This document discusses the challenge of interoperability between health systems and the role open source can play in addressing this challenge. It notes that open source software and specifications allow systems to avoid vendor lock-in, but that open source applications alone do not ensure interoperability unless everyone uses the same system. It argues that the strength of open source lies in open infrastructure components, not just applications. An open platform based on common open standards and information models could substantially accelerate app development and lower barriers to the market while avoiding lock-in.

1. Dr Ian McNicoll
Co-chair openEHR Foundation
freshEHR Clinical Informatics Ltd.
Operon Systems Ltd.
The challenge of interoperability
and the role of open source.
eHealth Summit Dublin Sept 2016

2. Introduction
Dr Ian McNicoll
Clinician
Former Scottish GP
Health informatician
Co-chair openEHR Foundation
freshEHR Clinical Informatics/ Operon
Systems Ltd.
Commercial software developer
‘Clinical hacker’

3. The brief …
The challenge of interoperability:
How public health players can create a
new landscape for interoperability by
leveraging a system built on open
source.

4. Interoperability
Exchange of structured, coded
actionable information between
different applications
’Semantic interoperability’
a grand plan of logics, linguistics and
philosophy
‘Evolutionary interoperability’
wrangling enough computable
meaning out of a horrible mess to
make useful progress
Innovation <> standardisation

5. open source
Software (or specifications)
whose licence allows it to be
used without fees
but someone ‘pays’ to build
and support it
Either
D-I-Y
service agreement
Not necessarily cheaper than
licence fees
but avoids vendor lock-in

6. open source in health UK
Commission open source
infrastructure
Spine 2
eReferrals
Promote open source adoption
NHS England Open Source
Programme
Code4Health
Apperta Foundation

7. open source UK - success
Success stories
openMaxims
open-eOBS
openEyes (eventually)
openEP (coming soon)
RippleOSI
inc. St James’s Hospital,
Dublin

8. open source - barriers
eHealth market is very difficult
Doubly so if you adopt an open-
source business model
Few international commercial
success stories
Purchasing authorities risk-averse
Anxieties about support /security
Reluctance to work collaboratively
with other potential funders
or are expecting ‘free’ software

9. How do open source applications help
interoperability?
They don’t!!
well only a bit …
unless everyone uses the same
system
we tried that in the UK
…. didn’t go so well
The information is still largely
locked into
one set of siloed software
one siloed technology

10. open source - build the infrastructure
Strength of open source lies
largely in licence-free
components not apps
a powerful evolutionary,
distributed eco-system
the methodology is the critical
innovation

11. A manifesto for eHealth standards?
health care standards must be
open source and free
adopt open-source
methodologies
rapid, agile lifecycle
development
change request mechanisms
Embrace complexity

12. Why do systems not talk to each other?

13. Why do systems not talk to each other?

14. the ‘information model’
Is used to manipulate
information in the computer’s
memory
Often written in a specific
program language
Generally locked-in to each
application
Not easily shareable

15. Health record- the science
What do we know about
‘blood pressure’?
if consistently raised, leads to
significant health problems
a measure of systemic arterial
pressure
which is a measure of vascular
pressure
other ‘blood pressures’ are
available … THE ONTOLOGY OF BLOOD PRESSURE: A CASE STUDY IN
CREATING ONTOLOGICAL PARTITIONS IN BIOMEDICINE
A. KUMARa
, B. SMITHb,

16. health record - the practice
What do we know about
Ian’s blood pressure?
156/94 at 09:54 on 1st
Sept 2016
we had to use a smaller
cuff
and it was in a GP
surgery
but he rushed to get here
How, why, where, when is as
important as the physiology

17. information models - powering the web

18. information models - powering the web

19. Best of breed integration

20. Best of breed integration

21. Best of breed integration

22. Best of breed integration

23. Best of breed integration

24. Clinical dysoperability

25. Clinical dysoperability

26. Clinical dysoperability

27. The rise of the platform
https://
www.datstat.com/
2016/08/digital-
health/apps-
platform-
innovation

28. Closed platform

29. Closed platform

30. Closed platform

31. Closed platform

32. Closed platform

33. clinician-led,open platform

34. clinician-led,open platform

35. clinician-led,open platform

36. clinician-led,open platform

37. clinician-led,open platform

38. clinician-led,open platform

39. 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
openehr.org

40. open source, shared, clinically-led
information content definitions

41. SMARTPlatforms
Pluggable Webapp
API
HL7 FHIR
Clinical Content Exchange
NHS API
Clinical Data
Repository
(CDR)
Detailed
Clinical Content
Development
Clinical leadership PRSB
Terminology
Centre
HSCIC
Non
openEHR
systems
Archetype+ SNOMED Clinical
Content definitions

42. open source … a mixed economy
open source applications in health
are a good thing
but not easy to make work
commercially
do not enhance interoperability
open source infrastructure /
methodology can make a significant
difference
A mixed business model economy
with open source applied where
‘commons’ makes a real difference

43. consider the ‘open platform’
must be based on a common, open
information model
open specifications
open source clinical content definitions
other parts of the ecosystem need not
be open source
critical infrastructure for new app
developers
substantially faster development
much lower barriers to market
no vendor / technology lock-in

44. Thank you