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Andaman7 technology series #7 - No protocol API

Vincent Keunen - CEO and founder Andaman7

 

 Article written by Vincent Keunen, founder of Andaman7.  @vincentkeunen @vincentkeunen - Twitter of Vincent Keunen (CEO & Founder Andaman7)

 

 

Andaman7 technology series #7 - No protocol API

 

This is the seventh article of our series dedicated to the technology of Andaman7. Our goal with this initiative is to contribute to the field of “health IT” by discussing challenges and possible solutions (more details on these challenges in our article #1). To read the previous articles, start with the first one: Andaman7 technology series #1 - Introduction.

The opinions in these series are our own. They are based on our 25 years of experience in the field building large scale EHRs (Electric Health Record) and medical information exchange systems (1). We share them in good faith to help move the needle forward and inspire others. And of course, we also want to promote our own Andaman7 initiative, a project by patients for patients (2). Terms and acronyms are explained in our lexicon (3). We are open to and welcome discussion on these topics. You can find us on LinkedIn, Twitter and Facebook and we can also discuss on other media you would like to invite us to.

Today, let’s talk about No protocol API.

For more than 30 years, health IT has come up with new and better standards. The result is a long list of “not so standard” standards. Data exchange standards include: e-mail, ftp, direct, APIs, web services and more. Data formats and codification systems abound, making things even more complex. Every new standard (eg. FHIR) brings the hope of the holy grail: interoperability.

We recognise the need for and benefits of standards.  But to be successful, standards must be (at least) free to use, well documented, easy to implement and popular.  Many standards, sadly, don’t  fit the previous description, FHIR is becoming the exception as adoption and documentation are growing steadily.  However, it’s not that simple.  And today, it is still focused on care stakeholders while other formats are targeted to the research sector.

At Andaman7, we did not want to wait for the “solution that is on the horizon and that will solve all problems - eventually”. We did not want to use a proprietary format either, like many vendors  do. 

So we came up with an open, “no protocol” API that simply goes to the roots of information processing (using foundational programming data types) with a thin “business layer” taking into account the specifics of the health sector (based on a limited set of “Atomic Medical Items”, or AMIs). You may want to read more about our data model in “Andaman7 technology series #4 - Liquid data model” and “Andaman7 technology series #5 - A common foundation for care and research”.

The “no protocol” term was created in the same spirit as the “NoSQL” term and means that no knowledge of HL7, FHIR or any other protocols / formats / codification systems are necessary. This “No protocol API” is closely tied to our simplified data model.  It’s simple to use, is a bit more elaborate than simple “computer language data structures and protocols”, but not as deeply rooted in the business domain as many others (with advanced, therefore complex, data model schemas).  Since we wanted to use our Andaman7 data structures and protocol in two domains (care and research), having a “cognitively poorer” schema and protocol was a good idea.

This “no protocol API” has allowed us and partners to set up interoperability with other systems in record time (a few days to a few weeks of work), including bidirectional information exchange.  It has also allowed us to bridge the gap between care systems (EHRs) and research systems (EDCs).

Let’s be clear: we do recognize the importance of de jure or de facto standards (like HL7, FHIR, ICD, LOINC, Snomed, DICOM, CDISC, ODM…) and continuously build bridges to those standards to extend the ease of integration of Andaman7 with systems supporting them. We plan to support all sufficiently popular standards.

The “A7 protocol” is to mobility and modern Internet what HL7 is to classic and sometimes complex health IT systems.

That’s it for today. Our next article will be on “Extreme traceability”.

Stay tuned.

To read the summary of these articles, combined into our white papers, go to:

(1) In a previous company, we built a prevention-focused EHR that is today used for some 1 million people (most are in good health, some are patients). We also built the technology for the two largest “medical messaging systems” of Belgium, still being used today by 90% of all hospitals and doctors.
(2) Read our story
(3) Consult the lexicon. It's a work in progress. Don’t hesitate to make suggestions and remarks to support@andaman7.com.

Easily providing patients with their lab test results

Andaman7 is a digital and multi-pathology health platform that offers solutions for healthcare stakeholders in the broadest sense: research institutions, pharmaceutical companies, medical device manufacturers, hospitals, doctors, medical laboratories, patient associations and health professionals. 

Description

Integrating Andaman7 with Laboratoires Réunis, a major medical laboratory in Luxembourg. Patients can now get their lab test results directly from their lab in the Andaman7 health record mobile app. 

