%0 Journal Article %J J Med Syst %D 2015 %T Enabling Better Interoperability for HealthCare: Lessons in Developing a Standards Based Application Programing Interface for Electronic Medical Record Systems. %A Kasthurirathne, Suranga N %A Mamlin, Burke %A Kumara, Harsha %A Grieve, Grahame %A Biondich, Paul %X

We sought to enable better interoperability and easy adoption of healthcare applications by developing a standardized domain independent Application Programming Interface (API) for an Electronic Medical Record (EMR) system. We leveraged the modular architecture of the Open Medical Record System (OpenMRS) to build a Fast Healthcare Interoperability Resources (FHIR) based add-on module that could consume FHIR resources and requests made on OpenMRS. The OpenMRS FHIR module supports a subset of FHIR resources that could be used to interact with clinical data persisted in OpenMRS. We demonstrate the ease of connecting healthcare applications using the FHIR API by integrating a third party Substitutable Medical Apps & Reusable Technology (SMART) application with OpenMRS via FHIR. The OpenMRS FHIR module is an optional component of the OpenMRS platform. The FHIR API significantly reduces the effort required to implement OpenMRS by preventing developers from having to learn or work with a domain specific OpenMRS API. We propose an integration pathway where the domain specific legacy OpenMRS API is gradually retired in favor of the new FHIR API, which would be integrated into the core OpenMRS platform. Our efforts indicate that a domain independent API is a reality for any EMR system. These efforts demonstrate the adoption of an emerging FHIR standard that is seen as a replacement for both Health Level 7 (HL7) Version 2 and Version 3. We propose a gradual integration approach where our FHIR API becomes the preferred method for communicating with the OpenMRS platform.

%B J Med Syst %V 39 %P 182 %8 2015 Nov %G eng %N 11 %R 10.1007/s10916-015-0356-6 %0 Journal Article %J Stud Health Technol Inform %D 2015 %T Towards Standardized Patient Data Exchange: Integrating a FHIR Based API for the Open Medical Record System. %A Kasthurirathne, Suranga N %A Mamlin, Burke %A Grieve, Grahame %A Biondich, Paul %X

Interoperability is essential to address limitations caused by the ad hoc implementation of clinical information systems and the distributed nature of modern medical care. The HL7 V2 and V3 standards have played a significant role in ensuring interoperability for healthcare. FHIR is a next generation standard created to address fundamental limitations in HL7 V2 and V3. FHIR is particularly relevant to OpenMRS, an Open Source Medical Record System widely used across emerging economies. FHIR has the potential to allow OpenMRS to move away from a bespoke, application specific API to a standards based API. We describe efforts to design and implement a FHIR based API for the OpenMRS platform. Lessons learned from this effort were used to define long term plans to transition from the legacy OpenMRS API to a FHIR based API that greatly reduces the learning curve for developers and helps enhance adhernce to standards.

%B Stud Health Technol Inform %V 216 %P 932 %8 2015 %G eng %0 Journal Article %J AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium %D 2011 %T OpenMRS, A Global Medical Records System Collaborative: Factors Influencing Successful Implementation. %A Mohammed-Rajput, Nareesa A %A Smith, Dawn C %A Mamlin, Burke %A Biondich, Paul %A Doebbeling, Brad N %X OpenMRS is an open-source, robust electronic health record (EHR) platform that is supported by a large global network and used in over forty countries. We explored what factors lead to successful implementation of OpenMRS in resource constrained settings. Data sources included in-person and telephone key informant interviews, focus groups and responses to an electronic survey from 10 sites in 7 countries. Qualitative data was coded through independent coding, discussion and consensus. The most common perceived benefits of implementation were for providing clinical care, reporting to funders, managing operations and research. Successful implementation factors include securing adequate infrastructure, and sociotechnical system factors, particularly adequate staffing, computers, and ability to use software. Strategic and tactical planning were successful strategies, including understanding and addressing the infrastructure and human costs involved, training or hiring personnel technically capable of modifying the software and integrating it into the daily work flow to meet clinicians' needs. %B AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium %V 2011 %P 960-968 %8 2011 %G ENG %1 http://www.ncbi.nlm.nih.gov/pubmed/22195155?dopt=Abstract %0 Journal Article %J International journal of medical informatics %D 2003 %T Open Source software in medical informatics--why, how and what. %A McDonald, Clement J %A Schadow, Gunther %A Barnes, Michael %A Dexter, Paul %A Overhage, J Marc %A Mamlin, Burke %A McCoy, J Michael %X 'Open Source' is a 20-40 year old approach to licensing and distributing software that has recently burst into public view. Against conventional wisdom this approach has been wildly successful in the general software market--probably because the openness lets programmers the world over obtain, critique, use, and build upon the source code without licensing fees. Linux, a UNIX-like operating system, is the best known success. But computer scientists at the University of California, Berkeley began the tradition of software sharing in the mid 1970s with BSD UNIX and distributed the major internet network protocols as source code without a fee. Medical informatics has its own history of Open Source distribution: Massachusetts General's COSTAR and the Veterans Administration's VISTA software have been distributed as source code at no cost for decades. Bioinformatics, our sister field, has embraced the Open Source movement and developed rich libraries of open-source software. Open Source has now gained a tiny foothold in health care (OSCAR GEHR, OpenEMed). Medical informatics researchers and funding agencies should support and nurture this movement. In a world where open-source modules were integrated into operational health care systems, informatics researchers would have real world niches into which they could engraft and test their software inventions. This could produce a burst of innovation that would help solve the many problems of the health care system. We at the Regenstrief Institute are doing our part by moving all of our development to the open-source model. %B International journal of medical informatics %V 69 %P 175-84 %8 2003 Mar %N 2-3 %1 http://www.ncbi.nlm.nih.gov/pubmed/12810121?dopt=Abstract