Karos Health Blog

We prepared, we drove, we did it again

IHE LogoThe Integrating the Healthcare Enterprise (IHE) North American Connectathon is the healthcare IT industry’s largest interoperability testing event. It‘s held every year in Chicago and this year over 150 vendors and more than 600 engineers tested the interoperability of their systems, setting a new participation record. IHE is focused on helping industry stakeholders develop better systems by fostering compliance with standards, electronic health record system connectivity and interoperability exchange of patient health information. There is no better way to demonstrate our interest and our commitment to enabling clinically relevant flow of patient information between providers and institutions.

Connectathon 2012Like last year, the Karos team loaded up a van with computer equipment and drove from Waterloo, Ontario to Chicago, an 8 hour trip. Although we have been participating in Connectathons for a number of years now, it is still a major undertaking that starts every year in September. In September each year, we decide on what we want validate, what products to bring, and start planning our activities for pre-connectathon testing in November and December.

While we have gained a lot of experience with these events throughout the years, we set the bar high for ourselves in always testing something new, and validating our assumptions as part of our product release cycle. For us, Connectathons are part of our product release cycle and not something we do on the side. Our focus this year was on validating the support for several IHE Integration Profiles for the latest release of Rialto Discover, which provides indexing of patients and clinical information.

In total, the latest iteration of our Rialto platform clearly demonstrated its interoperability leadership by successfully passing all tests for thirty-three (33) IHE Integration Profile / Actor combinations. We successfully validated several IHE Integration Profiles including the Patient Identifier Cross-referencing (PIX) Manager, Patient Demographics (PDQ) Supplier and the XDS Document Registry actors. In addition, we validated our support for the latest changes in the IHE Cross-Enterprise Document Sharing (XDS.b) and IHE Cross-Enterprise Document Sharing for Imaging (XDS-I.b) Integration Profiles for the Imaging Document Consumer, Document Consumer and Content Consumer actors.

Our team in Chicago with support from others in our office did an amazing job completing close to 200 tests. It is always impressive to see the vendor collaboration throughout the Connectathon week, all working to get the job done. One of our first timers to the connectathon sums it up nicely:

“For me, Connectathon was a great learning experience, it was great to see how other vendors work, the types of products and services offered by other vendors – and it just gives a whole new context to the work we are doing. Being able to speak with other vendors, meet them, and connect to their products from the inside (as opposed to describing your product to somebody, you are actually connecting to their product with yours and directly communicating and showing each other what your product does and that it works). Speaking with the different vendors and seeing the variety of companies and services around the world was amazing. The kindness and willingness of other vendors to run tests with you and others is fantastic – sure sometimes some of them are occupied, but most of them are extremely willing to help and run tests when you approach them. I think it was all around a great experience!”

Validating our products at the IHE Connectathon is core to our commitment to developing and implementing open standards that promote industry collaboration. We prepared, we drove, we did it again!

 

Happy New Year from Karos Health

Happy New Year! 2012Thank you, to all our partners and customers, for an amazing 2011. In the past year we’ve significantly grown our organization to meet the demands of our customers. We’ve released several new product versions and launched our newest product, Rialto Keystone at RSNA. We’ve successfully deployed our products in key customer environments and created significant partnerships.  These achievements could not have been made without your support.

The progress we made last year prepares us well for the many opportunities that lie ahead. We are very excited about that and looking forward to collaborating with our partners and customers in the new year. We wish you, your families and organizations best wishes for 2012.

Karos Health visits RSNA

Karos Health RSNA boothLast week a contingent of the Karos Health team was in Chicago for the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America. That’s a bit of a mouthful, and around Karos we just refer to it as RSNA. It’s an important annual event on our company calendar, as the Technical Exhibits portion of the assembly — essentially a trade show — provides an opportunity to meet with a vast number of healthcare hardware and software vendors.

We were at the event last year as well, but with a much more modest presence.

This year, we had our own booth, and many of the meetings that we had with partners and customers were held there. We had four demo stations, in contrast with our single station last year, and there were several occasions when we had multiple demonstrations going on. As with last year, we were quite proactive in arranging meetings ahead of time. In an encouraging development over last year, we saw more people who sought us out in our booth based on a recommendation or having a specific problem that they hoped one of our products could solve.

We introduced a new product at this year’s event and I was happy to be able to demonstrate it in its current early state. People were engaged, we got some good input and feedback, and the product looks like it meets a real need.

The event was a complete success for Karos. We could not have expected a better experience than we had. Now the work of following up on potential opportunities begins.

Partnerships for Employment Career Fair 2011

Hot on the heels of our co-op recruiting event at the University of Waterloo, Karos Health will be present at the Partnerships for Employment Career Fair on Wednesday, September 28, from 10:00am until 3:30pm at RIM Park in Waterloo.

