Handi-HANDI-HOPD Summit Ian McNicoll - 18 Sept 14 Ian London 18 Sept 2014

8/11/2019 Handi-HANDI-HOPD Summit Ian McNicoll - 18 Sept 14 Ian London 18 Sept 2014

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HANDI-HOPD:

Whats in the box?

Software apps to support health and care - Supporting the app paradigm

Creating a community of interest - That's HANDI

www.handi-hopd.orgDr Ian McNicoll

HANDIHealth

openEHR FoundationfreshEHR Clinical Informatics

HANDI-HOPD Planning meeting London Sept 2014
http://www.handihealth.org/http://www.handihealth.org/http://www.handihealth.org/http://www.handihealth.org/http://www.handihealth.org/


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INTRODUCTION

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Ian McNicoll

Clinician

Former Scottish GP

Health informatics

Director openEHR Foundation

freshEHR Clinical Informatics

Ocean Informatics UK

HANDIHealth

NHS Scotland SCIMP

Commercial software developer

GP Accounts


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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 ClinicalContent definitions

Apps developers


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What is an API?

Application Programming interface

allows one application to talk

directly to another. The app world runs on APIs

how Gmail calendar talks to

Apple Calendar

how my Train app knows my

next train home

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What is in an API

Modern API restful requests look like web

page urlhttps://api.twitter.com/1.1/statuses/user_timelin

e.json?screen_name=twitterapi&count=2

and carries some

sort of

structured content

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https://api.twitter.com/1.1/statuses/user_timeline.json?screen_name=twitterapi&count=2https://api.twitter.com/1.1/statuses/user_timeline.json?screen_name=twitterapi&count=2https://api.twitter.com/1.1/statuses/user_timeline.json?screen_name=twitterapi&count=2https://api.twitter.com/1.1/statuses/user_timeline.json?screen_name=twitterapi&count=2


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SMARTPlatforms API

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Scopes and permissions: OAuth2

Simple sign-in: OpenID Connect

Lightweight UI integration: HTML5

via Pluggable app framework


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SMARTPlatforms : Substitutable Apps

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SMART-on-FHIR

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HL7 FHIR

data model

replacing

SMARTPlatform

s

data model(RDF)


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HL7 FHIR API

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What is FHIR good at?

Communication of information between

systems with limited querying

Strengths

Developer friendly

Lightweight approach Great documentation / community

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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

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openEHR API

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Designed for storing and querying

rich clinical dataset

New content is defined directly

by clinicians and can be immediately

uploaded into the clinical data repository

Vendor-neutral data models

Technology-neutral data models

Vendor-neutral data querying

Technology-neutral data querying


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openEHR

Weaknesses

Complex technology

but new simplifying APIs appearing

Strengths

clinically-led data modelling

sharing archetypes= interoperability

Enterprise strength performance Mature versioning/governance

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dev.ehrscape.com

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http://dev.ehrscape.com/http://dev.ehrscape.com/http://dev.ehrscape.com/


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Vendor-neutral querying


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Vendor-neutral querying


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Vendor/technology-neutral platform

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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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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


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Interoperability is not a tech problem

The real barriers to practical interoperability are

cultural and clinical

Diverse recording practice (sometimes arbitrary)

Diverse recording requirements

Complexity / contextual nature of health data

Lack of clinical involvement in standards development

Too technical, too philosophical

Too time-consuming, too slow

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Traditional Standards Process

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Clinical stakeholders

engage through top-down

governance

Committee-based

Late vendor engagement

Fixed review cycles

Unclear / unresponsivechange request

mechanism


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Formal standards process is a barrier

Standards can be a barrier to progress

Ewan Davis, HANDI

http://www.woodcote-consulting.com/farwell-to-ruthless-standardisation/

Technical (ISO / SCCI)

Still largely a paper and committee-bound process

No clear problem report/changerequest mechanism

Slow review cycles

Professional (PRSB)

Valuable clinical requirements input

but distant from implementation

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open, shared data models: Archetypes

Clinically-led + collaboratively authored open-source crowd-sourcing methodology

Shared open repository CC-BY-SA licence

Agility in response to continually changing clinical

demand Clear ownership, change request mechanism

Tight version control

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GP2GP medication archetype


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Web-based clinical review

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FHIR + openEHR joint resource/archetype

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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

governance role


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Evolutionary standardisation

distributed Governance

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Implementers

Secondaryendorsement


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Publication and Secondary Endorsement

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Project editors decide on

formal publication, acting as

Benign Dictators

Professional bodies, vendorsand PRSB may Endorsea

resource as a secondary

exercise

this does not restrain the

formal publication process

By Royal Appointment

PRSB hires and fires Editors


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Blogs

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http://www.woodcote-

consulting.com/farwell-

to-ruthless-

standardisation/

http://coiera.com/201

3/11/01/are-

standards-necessary/ That the fraction of standards

produced that are actually complied with,will with time asymptote toward zero


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Links

twitter: @ianmcnicoll

HANDI-HOPD: handi-hopd.org

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

hopdscape-hopd.rhcloud.com

minimal-hopd.rhcloud.com

Marand Ehrscape API: dev.ehrscape.com

Leeds Innovation Lab Health Platform : http://leedslabplatform.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.uk

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http://handi-hopd.org/http://diy-hopd.rhcloud.com/http://hopdscape-hopd.rhcloud.com/http://leedslabplatform.com/http://www.openehr.org/http://smartplatforms.org/http://www.openehr.org/ckmhttp://www.clinicalmodels.org.uk/http://www.clinicalmodels.org.uk/http://www.clinicalmodels.org.uk/http://www.openehr.org/ckmhttp://smartplatforms.org/http://www.openehr.org/http://leedslabplatform.com/http://hopdscape-hopd.rhcloud.com/http://hopdscape-hopd.rhcloud.com/http://hopdscape-hopd.rhcloud.com/http://diy-hopd.rhcloud.com/http://diy-hopd.rhcloud.com/http://diy-hopd.rhcloud.com/http://handi-hopd.org/http://handi-hopd.org/http://handi-hopd.org/

Handi-HANDI-HOPD Summit Ian McNicoll - 18 Sept 14 Ian London 18 Sept 2014

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