Laboratoires Réunis is an independent clinical laboratory with more than 50 years of experience. They are committed to providing high quality testing services and accurate, timely tests results to all their patients. Their expertise extends from classical clinical chemistry diagnostics and microbiology to the diagnosis of infectious diseases and up to genetic testing. They also keep investing in science and technology in order to bring better outcomes for doctors and patients alike. The group is active in Luxembourg, France, Germany, Belgium and Maroc. With more than 100 centers and 250 employees in Europe, Laboratoires Réunis is a privileged partner for all healthcare biotech activities and business. 

The Challenge

The challenge is to be able to send lab data from the lab to patients, so that the information can be used by the patient.

Our solution

Andaman7 allows patients to get their lab test results automatically from the lab. Patients can easily see and track their data over time, since all structured data is charted in Andaman7. Traditionally data has been sent in unstructured PDF format without charts or the ability to chart the data.

This allows patients to centralize all their lab test results in their health record for better monitoring of their health, and to easily share their health data within their Circle of trust if they wish (i.e. family, doctors, nurses, physiotherapists, etc.). 

See all use cases

Andaman7 technology series #6 - Dynamically generated user interface

Vincent Keunen - CEO and founder Andaman7

 

 Article written by Vincent Keunen, founder of Andaman7.  @vincentkeunen @vincentkeunen - Twitter of Vincent Keunen (CEO & Founder Andaman7)

 

 

Andaman7 technology series #6 - Dynamically generated user interface

 

This is the sixth article of our series dedicated to the technology of Andaman7. Our goal with this initiative is to contribute to the field of “health IT” by discussing challenges and possible solutions (more details on these challenges in our article #1). To read the previous articles, start with the first one: Andaman7 technology series #1 - Introduction.

The opinions in these series are our own. They are based on our 25 years of experience in the field building large scale EHRs (Electric Health Record) and medical information exchange systems (1). We share them in good faith to help move the needle forward and inspire others. And of course, we also want to promote our own Andaman7 initiative, a project by patients for patients (2). Terms and acronyms are explained in our lexicon (3). We are open to and welcome discussion on these topics. You can find us on LinkedIn, Twitter and Facebook and we can also discuss on other media you would like to invite us to.

Today, let’s talk about Andaman7’s Dynamically generated user interface.

The initial goal of Andaman7 is pretty ambitious: building a distributed, collaborative EHR that could be used simultaneously and in near real time by many actors.

This poses challenges on the architecture and the storage mechanisms of such systems. To know more on these two subjects, read:

But it also poses a number of other challenges, this time at the visualisation level, or the user interface / user experience level.

By nature, an EHR is a complex piece of software. There are many data types: vitals, allergies, drugs, documents, blood tests, imaging reports, visit notes... and sometimes a lot of data for a given parameter or vital (does your watch take your pulse every minute?). Time stamps are also important: when did that happen, when was is registered and when was it valid? Does that sneezing happen at specific periods every year? What is the history of that data element?

And obviously, what a patient wants to see is different from what  a doctor wants to see, which is different from what a nurse / physio / you name it wants to see.

So we put a lot of effort to make an EHR as simple as possible for patients to view. As Pascal said “I wrote you a long letter because I didn’t have time to make it shorter”. It’s much harder to make something look simple. So don’t underestimate the simplicity of our user interface.

At the same time, we wanted an interface that would also be complete enough for healthcare professionals.

And we had still other objectives! As explained in "Andaman7 technology series #5 - A common foundation for care and research”, we wanted a tool and platform that would be not only ready for care actors, but also for research  actors.  That means still more flexibility to be able to display questionnaires, symptom assessment screens, PROs (Patient Reported Outcomes) screens and others.  

Given the need to be able to store any kind of data and to present that data in so many varying ways for different actors, we built a (semi) automatic user interface generator. This gives us the ability to very easily change the user interface of the app to accommodate new needs in a very efficient way (by changing metadata files without the need to change the application code).

Different actors each have their own way of seeing the same data.

And even for a given type of actor (say the patient), we can display the data in various ways:

  • Very complete, with a lot of detail, including history, who registered what...
  • Only an overview: useful when you go to a new doctor and need to quickly summarise your health history
  • Chronological view: useful when you want to see the latest additions to your health record, possibly coming from many sources like your doctor, your hospital, your lab, your connected devices, that trial you contributed to...

An architectural principle we used is sometimes called “separation of concerns” which, in this case, means completely separating how we store data  and how we display it. A very powerful choice, in retrospect.

