1 6 managing healthcare diversity
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The document discusses challenges with achieving interoperability in healthcare systems. It notes that interoperability is difficult to achieve due to clinical ego, vendor lock-in, and differences in how information is structured between organizations. The document advocates for a more open and collaborative approach to developing clinical standards that involves stakeholders from all levels and allows for diverse models to be captured and incorporated over time through consensus building. This evolutionary approach could help address interoperability challenges by democratizing how clinical content is modeled to reflect real-world practice.
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1 6 managing healthcare diversity
- 1. Dr Ian McNicoll Interoperability: managing healthcare diversity
- 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. 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. Traditional clinical standards development
- 5. Traditional clinical standards development
- 6. Traditional clinical standards development
- 7. Traditional clinical standards development
- 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
- 10. Copyright 2012 Ocean Informatics The maximum dataset: e-Cardiology record Tertiary Centre Regional Hospital A Regional Hospital B eCardiology RecordDiagnosis BP ECG
- 11. Building consensus Diagnosis BP ECG Regional Hospital A Regional Hospital B Tertiary Centre eCardiology Record
- 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. 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. 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. 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. 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. 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
- 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. 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. 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. 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?