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

IntroductionDr Ian McNicoll

Clinician

Former Scottish GP

Health informatician

Co-chair openEHR Foundation

freshEHR Clinical Informatics/ Operon Systems Ltd.

Commercial software developer

‘Clinical hacker’

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.

InteroperabilityExchange 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

open sourceSoftware (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

open source in health UKCommission open source infrastructure

Spine 2 eReferrals

Promote open source adoption NHS England Open Source Programme Code4Health Apperta Foundation

open source UK - successSuccess stories

openMaxims open-eOBS openEyes (eventually) openEP (coming soon)

RippleOSI inc. St James’s Hospital, Dublin

open source - barrierseHealth 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

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

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

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

Why do systems not talk to each other?

Why do systems not talk to each other?

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

Health record- the scienceWhat 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,

health record - the practiceWhat 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

information models - powering the web

information models - powering the web

Best of breed integration

Best of breed integration

Best of breed integration

Best of breed integration

Best of breed integration

Clinical dysoperability

Clinical dysoperability

Clinical dysoperability

The rise of the platformhttps://

www.datstat.com/2016/08/digital-

health/apps-platform-innovation

Closed platform

Closed platform

Closed platform

Closed platform

Closed platform

clinician-led,open platform

clinician-led,open platform

clinician-led,open platform

clinician-led,open platform

clinician-led,open platform

clinician-led,open platform

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

open source, shared, clinically-led information content definitions

SMARTPlatformsPluggable Webapp

API

HL7 FHIR Clinical Content Exchange

NHS API

Clinical Data Repository

(CDR)

Detailed Clinical Content

Development

Clinical leadership PRSB

Terminology CentreHSCIC

NonopenEHR systems

Archetype+ SNOMED Clinical Content definitions

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

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

Thank you