Recently, we added “Services” to Andaman7 (also known as a “marketplace” of services). That means partners and other companies with great ideas can contribute and offer their services to Andaman7 users (example services are: discover your genetic profile, order your medications online, find a clinical trial,...). And our dynamically generated user interface will come extremely handy to integrate those services deeper, allowing these partners to display new screens at the right place, all nicely integrated.

To summarise: different user interfaces can be presented to the diverse types of users, all based on a common framework and in the same application. Advanced features like questionnaires, forms, specific screens are very flexible and powerful in Andaman7.  

That’s what makes Andaman7 a great tool for care in a multi-disciplinary environment - where continuity of care is important. It’s also a great tool for next generation clinical trials and a number of uses cases in medical research.

That’s it for today. Our next article will be on “No protocol API”.

Stay tuned.

To read the summary of these articles, combined into our white papers, go to:

(1) In a previous company, we built a prevention-focused EHR that is today used for some 1 million people (most are in good health, some are patients). We also built the technology for the two largest “medical messaging systems” of Belgium, still being used today by 90% of all hospitals and doctors.
(2) Read our story
(3) Consult the lexicon. It's a work in progress. Don’t hesitate to make suggestions and remarks to support@andaman7.com.

Read next article in the series

Enabling remote care monitoring at a low cost

Andaman7 is a digital and multi-pathology health platform that offers solutions for healthcare stakeholders in the broadest sense: research institutions, pharmaceutical companies, medical device manufacturers, hospitals, doctors, medical laboratories, patient associations and health professionals. 

Description

Enabling a hospital to perform remote care monitoring, so that it can save time and improve patient follow-up. In this example, we were asked to find a way to follow patients remotely by closely monitoring the blood coagulation rate. 

The Challenge

The challenge stems from the need for greater collaboration and communication between hospitals and patients. The hospital wants two way data exchange with patients. They want to send them care instructions and receive blood coagulation data.

Our solution

The Andaman7 health record mobile app enables secure two-way data exchange with data collection from many sources: manual entry, connected devices, hospitals, labs, etc. Health data can be presented in many different formats: text, documents, images, videos, etc. The patient has access to all the information related to his or her illness in a specific section of the app which is dedicated to the hospital.

This allows the hospital to offer remote monitoring at a low cost and to better satisfy patients without overloading the nursing staff. 

See all use cases

Collecting patient outcomes before and after implant insertion

Andaman7 is a digital and multi-pathology health platform that offers solutions for healthcare stakeholders in the broadest sense: research institutions, pharmaceutical companies, medical device manufacturers, hospitals, doctors, medical laboratories, patient associations and health professionals. 

Description

This project enables a medical device manufacturer to collaborate with physicians and patients to monitor the patient’s status and progress before and after the medical device has been implanted in the patient. Data is collected several times during a three month period after the operation. 

The Challenge

To enable coordination between the physician, the manufacturer and the patient. The data is anonymized before sending it to the manufacturer and not-anonymized when sending it to the physician. 

Our solution

Andaman7 allows the sending of pseudonymized data. Andaman7 is also designed for a perfect coordination of information exchange between patients, health professionals and partners/study sponsors or CROs. 

The data recorded by the patient is sent to the manufacturer as pseudonymized information entered into the CROs EDC software via secure APIs. It is also sent in an identified way to the hospital so that the medical and nursing staff can monitor the patient's condition. 

Andaman7 supports these two data transfer technologies via the same Andaman7 platform. The data can also be entered in the hospital's Electronic Health Record (EHR) or in the surgeon's specialized software. 

  • Benefit for the patient: Patients are more satisfied, reassured, and feel listened to and cared for. They can see their progress and more easily interact with caregivers if there are any concerns or questions. They appreciate the reduction of trips to the hospital for data collection.
  • Benefits for the hospital: Patient health outcomes are improved through having better data and care coordination. Some hospitals earn increase revenue from remote patient monitoring and avoid readmissions penalties.
  • Benefits for the medical device manufacturer: Collecting data from the patient outside the clinical setting provides more data and clarity on how their device performs more often. They can also receive direct patient feedback to improve their devices and the patient experience. 

See all use cases

InteropEHRate: your health data with you - anytime and anywhere

With InteropEHRate, Europe wants to have open protocols for sharing medical data at the level of the 28 Member States. This innovative and ambitious, patient-centric project should promote the exchange of health information between European citizens, health professionals, and researchers.

