How We Did It. Unique data model abstraction layer to integrate, but de-couple EHR data from patient website design.

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1 EHR Accessibility The Big Idea: Provide a standardized and improved user experience for ALL disabled and abled patients while interacting with their providers Electronic Health Records System (EHR). The Difficulty: The EHR market is very fragmented. Existing EHRs pay little attention to the user experience and often are developed in outdated technology. Most providers try to prevent switching EHRs often because of cost and the burden of having to transfer patient data. The Innovative Solution: Develop a modern, patient-focused, 508 compliant design module that can be easily integrated by providers with any existing EHR. We Present Apollo: A patient-facing, fully-accessible internet portal for interacting with a provider s existing EHR system over the web. Health IT Professionals will recognize Apollo as a 508 Compliant Universal Tethered PHR that through our abstraction layer data model can interact with multiple EHRs.

2 How We Did It Unique data model abstraction layer to integrate, but de-couple EHR data from patient website design. Simple admin interface configured to work with multiple EHRs. Unique module and theme library built upon the opensource Drupal framework. Additional modules can support other EHR features and additional themes can support other website designs. Provider EHR Application Database Provider EHR Provider Website Apollo Patient Website Provider EHR Apollo Abstraction Layer Data Model EHR Connect Layer Data Handler Drupal Content Management System Apollo Module Library Apollo Theme Library

3 Apollo Framework Fully-functioning Administrative Features Select and Configure Apollo to Interact with Any Supported EHR. Select From Multiple 508 Compliant Design Themes. Extend Apollo Modules and Themes. Assign Multiple Permission Layers. Update Provider Information (i.e. contact information, resources, logo.) Function as Provider Website or as an Integrated Patient Portal. Patient Registration Uses Three Point Identification System. Providers Can Adopt Apollo Without Any Data Transfer. Abstraction Layer Data Model Ensures That No Patient Data is Stored or Processed by Apollo. All Data Processing Done by Existing EHR. Prototype Installation Our functioning prototype implementation interacts with OpenEMR version 4.1 (which meets 2011/2012 meaningful use certification requirements) and provides the ability for a patient to view and make adjustments to their primary record. Built on the Drupal open-source framework, Apollo can easily be configured to work with additional EHRs and tap into the extensive Drupal community to develop modules and themes to support additional EHR features or offer additional designs.

4 Design & Usability Strong User Experience for Disabled and Abled Users 508 / W3C Compliance (See appendix for test results). Fully Semantic Markup. Monochromatic, High Contrast Display. Representative Font Size Denoting Text Importance. Header Tags Describe Page Framework. Anchor Links at Top of Page Improve Screen Reader Navigability. Select Boxes Over Text Fields Ideal For Mobile Device Interaction. Labels for All Form Elements. Title Attributes for All Links. Alt Attributes for all Images. Multi-Lingual Support.

5 Impact and Adoption Apollo s holistic approach is the only proposal that could address EHR usability and 508 compliance issues on a large scale. Apollo is not simply a 508 compliant patient portal, but a fully functioning, extensible Drupal framework that can be integrated with any EHR. Providers can keep their existing EHRs and still offer the Apollo web portal to patients. Easy to install and configure with minimal technical skills and resources. Drupal framework takes advantage of the large developer community for implementation assistance and software extension. Open source framework allows Drupal community to help configure Apollo to work with more EHRs, develop modules to support additional features and design additional 508 compliant design themes. More than 20,000 registered Drupal developers who are experienced in open source development and can carry Apollo through future evolution of technology or changes in policy.

6 Appendix 508 Compliance Testing Results W3C Compliance Testing Results Model Apollo Installation Instructions

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35 Installing Apollo Prerequisites A web server must be available with PHP and MySQL available. There are no restrictions on server types, Operating Systems, or web server applications as long as they support PHP and MySQL. A database user must have access to the EHR database from the location of the Apollo installation. Steps 1. In the web server application, setup a publicly accessible website that includes support for PHP and MySQL. 2. In the directory provided for the web server application, download and unpack a standard Drupal 6 archive. 3. Perform the basic Drupal installation (instructions at 4. Download and Install the dependency modules into Drupal: a. Content (CCK) b. Date c. Date API d. Date Popup e. Registration f. jquery UI 5. Download and Install the Apollo Framework module. 6. As an administrator, visit yoursite/admin/settings/apollo/config. Here you can fill in all of the connection settings for your EHR database. 7. Create a Provider role and an Administrator role, and assign them permissions as required. All patients will use only the Authenticated role that is created by default.