openEHR sll-2015final

Rong Chen, MD, PhD
openEHR Management Board
Co-lead, openEHR Specification Program
CMIO, Cambio Healthcare Systems
Copyright 2015 openEHR Foundation
Thomas Beale
openEHR Management Board
Co-lead, openEHR Specification Program
CTO, Ocean Informatics

 "eHealth is just healthcare management of
the 21st century. It's not an ICT project.”
◦ Madis Tiik, CEO, Estonian E-Health Foundation
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation

Open or closed?
Retain or cede control?

gov
payers
vendors
provider
institutionssolutions
build
deploy care
SDOs
?
Q:How much influence
does the buyer really have?
A: control points
are usually limited to
Function points, limited
standards conformance

gov
payers
vendors
provider
build
deploy care
SDOs
?
How much influence
Government?

gov
payers
vendors
provider
build
deploy care
SDOs
e-health
programme
?
Technical
requirements
based on?

e-health
programme
gov
payers
vendors
provider
build
deploy care
SDOs
? integrate
PLATFORM
Now procurement
has a means of
requiring
conformance –
a fully defined set
of specifications

Copyright 2015 openEHR
1. Standard
Information model
2. Standard
content
definitions
Service API
B2B Service API
Service API
Service API
B2B Service API B2B Service API
Service API
Service API Service API
Service API
4. Standard
interfaces
3. Open terminologies
5. Semantic Querying
app app
other
system

e-health
programme
gov
payers
vendors
provider
build
deploy care
SDOs
? integrate
PLATFORM
Except the
buyer side has
no means of
influence

e-health
programme
gov
payers
vendor
provider
institutions
build
deploy care
SDOs
?
solution
PLATFORM
And no visibility

 Primarily the Patient data (EHR/CDR)
◦ Want to use as needed, including unplanned uses
◦ Value of data relies on its computability

 And ways of interacting with it
◦ Open application APIs - Enable new apps to be
added at any time in a known way, e.g. care
planning
◦ B2B service interfaces - e.g. lab data, EHR extract to
DW, quality registers
 And open knowledge engineering – develop
microbiology result definition and
terminology subsets…. Once, for the whole
jurisdiction

 Environment with (un-?)controlled cost
characteristic
 Cost characteristic is based on ability to
modify the environment in a relatively fine-
grained way, with the price relating to the
true underlying cost of the component in
question
◦ Add / remove apps
◦ Change / add back-ends
◦ Add / modify connection points
◦ Reprocess data at will

 With monolithic supplier, not only are the
technical details outsourced, so too is the
ability to control costs of incremental change
◦ The cost of a change is what the supplier says it is
 You are now invested in the supplier’s
development path, not your own

 No vendor lock-in
 Free access to, use & reuse of data… forever
 Incremental deployment of components
according to customer timeline
 Direct clinical engagement (ask Norway!)
 Control over costs

 We don’t propose a ‘bag of standards’
 Instead we propose a coherent platform
definition, managed by a single .org entity
◦ That defines many key elements – information
models, content models, guidelines,
◦ And sources others from elsewhere, and integrates
them properly
 IHE.net with openEHR profiles
 IHTSDO, WHO, WONCA, LOINC etc
 HL7 FHIR? CDA?
 OMG RLUS, EIS
 etc

 Most of the semantics come from clinical
models (‘archetypes’ and ‘templates’) and
terminology
 These are built by clinical people (e.g. Norway
MoH / Bergen…) in a crowd-sourced fashion
 They ultimately define data-sets & value-sets
 Which can be used to generate usable
software artefacts
  we no longer wait for some SDO to
produce a standard for ‘discharge summary’

 Non-profit organisation based at UCL
 1300+ Members from 71 countries
 All specifications & schemas publicly available
 Software open source (GPL, LGPL, Apache2)

 Is to define (parts of) a health computing
‘platform’ that addresses these challenges:
◦ Information and workflow complexity
◦ Constantlychanging clinical requirements
◦ A long-lived patient-centric EHR
◦ Enables diverse e-health vendor components and
products to work together

 The clinical domain generates most of the
requirements
◦ And is changing all the time
 We therefore need to model the clinical
domain to do sustainable ICT
◦ Terminology models the ‘facts’
◦ We still need to model the information & workflow
 openEHR enables a model-based tool chain
for building sustainable software solutions

 Nr semantic definitions huge and constantly
growing – O(1E6)
 Nearly all semantic definitions only doable by
domain professionals
◦ Not IT people
 Number of technical expressions substantial
and always changing – O(1E2)
◦ Prog langs, various XSD, JSON, UI, …

 We need to enable domain professionals to
do the semantic modelling directly
◦  special tools and formalisms
 We need to do the models upstream of the
technical representations
◦  requires model  software transform tools
 We need to build systems that accept
generated model artefacts… forever

Copyright 2012 Ocean Informatics
Deployed
system
consumes new
content definitions
... forever
Forms and
messages formally
based on content
models

 The road ahead is a process not a product
 It’s an ecosystem not a monoculture

 http://www.openEHR.org
 http://www.openEHR.org/ckm

openEHR sll-2015final

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