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3 Themes on Health Information Exchange using CONNECT - notes from the code-a-thon

Posted on Thu, Aug 11, 2011 @ 06:00 AM

The summer CONNECT code-a-thon wrapped up today. This two-day event brings together health IT leaders to share feedback and write code for CONNECT, the open-source software solution that supports health information exchange. CONNECT implements the Nationwide Health Information Network (NwHIN) standards to ensure the compatibility of secure health information exchange throughout the country. The CONNECT solution is used by state and regional health information exchange organizations; by private companies, practices, hospitals, and collaboratives; and in federal agency health information exchange initiatives, including those by the Department of Defense, Centers for Disease Control and Prevention, Department of Veterans Affairs, Social Security Administration, and Centers for Medicare & Medicaid Services.

As members of the CONNECT development team, we were happy to meet the community of CONNECT users and have a chance to hear first-hand how they use CONNECT, what improvements and new features they’d like to see, and how health information exchange fits in with their organizations’ missions. The CONNECT community is passionate and committed – more than 180 people attended this code-a-thon. Here are a couple of the topics the community discussed:

    • Understanding how organizations use CONNECT. Given that CONNECT enables standards-based, secure exchange of health information, the code-a-thon included participants who use CONNECT to support their own missions. Dr. Louis Rubenson from the National Disaster Medical System (NDMS) participated in a panel of federal partners who shared how they use CONNECT today and what they'd like to be able to use CONNECT for in the future. NDMS assists in the state and local response to disasters. They use CONNECT to enable patient information to follow a patient throughout the disaster response, from emergency treatment centers to evacuation. Dr. Rubenson identified a need for a slimmed down version of CONNECT, able to operate efficiently over phone lines in a resource constrained environment, and encouraged the community to make it happen. In another code-a-thon session, Calvin Beebe from the Mayo Clinic Southeast Minnesota Beacon Community, which helps improve outcomes for adults with diabetes and children with asthma, shared how his organization uses CONNECT. Like many of the participants, he expressed a desire to see an increased focus on performance and scalability as CONNECT continues to mature. This was discussed in several other sessions, in fact....

    • Performance and scalability. This topic was one of the more active discussion groups during the code-a-thon, as many of the participants have started deploying CONNECT to their production servers. We see this is great news in the evolution of a product and the Nationwide Health Information Network (NwHIN) – so many exchanges are occurring that there’s an increased focus on performance and scalability. During one of the break out sessions, several ideas were thrown around to help CONNECT scale to handle the expected onslaught of requests as the NwHIN continues to grow. The easiest and probably the most obvious answer that one can apply to a system is to improve the hardware the gateway is installed on. CONNECT uses a significant amount of computing resources to handle the security checks and message orchestration, and it should be deployed on fairly strong hardware, but like any app, its performance can obviously be improved by beefing up the hardware to exceed minimum requirements. An out-of-the-box proposal was the idea of fronting a CONNECT server with a SSL accelerator and have that box handle the processor intensive SSL transactions, and allow the underlying layers underneath the accelerator could be switched to use only unsecured web services to communicate among components. Another approach that was talked about in detail is to simply load balance the workload to multiple instances of CONNECT by having a software or hardware switch in front of the server farm. Aside from optimizing resource allocation, this has the side benefit of increasing the reliability of the system. For a more software-oriented solution, the group agreed that the biggest performance improvement is to upgrade to the latest CONNECT release – recent refactoring improved the software’s performance. ONC and the FHA have requested that the CONNECT team focus on improving both scalability and performance, so the next scheduled releases will carry additional improvements.

  • Open source strategy. CONNECT is aiming to become one of the first truly open-source, community-driven products initially developed by the government. This is no small task, as the government is typically big on control and not so fond of unexpected changes. The good folks at Red Hat gave a fantastic talk about a vision for CONNECT's future that sparked discussion on community rights vs. control over a product. Especially when the product is in the health IT space, knowing that good people are working on the code is important. However, engaging the community in an open source product necessitates allowance for their contributions in any form. How do you resolve these differences? We talked at length about the distinctions, and consensus began to circle around the idea of having a group of vetted, core contributors (who are more than the contracted development team) with permissions to review and commit code, leaving all other registered users with the ability to submit issues, contribute code, attach files to issues, and comment where they feel they can contribute. The final path to a true open-source has yet to be finalized, but the discussion is open for community contributions!!!

The Johns Hopkins University Applied Physics Laboratory was a fabulous setting for the dynamic event, and we were inspired and challenged by those that we met. Please comment here if you have thoughts or other insights about the code-a-thon, CONNECT, and health information exchange in general.

(For deeper information, see the Federal Health Archiecture, which manages CONNECT in concert with the U.S. Department of Health and Human Services' Office of the National Coordinator for Health IT (ONC). Find out more about CONNECT and download source at www.connectopensource.org - and find CONNECT on Twitter using @connect_project and the code-a-thon hashtag (#CONNECTcodeathon). Find out about 5AM's work on CONNECT, our work on the Nationwide Health Information Network, and our health IT team, which also contributed to this blog post: Brian Humphrey, Mike Hunter, Arthur Kong, Zach Melnick, James Rachlin, and Andrew Sy.)


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