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

The Holy Grail : eHealth ‘interoperability’

http://cyber.law.harvard.edu/research/interoperability

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

HSPC: SMART on FHIR on Clinical Models

SMARTPlatforms API

• Scopes and permissions: OAuth2

• Simple sign-in: OpenID Connect

• Lightweight UI integration: HTML5 via Pluggable app framework

SMART-on-FHIR

HL7 FHIR data model

replacing

SMARTPlatforms

data model (RDF)

HL7 FHIR API

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

‘Code4Health’

NHS Code 4 Health

MedsRecDIY: http://diy-hopd.rhcloud.com/

GWYB: http://gwyb-handihopd.rhcloud.com/

Code 4 Health Dental App challenge

Rapid connected health app development

So what is openEHR?

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?

Megasuite Information architecture

Application

Information Model

Persistence (Database)

Query

‘Best of Breed’ Information architecture

Application

Information Model

Persistence (Database)

Query

Application

Information Model

Persistence (Database)

QueryIntegration engine

Information Model

Persistence (Database)

AppApp

‘Closed Platform' Information architecture

App

‘open Platform' Information architecture

open Information Model

AppApp App

Oracle MongoDbSqlServer

‘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

Vendor/technology-neutral information

Vendor-neutral querying

openEHR: Multi-level modelling

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

Sharing and collaboration

Clinical Information models Factory

openEHR in practice: Specifications

openEHR in practice: tools and models

openEHR in practice: Clinical Data Repositories

How is it used: underpins App development

How is it used : National standards development

openEHR … Needs you !

members.openehr.org

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

Medication ‘archetype’

Web-based ‘democratised’ collaborative review

Evolutionary standardisation‘distributed Governance’

Implementers

Secondary endorsement

From model to software…