The situation is clear. In terms of sharing and access to medical data, Europe lags behind the United States. Since 2015, under the leadership of the Obama administration and its Meaningful Use Stage 3 program, Uncle Sam has made interoperability and access to medical data his priority. The USA has laid the foundations for a health system in which patients are at the center of care and have permanent and easy access to their electronic health data. Health care providers can also access and use health data from different sources continuously and securely (1). The concrete effects of this proactive policy were pretty effective. “In a few years, all hospitals have turned to their respective software vendors and asked them to make their products accessible via any other software (API)," notes Vincent Keunen, CEO of Andaman7, the well known platform whose goal is to enable multiple interactions between patients and health stakeholders. "In a few years, the software vendors became open and fortunately they chose a common standard, FHIR. This decision put an end to some data silos, at least at the hospital level. This is the first time I have seen a standard so quickly adopted by so many stakeholders." 

What about Europe? Nothing like that exists right now. For example, it is almost impossible for an EU citizen to share health data with a hospital in a European country other than his own (and often in his own country too!). It is obviously easier to develop a single sovereign nation than a political entity with 28 Member States, and as many, if not more, electronic health data management systems. But the situation could change rapidly.

A bottom-up approach to data sharing

InteroEHRate is an ambitious European Union commissioned program that creates a patient centric, bottom-up approach to data sharing. It is implemented by a rather exceptional consortium of companies (including Andaman7), renowned institutions and experts (see interopehrate.eu for the full list). The research project was launched on January 1st, 2019 and with a budget of €7 million. It is in line with Recommendation C(2019) 800 recently issued by the European Commission. It will pave the way for fully interoperable electronic health data exchange (EHR) formats. However, it differs from existing projects because of its patient-centred approach!

"Until now, the European Commission's approach to medical data exchange policy has been mainly top-down. Typically, the exchange of patient data was only considered through national online contact points," says Matteo Melideo, head of the Information Systems for Healthcare Research Division of the Engineering group and coordinator of the InteropEHRate project. "What we want to do is propose a more bottom-up, decentralized strategy, in which key health data is managed by patients themselves, through intelligent electronic health records stored on their mobile devices. Thanks to InteropEHRate, a patient will be able to collect, consult and share medical data with healthcare professionals or researchers anywhere in Europe. In particular, he will be able to exchange this information with a doctor of his choice, even without an Internet connection, thanks to a local connection".

First results at the end of 2019

The innovative InteropEHRate programme should enable Europe to move from a "closed" model, driven solely by national healthcare organisations, to a vast ecosystem based on an open healthcare platform, where software providers, institutions and citizens from different countries can safely collaborate to improve healthcare and medical research, using standard technologies. Among the participants in the InteropEHRate program, everyone is confident in the validity of this innovative approach. "The project is planned to last for forty-two months, but we should already be able to present our first results and prototypes well before that, probably by the end of this year," says Matteo Melideo. "It should be noted that we are one of only two European funded projects specifically dedicated to interoperability. There is therefore a good chance that our work can change the future of healthcare and medical research in Europe. That is what we hope for, anyway. And we are confident about the results we can deliver.

(1) Interoperability. www.healthit.gov

Outside text

An exceptional consortium

InteropEHRate is a consortium of fifteen qualified European partners and experts from industry, SMEs, non-governmental organisations, hospitals, research centres and public bodies. The contributors to the project are: Andaman7, Engineering – Ingegneria Informatica, EHTEL – European Health Telematics Association, DTCA Hygeia – Diagnostic and Therapeutic Center of Athens, University of Trento, University of Vienna, EFN – European Federation of Nurses Associations, FTGM – Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, CHU de Liège – Centre Hospitalier Universitaire de Liège, UBITECH, University of Piraeus Research Center, “Bagdasar-Arseni” Clinical Emergency Hospital of Bucharest, SIVECO, Fraunhofer ISST – Institute for Software and Systems Engineering, Iatrikos Syllogos Athinon and Byte Computer.

Geographically speaking, the following countries are represented: Austria, Belgium, Cyprus, Germany, Greece, Italy, Romania.

Andaman7: an appreciated collaboration

Within the InteropEHRate consortium, Andaman7's support in the development of the project is particularly appreciated. "They are very enthusiastic and their contribution is extremely positive," says Matteo Melideo. "The interface they have succeeded in developing is also, in a way, the inspiration for our project. It allows everyone to have their health data on their phone and share them with a doctor or hospital of their choice. They have first-hand experience of this possibility in the American market". In fact, the application developed by this Belgian-American e-health company is now integrated with a very large number of hospitals in the United States, allowing 85% of all americans to retrieve their health data directly from their hospital / clinic and thus automatically enrich their health record and get real control over their health data.

