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Digital assembly Cardiff HANDI-HOPD workshop
1) The document discusses a workshop on digital health interoperability standards hosted by Dr. Ian McNicoll and organizations like HANDIHealth and openEHR. 2) It covers challenges with interoperability and different approaches like closed platforms, best of breed systems, and open ecosystems. 3) openEHR is presented as a solution, with its multi-level modeling approach defining clinical information and templates independently of technologies to enable interoperable app development and national standards.
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Digital assembly Cardiff HANDI-HOPD workshop
- 1. Digital Health Assembly: HOPD/ openEHR workshop www.handihealth.org Dr Ian McNicoll ian@freshehr.com ian@handihealth.org HANDIHealth openEHR Foundation freshEHR Clinical Informatics Digital Health Assembly Cardiff Feb 2015
- 2. Introduction • Dr IanMcNicoll • Clinician • Former Glasgow GP • Health informatics • Director HANDIHealth • Director openEHR Foundation • freshEHR Clinical Informatics • Commercial software developer • ‘Clinical Hacker’ 2
- 3. HANDIHealth CIC • Anot-for-profit Community Enterprise Company • There to support: – Developers – Health and care professionals – Patients, service users and carers
- 4. HANDI is agnostic •About – Platforms – Business models – Standards – Tools, services and approaches • Show the community the possibilities and let individuals decide • Lobby for an environment (technical, cultural and commercial) in which apps can flourish interoperate and be orchestrated
- 5. The Holy Grail: eHealth ‘interoperability’ 5 http://cyber.law.harvard.edu/research/interoperability
- 6. Interop: Towards an OpenDigital Care Ecosystem Megasuite Best of Breed Platform Open Ecosystem “One system to rule them all” • NPfIT • Enterprise/GP Systems • Limited external integrations Many systems ~ 100 • Portals • Integration engines • Bespoke integrations “Own the Platform” • Health Vault, Apple, Lorenzo, etc • ~1000 apps • Partner interfaces (Woodcote L3) The “Internet “of Digital Health • HANDI-HOPD • The Healthcare Services Platform Consortium
- 7. An open Ecosystemplatform? Closed OSS ClosedOSS Vendor DVendor B Vendor CVendor A API and messaging content based on open source clinical content definitions OSS components Vendor solutions Terminology Server Pathways KB ESB/SpineITK Integration component Commit Retrieve
- 8. 8 SMARTPlatforms Pluggable Webapp API HL7 FHIR ClinicalContent Exchange NHS API ‘inVivo’ Datastore API Detailed Clinical Content Development Clinical leadership PRSB Terminology Centre HSCIC Non openEHR systems Archetype+ SNOMED Clinical Content definitions Apps developers
- 9. HSPC: SMART onFHIR on Clinical Models 9
- 10. SMARTPlatforms API 10 • Scopesand permissions: OAuth2 • Simple sign-in: OpenID Connect • Lightweight UI integration: HTML5 via Pluggable app framework
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- 13. What is FHIRgood at? • Communication of information between systems with limited querying • Strengths • Developer friendly • Lightweight approach • Great documentation / community 13
- 14. Where might FHIRbe weaker? • Not designed for persistence • can work but will it scale? • partial querying only • Resources will not work ‘out of the box’ in the real world • Need local extensions and profiles • Version control / governance of the profiles 14
- 15. openEHR API 15 • Designedfor storing and querying rich clinical dataset • New content is defined directly by clinicians and can be immediately uploaded into the clinical data repository • Vendor-neutral data models Technology-neutral data models • Vendor-neutral data querying Technology-neutral data querying
- 16. openEHR • Weaknesses • Complextechnology • but new simplifying APIs appearing • Strengths • clinically-led data modelling • sharing archetypes = interoperability • Enterprise strength performance • Mature versioning/governance 16
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- 18. NHS Code 4Health 19
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- 21. Code 4 HealthDental App challenge 22
- 22. Rapid connected healthapp development 23
- 23. So what isopenEHR? 25
- 24. What IS openEHR? •NOT a downloadable ‘open source’ application • e.g. openEMR , openMRS • an open Specification for an EHR or EHR platform • Defines an technology-neutral/ vendor- neutral ‘information model’ 26
- 25. Copyright 2012 Ocean What isan ‘information model’? • Any definition of the structure and content of information that should be collected or shared, including terminology • A simple paper form - check boxes or Y/N questions • A ‘minimal dataset’ • A message or API definition • Internally every program or application has some kind of information model • Sharing information requires developing shared information models 27
- 26. Data entry definition 28 Whatexactly do you mean by record pulse and blood pressure? What are reasonable min/max limits to put on a temperature record? What are the allowable sizes of pupils in a drop- down box?
- 27. Megasuite Information architecture 29 Application InformationModel Persistence (Database) Query
- 28. ‘Best of Breed’Information architecture 30 Application Information Model Persistence (Database) Query Application Information Model Persistence (Database) Query Integration engine
- 29. Information Model Persistence (Database) AppApp ‘ClosedPlatform' Information architecture 31 App
- 30. ‘open Platform' Informationarchitecture 32 open Information Model AppApp App Oracle MongoDbSqlServer
- 31. ‘open Platform' Informationarchitecture • Technology and Vendor neutral • Define information structures independent of application layer • Rich enough to support eHealth apps • Handle audit/versioning • Define information structures independent of persistence layer • rapid incorporation of new datasets • vendor/tech neutral querying 33
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- 35. openEHR: Archetypes • opensource computable models of discrete clinical concepts • Familiar components of a health record • Blood pressure, Body weight, Symptom • Medication order, Family history • Urea, Creatinine results • ‘Maximal dataset’ • Capture as many clinical perspectives as possible • Universal use case 37
- 36. openEHR: Templates • Templatesdeliver the datasets by aggregating archetypes together • Key clinical endpoint and starting point for generation of technical artefacts • i.e. openEHR archetypes and templates can be used directly • Class libraries • GUI skeletons • Message schema • Define API Profiles 38
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- 38. Clinical Information modelsFactory 40
- 39. openEHR in practice:Specifications 41
- 40. openEHR in practice:tools and models 42
- 41. openEHR in practice:Clinical Data Repositories 43
- 42. How is itused: underpins App development 44
- 43. How is itused : National standards development 45
- 44. openEHR … Needsyou ! 46 members.openehr.org
- 45. 47 SMARTPlatforms Pluggable Webapp API HL7 FHIR ClinicalContent Exchange NHS API ‘inVivo’ Datastore API Detailed Clinical Content Development Clinical leadership PRSB Terminology Centre HSCIC Non openEHR systems Archetype+ SNOMED Clinical Content definitions Apps developers
- 46. Interoperability is nota tech problem “The real barriers to practical interoperability are cultural and clinical” Healthcare records are not just buckets of biological facts 48
- 47. Healthcare Information StandardsProcess #FAIL 49 Clinical stakeholders engage through top-down governance Committee-based Late vendor engagement Fixed review cycles Unclear / unresponsive change request mechanism
- 48. Clinically-led Content Service 50 Clinicalcontent service Clinical stakeholders, vendors engage directly with clinically-led content service Continual dialogue with all stakeholders via web-based collaborative tooling No fixed review cycles On-demand change request directly to clinical content service PRSB has high-level 4- country governance role
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- 53. From model tosoftware…