TIME FOR AN OPEN STANDARDS HEALTHCARE

PLATFORM?DR IAN MCNICOLL

CLINICAL MODELLING CONSULTANT, OCEAN INFORMATICS

DIRECTOR, OPENEHR FOUNDATION

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

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’

‘SUBSTITUTABLE’ APPS

‘small and agile’

• Resurgence in SME sector

• Role of Intellect

• Adaptable platforms

• IMS Maxims

• Black Pear Software

• Digital Spark

• MS Healthvault

• ‘Apps’ paradigm

• HANDIHealth

‘open’

• Open data

• Analytics, quality monitoring

• Open APIs / standards

• ITK, GP2GP

• GPSOC-R

• SMARTPlatform, FHIR

• Open source

• openEyes, Wardware

• Leeds Care Record

• Spine2

• “Safer Wards” Fund

‘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

THE ‘HANDI VISION’

Apps

EPREHR PHR

PHR EMRMeds

Repository

Drug KBTerminology

ServerService

DirectoryCDS Service Pathways KB

Services/Repositories

Infrastructural ServicesPDS/Record Discovery EWS ESB/Spine Security

Broker

‘CLOSED’ EHEALTH PLATFORM

Proprietary Clinical Content / API

Proprietary value-add components

Proprietary Querying and Persistence

TerminologyServer Pathways KBESB/Spine

ITK Integration component

‘OPEN SOURCE’ SILOED EHR ‘PLATFORM

Siloed Clinical Content / API

OSS Value-add components

Siloed Querying and Persistence

TerminologyServer Pathways KBESB/Spine

ITK Integration component

MULTIPLE CLOSED SILOS

NHS OPEN STANDARDS PLATFORM

Closed OSS ClosedOSS

Vendor DVendor B Vendor CVendor A

API and messaging content based on open source clinical content definitions

OSS components

Vendor solutions

TerminologyServer Pathways KB

ESB/Spine

ITK Integration component

Commit

Retrieve

OPENEHR DRIVEN STANDARDS PLATFORM

Closed source

Open source

Open source

openEHR CDR

Vendor DVendor B Vendor CVendor A

Open source Archetype-based clinical content information / querying model

OSS Value-add components

Vendor solutions

TerminologyServices Pathways KBESB/Spine

ITK Integration component

Commit

Retrieve

Query

GPSOC - OPENEHR

www.openehr.org

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

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

INDUSTRY/PROFESSION-DRIVEN STANDARDISATION‘OPEN GOVERNANCE’

Clinical Knowledge Administrators

Blood pressure Archetype Editors

Archetype Reviewer

Archetype Reviewer

Opthalmology Project Editors

Visual fields archetype

Visual acuity archetype

Reviewer Reviewer

Publish

Implementation

Secondary endorsement

OPENEYES GLAUCOMA : INITIAL AUTHORING

Gather evidenceFirst draft mindmap

Refine mindmap (inclusive dataset)Create /Upload Initial archetype

OPENEYES GLAUCOMA : IMPLEMENTATION

Template Data Schema

openEHR Repository(vendor #1)

openEHR Repository [10](open source)

OpenEyes(Moorfields)

Orsini

openEHR Repository(vendor #2)

openEHR APIopenEHR API openEHR APIopenEHR API

LocalSQL DB

openEHR APIopenEHR API

Wardware2 (Kings)

Orsini Clinical Content Service [4]

Persistence MgrPersistence Mgr

Industry :VistA, EMIS, TPP, HANDI

…

NHSvistaNHSvista

ESB / ITK / Spine components [2]

ESB / ITK / Spine components [2]

NHSvista Reporting API

[3b]

NHSvista Reporting API

[3b]

NHSvista Care API

[3a]

NHSvista Care API

[3a]

Leeds LCRLeeds LCR

LCR apps(Leeds)

OpenEyes/ openEHR Toolkit

[6]

OpenEyes/ openEHR Toolkit

[6]

openENT(UCLP)

[1] Clinical content

openEHR tech/spec dev. [5]

openEHR tech/spec dev. [5]

openEHR API integration [7]

EHRPaaS [9]

NHS vista- openEHR

Adaptors [8]

Professional RecordsStandards

Board

Professional oversight

LEEDS NHS CARE RECORD: OPEN PLATFORM

openEHR Foundation accreditedOpen Standards CDR Service layer

N3 hosted

ESB/Spine ITK Integration component

Commit

Retrieve

Query

OpenEHR Clinical Content “Archetypes”:

• Medication, allergies (GP2GP/ RCP/NHSS)• Problems, procedures (international)• End of Life content (ISB)• Vital Signs, NEWS (international)

SMARTPlatformsOpen APIs:

Leeds Clinical Portal

Clinicaldata repository

LEEDS INNOVATION LAB: OPEN PLATFORM DEMONSTRATOR

openEHR Foundation accreditedOpen Standards CDR Service layer

N3 hosted

FHIR ITK Integration component

Commit

Retrieve

Query

OpenEHR open source Clinical Content : “Archetypes”:

• Medication, allergies (GP2GP/ RCP/NHSS)• Problems, procedures (international)• End of Life content (ISB)• Vital Signs, NEWS (international)

SMARTPlatformsOpen APIs:

Leeds Clinical Portal

Clinicaldata repository

OPENEHR CLOUD ‘PLATFORM AS A SERVICE’

SQLServer NHS OSS? Postgres

SQLOracle

Code24Ocean openEyesMarand

openEHR Foundation accreditedImplementation-agnostic CDR Service layer

N3 hosted

Value-add components

CDRSolutions

TerminologyServer Pathways KB

ESB/Spine

ITK Integration component

Commit

Retrieve

Query

TIME FOR AN NHS OPEN STANDARDS E-HEALTH 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

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

openEHR Solutions

QUESTIONS