This is the introduction to a panel in the first eStandards conference aiming to bring together with Hospital CIOs, actors in the healthcare system: representative of payers, healthprofessionals to get a sense of the issues with interoperability in largescale eHealth deployment. Here Prof. Dipak Kalra provides the perspective of a health professional

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eStandards @ ConHIT
Next steps for standardisation in health information
sharing
Clinician viewpoint
Prof Dr Dipak Kalra
EuroRec

2. Dipak Kalra
• GP for 12 years
• deprived part of east London
• high ethnic mix, many refugees and migrant workers
• Health informatics (EHRs) 23 years
• clinical requirements, patient requirements
• information models, clinical models, standards development
• privacy protection and access controls, consent
• reuse of EHRs for research and learning health systems
• increasingly: the socio-technical and business models needed to scale
up interoperability
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3. What connectivity and computability
are clinicians impatient for?
• Connectivity: shared care (co-morbidity), safety (medication list!,
allergies!), including patient and family
• Smartness: overviews and trends (heart failure), risk stratification
(heparin), prescribing DS (inc OTC), care pathway steps (escalation),
referral DS (FH breast cancer), workflow support (team orchestration),
(not form filling)
• Learning: clinical audit, care pathway optimisation, outcomes
optimisation, avoidance of safety issues (pharmacovigilance), support with
research (own, multi-centre, cross-border, sponsored clinical trials)
• Cross border shared care - not only EU - reflecting the population of
modern cities
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4. What gaps do clinicians find in standards?
• Still an over-focus on engineering and technical matters (of little interest
to us)
• Semantic standards (clinical models and term lists) - multi-professionally
driven, involve the patient
• Guideline and DS rules that can be applied equally across systems and
settings
• Quality metrics that truly reflect outcomes oriented care (not the crude
benchmarks of today, which have multi-factorial determinants)
• Access policies that can truly scale across care settings and borders
• Connectivity with personal health records and systems
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5. The clinicians wish-list to eStandards,
and to decision makers
• Standards and nomenclatures should not impose an unreal precision on the
interpretation of clinical statements
• Applications and medical terminologies must reflect the words and phrases of the
clinicians, and the patients
• We collect too much irrelevant data: involve clinicians in defining what data are
really needed to support decision making
• Provide benefits to clinicians from good documentation such as contextual advisory
systems, support learning health systems including research
• Procurement contracts for health ICT services need to prioritise interoperability, to
stimulate industry adoption of standards and profiles
• Health ministries, insurers and commissioners should promote contracts endorsing
person centred care, i.e. requiring healthcare providers to collaborate, to co-ordinate
care and to engage patients
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