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Digital Health Assembly:HOPD / openEHR workshop
www.handihealth.org
Dr Ian McNicollian@freshehr.com
ian@handihealth.org
HANDIHealthopenEHR Foundation
freshEHR Clinical Informatics
Digital Health Assembly Cardiff Feb 2015
Introduction
• Dr Ian McNicoll• Clinician
• Former Glasgow GP
• Health informatics• Director HANDIHealth• Director openEHR
Foundation• freshEHR Clinical Informatics
• Commercial software developer• ‘Clinical Hacker’
HANDIHealth CIC
• A not-for-profit Community Enterprise Company
• There to support:– Developers– Health and care professionals– Patients, service users and carers
HANDI is agnostic
• About– Platforms– Business models– Standards– Tools, services and approaches
• Show the community the possibilities and let individuals decide
• Lobby for an environment (technical, cultural and commercial) in which apps can flourish interoperate and be orchestrated
Interop:Towards an Open Digital Care Ecosystem
Megasuite
Best of Breed
Platform
Open Ecosystem
“One system to rule them all”• NPfIT• Enterprise/GP Systems• Limited external integrations
Many systems ~ 100• Portals• Integration engines• Bespoke integrations
“Own the Platform”• Health Vault, Apple, Lorenzo, etc• ~1000 apps• Partner interfaces (Woodcote L3)
The “Internet “of Digital Health• HANDI-HOPD• The Healthcare Services Platform
Consortium
An open Ecosystem platform?
Closed OSS ClosedOSS
Vendor DVendor B Vendor CVendor A
API and messaging content based on open source clinical content definitions
OSS components
Vendor solutions
TerminologyServer Pathways KB
ESB/SpineITK Integration component
Commit
Retrieve
SMARTPlatformsPluggable Webapp
API
HL7 FHIR Clinical Content
Exchange NHS API
‘inVivo’Datastore
API
Detailed Clinical Content Development
Clinical leadership PRSB
Terminology Centre
HSCIC
NonopenEHR systems
Archetype+ SNOMED Clinical Content definitions
Apps developers
SMARTPlatforms API
• Scopes and permissions: OAuth2
• Simple sign-in: OpenID Connect
• Lightweight UI integration: HTML5 via Pluggable app framework
What is FHIR good at?
• Communication of information between systems with limited querying
• Strengths• Developer friendly• Lightweight approach• Great documentation / community
Where might FHIR be weaker?
• Not designed for persistence• can work but will it scale?• partial querying only
• Resources will not work ‘out of the box’ in the real world• Need local extensions and profiles• Version control / governance of the profiles
openEHR API
• Designed for storing and querying rich clinical dataset
• New content is defined directlyby clinicians and can be immediately uploaded into the clinical data repository
• Vendor-neutral data modelsTechnology-neutral data models
• Vendor-neutral data queryingTechnology-neutral data querying
openEHR
• Weaknesses• Complex technology• but new simplifying APIs appearing
• Strengths• clinically-led data modelling• sharing archetypes = interoperability• Enterprise strength performance• Mature versioning/governance
What IS openEHR?
• NOT a downloadable ‘open source’ application• e.g. openEMR , openMRS
• an open Specification for an EHR or EHR platform
• Defines an technology-neutral/ vendor-neutral ‘information model’
Copyright 2012 Ocean Informatics
What is an ‘information model’?
• Any definition of the structure and content of information that should be collected or shared, including terminology
• A simple paper form - check boxes or Y/N questions• A ‘minimal dataset’• A message or API definition
• Internally every program or application has some kind of information model
• Sharing information requires developing shared information models
Data entry definition
What exactly do you mean by record pulse and blood pressure?
What are reasonable min/max limits to put on a temperature record?
What are the allowable sizes of pupils in a drop-down box?
‘Best of Breed’ Information architecture
Application
Information Model
Persistence (Database)
Query
Application
Information Model
Persistence (Database)
QueryIntegration engine
‘open Platform' Information architecture
• Technology and Vendor neutral
• Define information structures independent of application layer• Rich enough to support eHealth apps• Handle audit/versioning
• Define information structures independent of persistence layer• rapid incorporation of new datasets• vendor/tech neutral querying
openEHR: Archetypes
• open source computable models of discrete clinical concepts
• Familiar components of a health record• Blood pressure, Body weight, Symptom• Medication order, Family history• Urea, Creatinine results
• ‘Maximal dataset’
• Capture as many clinical perspectives as possible• Universal use case
openEHR: Templates
• Templates deliver the datasets by aggregating archetypes together
• Key clinical endpoint and starting point for generation of technical artefacts
• i.e. openEHR archetypes and templates can be used directly
• Class libraries• GUI skeletons• Message schema• Define API Profiles
SMARTPlatformsPluggable Webapp
API
HL7 FHIR Clinical Content
Exchange NHS API
‘inVivo’Datastore
API
Detailed Clinical Content Development
Clinical leadership PRSB
Terminology Centre
HSCIC
NonopenEHR systems
Archetype+ SNOMED Clinical Content definitions
Apps developers
Interoperability is not a tech problem
“The real barriers to practical interoperabilityare cultural and clinical”
Healthcare records are not justbuckets of biological facts
Healthcare Information Standards Process #FAIL
Clinical stakeholders engage through top-down governance
Committee-based
Late vendor engagement
Fixed review cycles
Unclear / unresponsive change request mechanism
Clinically-led Content Service
Clinical content service
Clinical stakeholders, vendors engage directly with clinically-led content service
Continual dialogue with all stakeholders via web-based collaborative tooling
No fixed review cycles
On-demand change request directly to clinical content service
PRSB has high-level 4-country governance role
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