of time and truth are preserved forever.

Presenter Info: Bob Calco

Mr. Calco is a seasoned enterprise architect and a proven software innovator with over 20years of healthcare, financial services and retail industry experience.

He excels at designing and implementing modern distributed systems. His extensiveexperience and talent with programming languages has given him a strong sense of therelative strengths and weaknesses of mainstream platforms in use today.

Mr. Calco was the prime visionary and chief architect for the VistA.js Platform within theVA, including its current embrace of open source technologies to fulfill specific platformfunctions and capabilities. Mr. Calco is currently engaged leading the R&D and technicalarchitecture for Apex’s forthcoming commercial products.

First Came Zoetropes

Then Came RotoScoping

Now We Have IMAX

Category: Interoperability

HL7 FHIR® and the Multi-Tenant World

The Story Teller’s Dilemma with Data

• It changes over time. History today looking back isn’t necessarily history as it actually happened.

• No two people experience history as it happens the same way.

• What DID the story look like before it changed … who changed it? When? Why?

How do we get to “Story Telling”?• We need a new information model, one that deals with truth and time.

• We need a new database architecture for the modern world

– Multitier Database Architecture

– Independently Scalable Database Components

• HL7 FHIR® (and never forget!)

• The new art of the possible with this model

– Collaborative multimodal & multiuser consuming interfaces

– Generating novel insights into User Experience and Domain Data

Let’s Get Real• Toward a Real-World Information Model

• We can’t change the past

• Things are always becoming

• Everything is asynchronous

• Only the future is mutable

Let’s Get Technical• From CRUD to CRxx

• Immutability => Freedom from Updates and Deletes

• Eliminate entire class of problems

• No more locks

• No more semaphores

• No more race conditions

• No more collisions

• Dogs and cats living together (just kidding!)

• Handling novelty harmoniously

Let’s Get (even more) Technical

• How can you possibly store all that data?

• Huge Populations

• Enormous number of Episodes

• Continually Streaming Novelty

• How can you possibly scale effectively and perform efficiently?

• Command Query Responsibility Separation (CQRS) at the client AND the server level

• Partitioning data by domain

• Sharding partitions by time

• Manage identity as a first class database citizen.

Federated Data Domain Reconciliation

Portable, Usable Interfaces at the Point of Care

• Scenario-Specific User Experiences

– Multi-Modal

– Collaborative

– Service Specific

• Introducing evidence based usability

– Better outcomes driven by improved UX

New Business Intelligence Strategies• Always up-to-date

longitudinal

patient record

• Real Time

Insights

• Based on

observing, not

reconstructing,

history

• Comprehensive

Clinical

Summary

• Based on

patient-based

clinical

experience

• Informed

decisions about

health and

treatment

New Business Intelligence Strategies

• Reduced design & development time

– Refine the problem

– Focus on the answer

• Create BI repositories & data warehouses as needed

– Stays up to date with SORS

– Only delta’s are communicated

The Story … so far!• True, Seamless Interoperability based on reality, not abstractions.

• Innovating toward a new information model

• Innovating toward a new database architecture

• HL7 FHIR® everywhere, all the way down

• Focus on the Art of the Possible. Investigate every “we wanted to do this, but…”

• Multimodal, multiuser, service specific interfaces driving improved outcomes

• A new way to create and consume truly insightful Business Intelligence

Q&

A