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1 6 managing healthcare diversity

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This presentation provides an insight in to the challenges of managing healthcare diversity.

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1 6 managing healthcare diversity

  1. 1. Dr Ian McNicoll Interoperability: managing healthcare diversity
  2. 2. Why is interoperability so hard? 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 Financial, Legal, Project timescales
  3. 3. interoperability “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.” SemanticHealth EU report
  4. 4. Traditional clinical standards development
  5. 5. Traditional clinical standards development
  6. 6. Traditional clinical standards development
  7. 7. Traditional clinical standards development
  8. 8. 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 a
  9. 9. ‘multiple non-coterminosity’ HB A&C HB GGHBClydebank PCT HB HB
  10. 10. Copyright 2012 Ocean Informatics The maximum dataset: e-Cardiology record Tertiary Centre Regional Hospital A Regional Hospital B eCardiology RecordDiagnosis BP ECG
  11. 11. Building consensus Diagnosis BP ECG Regional Hospital A Regional Hospital B Tertiary Centre eCardiology Record
  12. 12. Building consensus Diagnosis BP ECG 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
  13. 13. Building consensus Diagnosis BP ECG 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
  14. 14. Building consensus Diagnosis BP ECG 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
  15. 15. Building consensus Diagnosis BP ECG 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
  16. 16. Building consensus Diagnosis BP ECG Regional Hospital A Regional Hospital B Tertiary Centre eCardiology Record eCARDIOLOGY TEMPLATE Diagnosis Date of Diagnosis Date Recorded BP Systolic Diastolic Position Cuff Size ECG Automated report Heart rate PR interval QRS interval
  17. 17. Positively manage diversity Democratise clinical content modelling widest natural community possible Web 2.0 “social network” applications Capture content at all organisational levels Include diverse models Today’s outlier may be tomorrow’s standard
  18. 18. Evolutionary standardisation
 ‘distributed Governance’ Implementers Secondary endorsement
  19. 19. Evolutionary standardisation
 ‘distributed Governance’ Implementers Secondary endorsement
  20. 20. Publication and Secondary Endorsement Project editors decide on formal publication, acting as “Benign Dictators”
 Professional bodies, vendors and PRSB may Endorse a resource as a secondary exercise
 this does not restrain the formal publication process “By Royal Appointment” PRSB hires and fires Editors
  21. 21. Publication and Secondary Endorsement Project editors decide on formal publication, acting as “Benign Dictators”
 Professional bodies, vendors and PRSB may Endorse a resource as a secondary exercise
 this does not restrain the formal publication process “By Royal Appointment” PRSB hires and fires Editors
  22. 22. Clinical modelling core 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 tooling - ‘CKM’ Informal tooling - Wiki, GitHub
  23. 23. Building modelling capacity Vendors (esp. clinical champions/ designers) Professional clinical bodies Academic units Public health and reporting bodies Ground level clinicians build informatics expertise Agile change request mechanism Who do I contact if I need new content?
  24. 24. Clinical Knowledge Manager

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