Partnerships for Employment provides an opportunity for students and alumni from the University of Guelph, University of Waterloo, Wilfrid Laurier University, and Conestoga College to meet with employers and to learn more about the employment opportunities available. Karos Health happens to have several software-related positions open, and we’re looking forward to meeting with potential candidates at the fair.

If you’re planning on being at the event, and are interested in working at Karos Health, please drop by and see us at booth 77 and say hello. We’d love to meet you.

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Karos Health co-op recruiting event at UW

As we’ve indicated in the past, Karos Health recruits students from the University of Waterloo for co-op work terms. It’s only September, but we’re already looking ahead to the Winter 2012 term and we’re actively looking for software developers and software testers.

To that end, on September 21, from 11:30am to 1:00pm, Karos Health will hold a recruiting event at the Davis Centre on the University of Waterloo campus. We’ll be in The Fishbowl, happily chatting with anyone who wants to learn more about of working at Karos.

You can read more about our co-op jobs now, or just plan on coming out to the event and learning about us there.

We’re a small startup with a terrific team that already has products in the market and customers who are excited by what we’re doing. We’re collaborative, smart, and committed to creating great products while having fun doing it. At Karos you’ll have a chance to try different things, get your code into shipping products, test new product releases and make a meaningful difference to health care providers and patients. And, once a month, you’ll be fed the best waffles you’ve ever eaten.

If you’re at all curious about working at Karos, this will be an opportunity to talk to many of the people, including current and past co-op students, who are creating the software that powers our products. Want to know what tools we use? Or how we manage our source code? Or how we practice Scrum and other Agile techniques? This is the place to find out, and to hear about why your next great co-op job might well be here at Karos.

No RSVP required. Just come by the Davis Centre, enjoy some free food that we’ll provide, and learn about working at a terrific software startup right here in Waterloo.

 

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Proven Products at eHealth Showcase

Karos participated in the Interoperability Showcase at the eHealth Conference in Toronto this week. This multi-vendor interoperability showcase demonstrates clinical workflows and use cases in the Canadian healthcare system according to both the Canada Health Infoway’s HIAL architecture and the IHE’s Cross-Enterprise Document Sharing (XDS) framework. It was a great opportunity for us to showcase our products, and a great opportunity for the attendees to see the types of important clinical scenarios that can be supported by open standards.

Karos participated in two of the five clinical scenarios, providing key infrastructure elements for the overall operation of the scenarios. The first scenario focused on telehealth. This scenario tells the story of a patient suffering from chronic obstructive pulmonary disease (COPD). The patient takes home vital sign readings every day, and uploads these readings to a centralized EMR system. These vital signs can be immediately reviewed in the nurses’ clinical setting. One day, the nurse notifies the patient concerning an irregular reading. The patient is requested to go to their local health care facility to visit the nurse. The nurse augments the patient’s chart with additional vital signs, and then schedules a telemedicine call with a remote specialist to review the patient’s complete set of information. The remote specialist is able to give a verbal medication order to the nurse, and the nurse provides the medication to the patient. The patient returns home, and continues to self manage in the comfort of their own home.

In this scenario, Karos provided a Patient Identifier Cross Referencing (PIX) and Patient Demographic Query (PDQ) service for all the interactions, enabling the query for patients, and the supply of the patient demographics to the requesting system. Karos also provided the XDS Document Registry, which indexes all of the patient’s clinical information for future query and retrieval.

In the second scenario, based on an eReferral, an elderly women suffering from vertigo, is assessed by her primary care provider and referred a specialist. The primary care provider was able to review the complete set of clinical information on the patient prior to the referral. The specialist receives the referral, has an appointment with the elderly women, and diagnoses the problem. The specialist prepares a visit summary document in his practice management system. The visit summary is sent to the repository and a notification is sent back to the primary care physician that the report is available. In the eReferral scenario, Karos provided the PIX and PDQ service and the XDS Document Repository. The XDS Document Repository stored lab results and medical summary information of the patients in HL7 CDA format.

In each of these scenarios, there were 6-10 vendors’ products involved in the overall workflow, from personal care devices to EMR systems to standards compliant infrastructure components.   They all worked together to facilitate better care for the patient.

We had groups of people being taken on the tour all day both days. The people that we spoke too seemed very engaged in learning about open standards and how the various systems came together to create the workflows. It was a great experience. Events like the Interoperability Showcases and the IHE Connectathons, we believe are key, to show that interoperability is achievable.

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Is Rip and Replace the Only Strategy?

