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DHACA Keynote:Avoiding duplication in Health and Social Care
Software apps to support health and care - Supporting the app paradigm –
Creating a community of interest - That's HANDI
www.handihealth.org
Dr Ian McNicoll
HANDIHealth
openEHR Foundation
freshEHR Clinical Informatics
DHACA meeting Jan 2015
Introduction
• Dr Ian McNicoll
• Clinician
• Former Glasgow GP
• Health informatics
• Director HANDIHealth
• Director openEHR
Foundation
• freshEHR Clinical
Informatics
• Commercial software developer
• ‘Clinical Hacker’
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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
“Avoiding Duplication in Health and Social Care”
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“Making the impossible very difficult”
So what’s wrong with “Duplication” then?
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Duplication unhelpful: Me-too Drugs?
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Duplication helpful: Better Drugs?
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Duplication unhelpful: Me-Too Apps?
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Duplication helpful: Better Apps?
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Duplication unhelpful: Care Records
• Multiple copies of same information
• Patients asked same questions repeatedly
• Devices do not talk to records
• Systems do not talk to each other
• Re-entry of data ++++
• No “Data Liquidity”
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Duplication helpful: ’standardisation’?
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http://cyber.law.harvard.edu/research/interoperability
Avoiding unhelpful duplication:
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
SMARTPlatforms
Pluggable Webapp
API
HL7 FHIR
Clinical Content
Exchange NHS API
‘inVivo’
Datastore API
Detailed
Clinical Content
Development
Clinical leadership PRSB
Terminology
CentreHSCIC
Non
openEHR
systems
Archetype+ SNOMED Clinical
Content definitions
Apps developers
•New content is defined directlyby stakeholders and can beused technically immediately
• Recently adopted by HSCIC for content modelling
•Vendor-neutral data modelsTechnology-neutral data models
•Vendor-neutral data queryingTechnology-neutral data querying
openEHR API
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Building out the platform
• SMART and HL7 FHIR support
• BlackPear , Marand
• More openEHR providers
• Lockheed Martin - OceanEHR
• Medvision360
• Code24
• More demo apps
• LiveCode mobile App demo
• Knowledge resources
• FirstDataBank
• Indizen cloud terminology service
• CDS resources
• openClinical - PROFORMA
• Cambio GDL
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NHS Code 4 Health
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Rapid connected health app development
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SMARTPlatforms
Pluggable Webapp
API
HL7 FHIR
Clinical Content
Exchange NHS API
‘inVivo’
Datastore API
Detailed
Clinical Content
Development
Clinical leadership PRSB
Terminology
CentreHSCIC
Non
openEHR
systems
Archetype+ SNOMED Clinical
Content definitions
Apps developers
Interoperability is not a tech problem
“The real barriers to practical interoperability
are cultural and clinical”
Healthcare records are not just
buckets of biological facts
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Healthcare Information Standards Process #FAIL
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Clinical stakeholders
engage through top-down
governance
Committee-based
Late vendor engagement
Fixed review cycles
Unclear / unresponsive
change request
mechanism
Clinically-led Content Service
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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
Medication ‘archetype’
Web-based ‘democratised’ collaborative review
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Evolutionary standardisation
‘distributed Governance’
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Implementers
Secondary
endorsement
Avoiding Duplication?
• Not always desirable
• Not always possible
• Learn from
• The internet
• Open source software
• Evolution
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Links
• twitter: @ianmcnicoll
• HANDI-HOPD:
• handi-hopd.org
• minimal-hopd.rhcloud.com
• openEHR Foundation : www.openehr.org
• SMARTPlatforms: smartplatforms.org
• HL7 FHIR: hl7.org/implement/standards/fhir/
• International archetype repository: www.openehr.org/ckm
• UK archetype repository: www.clinicalmodels.org.uk32
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