Given at EHI Live 6th Nov 2013 HANDIHealth Presentation Stage.

1. TIME FOR AN OPEN
STANDARDS
HEALTHCARE
PLATFORM?
DR IAN MCNICOLL
CLINICAL MODELLING CONSULTANT, OCEAN INFORMATICS
DIRECTOR, OPENEHR FOUNDATION

2. INTRODUCTION
Dr Ian McNicoll

Former Glasgow GP

Director openEHR Foundation

Health informatics consultancy




Ocean Informatics UK Clinical
Modelling Consultant
NHS Scotland, CfH, GP2GP, RCP
health informatics consultancy
HANDIHealth , BCS PHCSG
Commercial software development

3. TIME FOR ‘OPEN PLATFORMS’?
•
USA
•
•
SMARTPlatforms
UK
•
GP Systems of Choice (GPSOC) refresh
•
Phase 1 GP systems open APIs
•
Phase 2 GP systems Common APIs
•
De-facto ‘open platform’

4. ‘SUBSTITUTABLE’ APPS

5. ‘small and agile’
• Resurgence in SME sector
•
Role of Intellect
•
Adaptable platforms
•
IMS Maxims
•
Black Pear Software
•
Digital Spark
•
MS Healthvault
• ‘Apps’ paradigm
•
HANDIHealth

6. ‘open’
•
Open data
•
•
Analytics, quality monitoring
Open APIs / standards
•
•
GPSOC-R
•
•
ITK, GP2GP
SMARTPlatform, FHIR
Open source
•
openEyes, Wardware
•
Leeds Care Record
•
Spine2
•
“Safer Wards” Fund

7. ‘clinical engagement’
• Formal clinical ownership
•
Joint GP IT Committee (RCGP / BMA)
•
RCP ITU / Professional Records Standards Body
•
UK – increasing 4-countries engagement
• Guerilla activity
•
‘Clinicians who code’, DigiDocs
•
NHS Hackday, openGPSOC
•
DIY
•
Renal PatientView
•
Multiple MS Access/ Excel databases

8. THE ‘HANDI VISION’
Apps
EPR
CDS Service
PHR
Meds
Repository
EHR
Terminology
Server
EMR
PHR
Drug KB
Pathways
KB
Service
Directory
Services/Repositories
PDS/Record Discovery
EWS
ESB/Spine
Infrastructural Services
Security
Broker

9. ‘CLOSED’ EHEALTH PLATFORM
ITK Integration
component
ESB/Spine
Terminology
Server
Pathways
KB
Proprietary
value-add
components
Proprietary Clinical Content / API
Proprietary Querying and Persistence

10. ‘OPEN SOURCE’ SILOED EHR ‘PLATFORM
ITK Integration
component
ESB/Spine
Terminology
Server
Pathways
KB
OSS Value-add
components
Siloed Clinical Content / API
Siloed Querying and Persistence

11. MULTIPLE CLOSED SILOS

12. NHS OPEN STANDARDS PLATFORM
ITK Integration
component
ESB/Spine
OSS
components
API and messaging content based on
open source clinical content definitions
Terminology
Server
Pathways
KB
Commit
Retrieve
OSS
Closed
OSS
Closed
Vendor A
Vendor B
Vendor C
Vendor D
Vendor
solutions

13. OPENEHR DRIVEN STANDARDS PLATFORM
ITK Integration
component
ESB/Spine
OSS Value-add
components
Terminology
Services
Open source Archetype-based clinical
content information / querying model
Pathways
KB
Commit
Retrieve
Query
openEHR
CDR
Closed
source
Open
source
Open
source
Vendor A
Vendor B
Vendor C
Vendor D
Vendor
solutions

14. GPSOC - OPENEHR
www.openehr.org

15. INTEROPERABILITY IS NOT A TECH
PROBLEM
• Interoperability is a clinical problem
•
Diverse recording practice (sometimes arbitrary)
•
Diverse recording requirements
•
Complexity / contextual nature of health data
•
Lack of clinical involvement in standards development
•
Too technical, too philosophical
•
Too time-consuming, too slow