Vendors seem to believe that healthcare providers should replace their existing IT systems and replace them with the latest and greatest products to gain the productivity and value providers are seeking. While this approach has some merits, it is highly disruptive and not cost-effective considering the significant investment that has to be made in retraining users on these new systems. It takes a huge amount of effort and significant resources to replace a clinical information system, and productivity gains associated with a new system will only be reached after years of operation. There must be a better strategy that is less disruptive, more cost effective and improves provider productivity and clinical outcomes.

Non-displacement is one of the key design goals that influences the development of Karos’ products. Non-displacement means that we would prefer to build on what exists, as opposed to build something that creates the need for replacement.

The rationale for focusing on this characteristic is straight forward and has been discussed a lot: it is about the cost of change. Not only is there typically a significant investment in the actual technologies used, but also the users of these technologies have invested their time in becoming productive with the technology. The users understand what they need to do. They understand the work-arounds, shortcuts and all of the things that don’t work as expected in their current applications. Change for them often means significant pain associated with becoming proficient again.

Consider how non-displacement has been made manifest in Karos’ products. Rialto Consult enables teleradiology: the complete electronic round trip for images, orders and results between the imaging center and the radiologist. When a radiology group considers extending their reach by servicing additional imaging clients, do they want to purchase a new PACS? Do they need a new web-based PACS infrastructure? Do they want to learn a new system in the hopes that they can grow a teleradiology business?

Or would these radiologists prefer to use their existing PACS? Would they prefer to extend their existing PACS with a open-standards based, interoperable workflow layer that provides for image and order transfer from the imaging center directly to their existing PACS and existing worklist?  We believe they would.  And what if that open-standards based application provided status communication between the provider and the radiologist, so that radiologist could easily and quickly communicate the discovery of a critical funding? Rialto Consult offers the provider-radiologist communication layer too.

Rialto Connect can enable the connectivity of existing clinical information systems to other systems.  Often, this takes the form of connecting an existing clinical information system (CIS) to an IHE XDS based exchange, enabling this CIS to publish and retrieve information to and from the XDS exchange network. The existing CIS is an important source of patient information, and should be leveraged by every system and every user connected to the exchange network.

Rialto Connect can also connect other clinical systems to solve other workflow issues. Rialto Connect can be placed between a local hospital PACS and a centralized diagnostic imaging repository to ensure seamless workflow between the two. The local PACS needs to find and ingest relavent prior studies from the centralized repository, and therefore order creation, tag morphing and report fetching must all be coordinated by Rialto Connect.  Again, the local PACS was the choice of the radiologists, and it should be leveraged into the future growth of the regional radiology services.

Combined with Rialto Vault for clinical information storage, Rialto Connect may also connect a patient or provider portal, that is built on a query-based model, with a key clinical information system that can only provide HL7 outbound messages.

We believe that non-displacement is the right strategy.  It leverages existing choices, and improves clinical workflow and sharing of information. We believe that enabling greater productivity in the provider community and ensuring seamless access to clinical information are key goals within healthcare.  We believe that non-displacement is the least disruptive strategy, leveraging past investments to achieve seamless access to clinical information.

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Karos Health sponsors Coding Dojo

Karos Health is proud to announce that we are one of the sponsors for the upcoming Waterloo Agile Lean Coding Dojo. Coding Dojo is a meeting where developers who are passionate about coding get together to work on a programming challenge. They are there to engage in Deliberate Practice in order to improve their skills. More information about coding dojos can be found in the following videos:

The Waterloo Agile Lean Coding Dojo is happening on Saturday, May 28th at the Stone Crock Conference Facilities in St. Jacob’s. Find out more and/or register on the LinkedIn page.

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Bridging the Canadian Chasm

While preparing for the Interoperability Showcase, it became clear that there is a need to bridge the gap between Canada Health Infoway’s Health Information Access Layer (HIAL) architecture and the Integrating the Healthcare Enterprise (IHE) framework for sharing of clinical information.

The Interoperability Showcase will be held during the eHealth Conference in Toronto from May 29th to June 1st, 2011 at the Metro Toronto Convention Centre. This multi-vendor interoperability showcase demonstrates clinical workflows and use cases in the Canadian healthcare system according to both the Canada Health Infoway’s HIAL architecture and the IHE’s Cross-Enterprise Document Sharing (XDS) framework.  A key objective of the Showcase is to provide conference attendees with a clear view of how interoperability standards are incorporated into products to support actual clinical scenarios, where the exchange of patient information is paramount to the overall delivery of patient care and safety, and enables healthy outcomes.  We hope that you are able to attend this showcase.

The IHE and CHI approaches have the same goal in providing accurate and timely access to a patient’s health information across healthcare enterprises. Access to a unified view of the patient’s health information despite the multiple data sources and disparate applications, aids healthcare professionals as they efficiently guide patients along their journey from diagnosis to recovery, and helps avoid preventable errors.

