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

Introduction

• Dr Ian McNicoll

• Clinician

• Former Glasgow GP

• Health informatics

• Director HANDIHealth

• Director openEHR

Foundation

• freshEHR Clinical Informatics

• Commercial software developer

• ‘Clinical Hacker’

2

HANDIHealth CIC

• A not-for-profit Community Enterprise

Company

• There to support:

– Developers

– Health and care professionals

– Patients, service users and carers

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

The Holy Grail : eHealth ‘interoperability’

5

http://cyber.law.harvard.edu/research/interoperability

Interop:

Towards an Open Digital 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

An open Ecosystem platform?

Closed OSS Closed OSS

Vendor D Vendor B Vendor C Vendor A

API and messaging content based on open source clinical content definitions

OSS components

Vendor solutions

Terminology Server Pathways KB

ESB/Spine ITK Integration component

Commit

Retrieve

8

SMARTPlatforms

Pluggable Webapp

API

HL7 FHIR

Clinical Content

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

HSPC: SMART on FHIR on Clinical Models

9

SMARTPlatforms API

10

• Scopes and permissions: OAuth2 • Simple sign-in: OpenID Connect

• Lightweight UI integration: HTML5

via Pluggable app framework

SMART-on-FHIR

11

HL7 FHIR

data model

replacing

SMARTPlatform

s

data model

(RDF)

HL7 FHIR API

12

What is FHIR good at?

• Communication of information between

systems with limited querying

• Strengths

• Developer friendly

• Lightweight approach

• Great documentation / community

13

Where might FHIR be 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

openEHR API

15

• Designed for 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

openEHR

• Weaknesses

• Complex technology

• but new simplifying APIs appearing

• Strengths

• clinically-led data modelling

• sharing archetypes = interoperability

• Enterprise strength performance

• Mature versioning/governance

16

‘Code4Health’

18

NHS Code 4 Health

19

MedsRecDIY: http://diy-hopd.rhcloud.com/

20

GWYB: http://gwyb-handihopd.rhcloud.com/

21

Code 4 Health Dental App challenge

22

Rapid connected health app development

23

So what is openEHR?

25

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

Copyright 2012

Ocean

Informatics

What is an ‘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

Data entry definition

28

What exactly 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?

Megasuite Information architecture

29

Application

Information Model

Persistence (Database)

Query

‘Best of Breed’ Information architecture

30

Application

Information Model

Persistence (Database)

Query

Application

Information Model

Persistence (Database)

Query Integration engine

Information Model

Persistence (Database)

App App

‘Closed Platform' Information architecture

31

App

‘open Platform' Information architecture

32

open Information Model

App App App

Oracle MongoDb SqlServer

‘open Platform' Information architecture

• 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

Vendor/technology-neutral information

34

Vendor-neutral querying

openEHR: Multi-level modelling

36

openEHR: Archetypes

• open source 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

openEHR: Templates

• Templates deliver 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

Sharing and collaboration

39

Clinical Information models Factory

40

openEHR in practice: Specifications

41

openEHR in practice: tools and models

42

openEHR in practice: Clinical Data Repositories

43

How is it used: underpins App development

44

How is it used : National standards development

45

openEHR … Needs you !

46

members.openehr.org

47

SMARTPlatforms

Pluggable Webapp

API

HL7 FHIR

Clinical Content

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

Interoperability is not a tech problem

“The real barriers to practical interoperability

are cultural and clinical”

Healthcare records are not just

buckets of biological facts

48

Healthcare Information Standards Process #FAIL

49

Clinical stakeholders

engage through top-down

governance

Committee-based

Late vendor engagement

Fixed review cycles

Unclear / unresponsive

change request

mechanism

Clinically-led Content Service

50

Clinical content

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

Medication ‘archetype’

Web-based ‘democratised’ collaborative review

52

Evolutionary standardisation

‘distributed Governance’

53

Implementers

Secondary

endorsement

54

From model to software…