For more information on InteropEHRate: www.interopehrate.eu
Contact: B2B@andaman7.com 

Reducing the drop-out rate and improving data quality

Andaman7 is a digital and multi-pathology health platform that offers solutions for healthcare stakeholders in the broadest sense: research institutions, pharmaceutical companies, medical device manufacturers, hospitals, doctors, medical laboratories, patient associations and health professionals. 

Description

With Janssen France, Andaman7 developed a solution to ease the data collection process for both patients and researchers, as part of a quality of life study. 

Results from quality of life studies are generally very irrelevant in terms of outcomes. Patients often don’t understand how they benefit from participation in quality of life studies. The questionnaires are usually long and difficult to complete. For example, when a patient is asked how many migraines he/she has had over the last 3 months, it is unlikely that he/she will actually remember them and be able to provide correct information. 

Two problems arise for this type of clinical study: poor quality of the data collected and high drop-out rates among patients. On top of that, quality of life studies must be conducted over long periods of time in order to extract convincing results. 

The questionnaires are also usually submitted in paper form, which makes the task even more difficult for patients and also requires costly data entry by study coordinators, with an increased risk of errors. 

The Challenge

The challenge for Andaman7 is to make capturing of this data much more pleasant for patients and reduce the patient drop-out rate while increasing the quality of data collected. 

Our solution

The Andaman7 health record mobile app is a simple and easy to use way for patients to collect data about their health. Andaman7 is connected to a large number of connected devices such as glucose and blood pressure monitors. By replacing a large number of questions related to a patient’s quality of life with data from connected devices, we can ease the patient and research site data entry burden. For example: physical activity, number of hours of sleep, and other data elements are captured automatically. This reduces the number of questions and drop out rate while increasing the data quality. 

Since Andaman7 is on the patient’s smartphone they can easily complete the data entry at any time from any location.

We also provide patients with a widget of the study on their smartphone or tablet (rather than having to go through the Andaman7 app). This makes entering of certain information, such as the occurrence of pain, even faster. The information is recorded with only a few quick taps on the screen.  

See all use cases

Building a trial ready cohort

Andaman7 is a digital and multi-pathology health platform that offers solutions for healthcare stakeholders in the broadest sense: research institutions, pharmaceutical companies, medical device manufacturers, hospitals, doctors, medical laboratories, patient associations and health professionals. 

Description

Implementing a solution to build a trial ready patient cohort or trial readiness cohort, for a top 10 pharmaceutical company (NDA). 

The Challenge

It is important and difficult to recruit so-called "active" patients to carry out a clinical study. An "active" patient is a patient who suffers from a chronic disease and who can provide current data on their condition at the time when symptoms arise.  

Crohn's disease is a good example of such a situation since it is a disease with unpredictable events. Indeed, the patient has the disease but the inflammation, if it happens, only occurs at a certain point in time, called a "flare-up". At that time, it is very important to detect the event and put the patient on a clinical trial as soon as possible. 

Being able to detect this precise moment in order to start a clinical study is very beneficial for the quality of the responses received and the follow-up of the patient. The goal of this project is to establish a patient cohort meeting a set of specific criteria, i.e. a group of patients in a position to be able to join a clinical study very quickly, as soon as specific symptoms appear. 

Our solution

The Andaman7 app is given to all Crohn's disease patients in the gastroenterology department of the partner hospital. Patients report the occurrence of various symptoms by completing a short questionnaire (e. g. level of pain, fever, blood in stool, etc.). If the inclusion criteria to activate the clinical study are present, the doctor and Andaman7 invite the patient to join the study and send him/her appropriate questionnaires. This type of solution is beneficial for the patient, the hospital, and the pharmaceutical company conducting the clinical study. 

  • Benefits or the patient: Patients are regularly monitored despite the fact that he or she is not at the care facility. They feel better supervised and reassured.
  • Benefits for the hospital: Better quality of care for patients without having to bring the patient to the hospital. To prevent hospitals and doctors from receiving too much direct information on patient status, we work with companies that specialize in processing information sent by patients so that there is a first filter. These external companies have developed real expertise and precise algorithms that allow the scoring of the patient's condition. The physician is then informed of the seriousness after the relevant information has been filtered. 
  • Benefit for the pharmaceutical company: This type of flare-up monitoring allows the establishment of a "patient ready cohort" and thus a real saving of time and cost for the study sponsor.   

See all use cases

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