16. OPENEHR ARCHETYPES:
OPEN SOURCE CLINICAL INFORMATION
COMPONENTS
• Clinically-led + collaboratively authored
•
open-source ‘crowd-sourcing’ methodology
•
democratised clinical content development
•
Shared open repository CC-BY-SA licence
• Agility to respond to continually changing clinical demand
•
Clear ownership, change request mechanism
•
Tight version control

17. INDUSTRY/PROFESSION-DRIVEN
STANDARDISATION
‘OPEN GOVERNANCE’
Implementation
Clinical
Knowledge
Administrators
Blood pressure
Archetype
Editors
Secondary
endorsement
Opthalmology
Project Editors
Archetype
Reviewer
Visual fields
archetype
Archetype
Reviewer
Visual acuity
archetype
Reviewer
Review

18. OPENEYES GLAUCOMA : INITIAL
AUTHORING
Gather evidence
First draft mindmap
Refine mindmap (inclusive dataset)
Create /Upload Initial archetype

19. OPENEYES GLAUCOMA : IMPLEMENTATION
Template Data
Schema

20. Professional oversight
[1] Clinical content
LCR apps
(Leeds)
NHSvista
Care API
[3a]
openENT
(UCLP)
Wardware2
(Kings)
OpenEyes
(Moorfields)
NHSvista
Reporting API
[3b]
ESB / ITK / Spine components
[2]
NHS vistaopenEHR
Adaptors [8]
openEHR API integration [7]
Local
SQL DB
EHRPaaS [9]
openEHR API
openEHR API
openEHR
Repository
(vendor #1)
openEHR
Repository
(vendor #2)
openEHR API
openEHR
Repository [10]
(open source)

21. LEEDS NHS CARE RECORD: OPEN PLATFORM
OpenEHR Clinical Content “Archetypes”:
•
•
•
•
Medication, allergies (GP2GP/ RCP/NHSS)
Problems, procedures (international)
End of Life content (ISB)
Vital Signs, NEWS (international)
Open
APIs:
ESB/Spine
ITK Integration
component
openEHR Foundation accredited
Open Standards CDR Service layer
SMARTPlatforms
Commit
Retrieve
Query
Leeds Clinical Portal
N3
hosted
Clinical
data repository

22. LEEDS INNOVATION LAB: OPEN PLATFORM
DEMONSTRATOR
OpenEHR open source Clinical Content : “Archetypes”:
•
•
•
•
Medication, allergies (GP2GP/ RCP/NHSS)
Problems, procedures (international)
End of Life content (ISB)
Vital Signs, NEWS (international)
Open
APIs:
FHIR
ITK Integration
component
openEHR Foundation accredited
Open Standards CDR Service layer
SMARTPlatforms
Commit
Retrieve
Query
Leeds Clinical Portal
N3
hosted
Clinical
data repository

23. OPENEHR CLOUD ‘PLATFORM AS A
SERVICE’
ITK Integration
component
N3
hosted
ESB/Spine
Value-add
components
openEHR Foundation accredited
Terminology
Server
Pathways
KB
Commit
Retrieve
Implementation-agnostic CDR Service layer
Query
Oracle
Marand
SQL
Server
Ocean
NHS OSS?
Postgres
SQL
openEyes
Code24
CDR
Solutions

24. TIME FOR AN NHS OPEN STANDARDS EHEALTH PLATFORM?
• Provide commoditised eHealth application services
•
persistence/querying/audit/ connectivity
•
Can handle rich, complex clinical information
•
Vendor/technology stack neutral
•
Add-on common services
•
ITK, N3, Spine , APIs
•
DSS, terminology services
• EHR PaaS model
•
Platform as a Service
•
Cloud-based ‘pay as you go’
•
Choice of provider
•
Solves the ‘MSAccess’ problem

25. LINKS
• twitter: @ianmcnicoll
• Leeds Health Innovation Lab : www.leedsinnovation.com
• openEHR Foundation : www.openehr.org
• International archetype repository: www.openehr.org/ckm
• UK archetype repository: www.clinicalmodels.org.uk

26. openEHR Solutions