Very briefly, the HIAL is based on a messaging architecture, while XDS is based on a document architecture.  This blog post is not about the merits of either approach.   There is an enormous amount of information concerning the HIAL and the Pan-Canadian blueprint on Canada Health Infoway’s website.  Similarly IHE’s website has a tremendous amount of information on its XDS framework.  Karos believes that both approaches will co-exist in the Canadian healthcare system for some time.  The real question is how these two approaches can be connected to integrate patient health information across both architectures.

Rather than capture a tremendous amount of technical detail in this blog post, we have put the details in a separate paper called “Bridging the Canadian Chasm.   This paper describes a solution based on the open source product Mirth Connect and Karos’ Rialto Toolkit, that publishes patient health information from the HIAL to IHE XDS. This paper describes in more detail, how the integration of Mirth Connect and Rialto Toolkit supports:

  • The capturing of clinical information sent from a HIAL
  • Parsing of pertinent information from the clinical information for indexing and storing
  • Routing of clinical information to a repository for storage and future retrieval

The paper documents the detailed steps required to integrate Mirth Connect and Rialto Toolkit to create a bridge that stores an incoming HL7 CDA document into an XDS repository.  The solution uses the Mirth Connect to process the incoming HL7 CDA document and construct the appropriate XDS metadata and then uses Rialto Toolkit to submit the HL7 CDA document in its entirety to an XDS repository. The solution effectively bridges the chasm between a HIAL infrastructure and IHE XDS implementation.

The link to the paper is available to the right, in White Papers, under the resources header.  Feel free to download. I look forward to receiving your comments and don’t hesitate to contact me if you need any further assistance, aron.tennant at karoshealth.com.

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Karos’ First Fedex Day

About two weeks ago, Karos Health held its first Fedex Day.   For those of you not familiar with this, basically everyone gets to work on whatever pet project they’ve had in the back of their minds, so long as they can build something to show off to the rest of the team by the end of the next day.   This concept was taken from the Australian software company Atlassian.

The rules we observed for our Fedex Day were as follows:

  • At 4pm the day before, we brainstormed and wrote down everyone’s ideas of what could be done, and then allowed everyone to sign up for the ideas.
  • The ideas had to be something “out of the ordinary”. This is bit hard to define – but basically the spirit is that you can’t do something you would normally do. It’s a chance to attack all those “I wonder if XYZ would work… “, or “It would be nice if we could… “.
  • The task must be deliverable in one day (hence Fedex Day – “We deliver…”). This doesn’t mean it has to be finished, polished and shipped to a customer, but it must do something and work to some extent. It must show enough promise that we can either decide to continue working on it, or dump it.
  • The fridge was stocked with food and drink, and more food was brought in to keep the team going, supporting those who wished to work into the wee hours.
  • At about 4pm, we met up for a “Show Off” meeting where everybody could show off what they’ve done, combined with chocolate cake and beer.

Unlike Atlassian, Karos allowed all its employees to participate, not just the development staff.   The marketing and account management people joined in and worked on things they had always wanted to get done too.

In all honesty, we found Fedex Day a little challenging on a couple of fronts.   We did have a couple of people who were not completely sure of the boundaries — how far could they really diverge from their daily work; should Fedex activities align or support corporate activities; can I really work on anything?  Clearly, working through these issues takes guidance and support from the leadership of the company to really free their employee’s minds, and potentially inspire the employees with their own ideas of what might be interesting and challenging.   We had a lot of that support, and the team really came together with more great ideas during the initial planning meeting.

It was also difficult for those in customer facing roles to take the time away from the customers.  Many of us came in a little early on Fedex Day morning to attend to any customer matters, and by 9:00-ish we were almost completely focused our Fedex Day plans.  Apart from a couple of phone calls returning us to reality, the day proceeded as planned.

Atlassian described the following goals for Fedex Day:

  • Foster creativity.  Karos Health employs a lot of really smart and creative people, and we’d like to keep it that way.
  • Scratch itches. Every developer has something that bugs them about our products, or something they’d like to see them do.
  • Spike. Often, radical ideas don’t get traction because we don’t understand how they’d work or what benefit they’d provide.
  • Have fun. Having Fedex Days create a fun place to work.

I think Karos hit all of the goals.   We had a couple of teams fix some product issues.   We had other teams that wanted to create something completely new just to see if it could be done.  We had others consider new processes for our internal operations.  And certainly, we had a lot of fun.   Perhaps the best part though, was the final “demo”.  It was truly amazing to see how far people could get with their ideas, and how great the ideas really were.

This first FedEx Day was a great success and will certainly be continued.   All of us are looking forward to the next Fedex Day at Karos.

Read more about Atlassian’s first Fedex Day if you are interested.

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