Is interoperability in Health IT actually impossible?

1. Ian McNicoll
Past Co-chair openEHR International
CCIO freshEHR
INTEROPen Board Member
Interoperability in health is
impossible .. Discuss …

2. Ian McNicoll
Clinician
Clydebank GP for 15 years
Health informatician
Past Co-chair openEHR International
Founding Fellow FCI
Hon. research associate, UCL
INTEROpen (UK)
Commercial
CEO, freshEHR Ltd.
CCIO, inidus Ltd.

3. The ‘day job’ - building health and care
records systems

4. What is openEHR?
An open specification for a health
‘information model’
capable of supporting an open
platform ecosystem
vendor neutral
technology neutral
licensed to allow open and closed
source business models
Non-Profit ‘industry / clinical/ health
organisation’ collaborative
openEHR International/ openEHR
Foundation
openehr.org
http://members.openehr.org/

5. FCI - Mentimeter survey
What is your priority for eHealth in coming years?
Interoperability

6. “My ‘system’ will not talk to your ‘system’”
User interface
Information model
Database

7. “Interop in health is impossible”
20+ year promise that
‘interoperability’ will solve the
challenges of eHealth
“The only sector where
interoperability might be
impossible is electronic health
records”
https://youtu.be/jnNjemROFgs?t=
2932

8. Mismatched clinical information models

9. How ‘systems’ work now…

11. What we actually need?
Multiple best-of-breed applications
but as tightly integrated as if they
were a single application
Coherent information
minimise mappings
No ‘single system’ or vendor
empower small vendors by doing
much of the heavy lifting
No technology lock-in
Where’s your Blackberry now?

12. What if …
Interoperability is the answer to
the wrong question?
Can we build healthIT systems
to minimise the need for
interoperability?
What if we bake-in ‘data fluidity’
into the ecosystem?
and build more cost-effectively?

13. One ‘system’, multiple apps

14. ‘Standards’ do not deliver standardisation
HL7 FHIR/ openEHR
need local profiles
/extensions
SNOMED CT
need local termsets/
extensions
PRSB
Not an Information
standard
Guidance akin to NICE
High-level requirements

16. Is the ‘primacy’ of the ‘GP system’ over?
What are we prepared to give up
as a ‘source-of-truth’?
DNACPR preferences?
Organ donation?
Housing assessment?
Communal Allergies list?
Communal Vaccination record?
GP/Community prescribing
Communal Problem list

17. Coherent Citizen-oriented services
https://wardle.org/strategy/2019/09/22/health-technology.html

18. Making records that work for all of us
From ‘my system’ to a citizen-centric
information system
separate data/rules from applications
co-production with ‘citizen as
professional’
single source-of-truth where that makes
sense
open platforms / vendor & tech-neutral
information standards which minimise the
need for interoperability ‘Baked in data
fluidity’
standardisation by negotiation not by
science, clinically-driven

19. https://inidus.com/openehr/