Interoperability: Managing clinical · PDF fileManaging clinical diversity ... Good understanding of openEHR paradigm and ... Web- based collaborative authoring

Interoperability:

Managing clinical diversity

Ian McNicoll

© Ocean Informatics 2011

“It must be kept in mind that interoperability implementation also depends on social, cultural and human factors within each organisation, region and country, each system and each time period.”

“Realising full interoperability is not necessarily a consensual goal in every place at any fixed time.”

SemanticHealth EU report

interoperability


dysoperability

The „usual suspects‟ ?

Clinical ego, technophobia, vendor lock-in

Innovation, research

The consultant‟s MS-Access database

Information granularity

„Family history of breast cancer‟

GP, Breast Cancer unit, Research Genetics Unit

Organisational constraints

Health vs. social care

Financial constraints, Legal constraints

HB

Multiple non-co-terminosity?

A&C HB GGHB Clydebank PCT

HB

HB


• National clinical datasets

• National forms libraries

• National Care pathways

National clinical consensus

National Mobility Assessment

Why is the minimum dataset process so frustrating?

Physio

Secondary Care

GP

Comm Care

National Mobility

Assessment

The maximum dataset: e-Cardiology record

Tertiary Centre

Regional Hospital A

Regional Hospital B

eCardiology Record

Diagnosis BP

ECG

Diagnosis BP

ECG

eCARDIOLOGY TEMPLATE

Diagnosis

Date of Diagnosis Date Recorded

BP

Systolic -163030003 Diastolic - 163031004

Position Cuff Size - 246153002

ECG

Automated report Heart rate PR interval

QRS interval

Diagnosis Date of Diagnosis

BP

Systolic Diastolic

Coded finding – “normal” Exertion level

Cuff size Position

ECG

Multimedia Automated report

Regional Hospital A

Regional Hospital B

Tertiary Centre

eCardiology Record

Diagnosis Date recorded

BP

Systolic Diastolic Cuff size Position

ECG

Automated report

Diagnosis Event Date

BP

Systolic Diastolic

ECG

Heart rate PR interval

QRS interval

MAXIMAL DATASET

Diagnosis Date of Diagnosis (Event Date)

Date Recorded

BP Systolic Diastolic

Coded finding – “normal” Exertion level

Cuff size Position

ECG

Multimedia Automated report

Heart rate PR interval

QRS interval

eCARDIOLOGY TEMPLATE

Diagnosis Date of Diagnosis

Date Recorded

BP Systolic

Diastolic Position Cuff Size

ECG

Automated report Heart rate PR interval

QRS interval

Snomed Term bindings

Snomed Query

binding = Any Cardiac

condition


What does not work?

Clean–room, top-down technical modelling

Diktat by government

Late vendor involvement in model harmonisation

Message or „domain‟ driven modelling

Secondary uses driven modelling

Project-driven modelling without reusable clinical

concepts


Embrace diversity

Break the endless strategic cycling between

central „ruthless standardisation‟

unconstrained local variation

Develop methodologies and tools that embrace

both

central standards and local variation

Allow standards to develop

Organically

by diktat (where circumstances are favourable)

in a controlled and cooperative environment


Positively manage diversity Democratise clinical content modelling

Non-proprietary approach, widest natural community

possible

Modelling tools and methodologies must be

Clinically orientated, non-technical, minimise demands on

clinical time

Web 2.0 “social network” applications

Capture content at all organisational levels

Include diverse models

Today‟s outlier may be tomorrow‟s standard

Communicate who is modelling what

Federated approach “Subsidiarity”


Web 2.0/3.0 collaboration

Clinical Knowledge Manager

Web based collaborative archetype/template/termset

reviews

Governed „authoring‟ environment

Community-led „archetype incubator‟

To encourage early, informal collaboration

Communication with clinical/technical stakeholders

Feeds CKM with early drafts

Lightly governed


Clinical modelling capacity I

Core modelling team with clinical informatics

leadership Good understanding of openEHR paradigm and

appropriate use of terminology

Close involvement with international modelling efforts

Web- based collaborative authoring

Formal - CKM

Informal


Clinical Knowledge Manager


Building modelling capacity II

Good 2-way communications + relationships

Vendors (esp. clinical champions/ designers)

Professional clinical bodies

Academic units

Public health and reporting bodies

Ground level clinicians

build informatics expertise

Education and dissemination of skills

Who is doing what?

Who do I contact if I need new content?

Agile response to change request


The risk of losing control…

“Let's look at a laboratory test result for example. Using

the HL7 RIM…. there are at least 7 ways within the

published standards to say the same thing….”

* Care Record

* Clinical Genomics Pedigree

* Clinical Document Architecture

* Clinical Statement

* Common Message Element Types

* Public Health Reporting: Individual Case Safety Report

* Periodic Reporting of Clinical Trials

* Laboratory Results

Keith Boone : http://motorcycleguy.blogspot.com/2009/07/at-rim-of-dam-or-edge-of-precipice.html

http://motorcycleguy.blogspot.com/2009/07/at-rim-of-dam-or-edge-of-precipice.html
















In modern farming terms?

…combine the productivity and efficiency of high yield

„standardised‟ monoculture

… with the necessity of local bio-diversity

A semantic ecology?

Documents

Interoperability: Managing clinical · PDF fileManaging clinical diversity ... Good understanding of openEHR paradigm and ... Web- based collaborative authoring