Thomas Beale CTO, Ocean Informatics Copyright 2012 Ocean Informatics Tromso 27 May 2014.

Copyright 2012 Ocean Informatics

ADL/AOM 1.5 – A JOURNEY OF PAIN AND

ENLIGHTENMENT- PART 1

Thomas BealeCTO, Ocean Informatics

Tromso 27 May 2014


Some history

Good European Health Record: requirements and EHR architecture1992

2004

Synapses:FHR and Clinical Object Dictionary

SynEx: middleware component architecture

Medicate: remote asthma monitoring and alerts

6WINIT: wireless IPv6

EHCR SupA:revised requirements and architecture Good Electronic Health Record

mNET: wireless demonstrator

GPGC projects (1) EHR kernel services

(2) legacy data transformation(3) diabetes extraction and

merge

Formal Archetype approach

Release 1Feb 2006Release 1.0.115 Apr 2007

ADL -> CEN, ISO, 2008

The openEHR Foundation

Non-profit organisation based at UCLEstablished by UCL and Ocean Informatics

in 2000 to own the IPConverted to a NFP owned by UCL

800+ Members from 71 countriesAll specifications & schemas publicly

availableSoftware open source (GPL, LGPL, MPL)

Now Apache 2.0Archetypes – CC-BY-SA

History of openEHR so far

Sep 2001 Specification development starts Feb 2003 Formal Change Request system

◦ …196 CRs…initial schemas, implementations 10 Feb 2006 Release 1.0 2007 Release 1.0.1 2008 Release 1.0.2 2008 ADL spec ISO 13606-2 … a lot of implementation 2014

◦ ~8 commercial vendors◦ CKMs in 5 countries + openEHR.org/ckm



Who to blame …


Strategic Considerations


Platform-based consortia starting to appear◦ Open health-services platform consortium

Harris, Intermountain, Cerner, VA,… http://healthcaresoa.org/

◦ CommonWell Alliance Allscripts, Cerner, Athenahealth, …

App-oriented standards / specifications◦ HL7 FHIR◦ Harvard SMART

Large turnkey procurements still occurring, e.g. Denmark

1. Key market trends

http://healthcaresoa.org/

http://healthcaresoa.org/


http://tbkconsultblog.com/2014/01/08/why-the-e135m-deal-went-to-epicnnit/




FHIR is the new hype◦ FHIR evangelists say that CDA is dead in 2 years◦ But where is the ‘EHR’ in FHIR?

IHTSDO◦ SNOMED being re-oriented; ontological

underpinning being added◦ Agreement with LOINC◦ ICD11 mapping

CIMI – clinical models

2. The standards space today


openEHR.org◦ 10 years early!◦ The only platform today with a solid information

model and system for content definition and terminology binding

◦ ADL 1.5 chosen by CIMI◦ Tenders now starting to include openEHR◦ 6 countries with CKMs (including Norway)

2. The standards space today


These things no longer owned by 1 company:◦ Public platform definition - ???◦ Public terminology definition – IHTSDO, WHO, …◦ Public content definition - archetypes

How procurement can work◦ Control points are now with procurement, if they

want them◦ If industry wants to be an active player, it needs to

help build platform specifications What’s missing: a common forum for

platform definition

3. The new world


The economic picture

specify

mandate

implement

procure

deploy

support

develop

procure

deployP

LA

TF

OR

MA

PP

S

SDOs, de facto

NHS, MoH

industry

provider org

provider org

industry

app developers

provider org

provider org

con

fid

ence

Rep

rese

nta

tio

n o

f d

om

ain

nee

ds

openEHRcommunity


Platform ecosystem - user

Apps

EPR

EHR PHRPHR EMR

Meds Repository

Drug KB

Terminology

Server

ServiceDirectory

CDS Service

Pathways KB

Services/Repositories

Infrastructural ServicesPDS/Record Discovery

EWS ESB/SpineSecurit

y Broker


Platform ecosystem - technical

Apps

EPR

EHR PHRPHR EMR

Meds Repository

Drug KB

Terminology

Server

ServiceDirectory

CDS Service

Pathways KB


Infrastructural ServicesPDS/Record Discovery

EWS ESB/SpineSecurit

y Broker


Platform ecosystem - economic

App

dev 1

App

dev 2

App

dev 5

Apps

Company A Company

B Company D

Company E

Company F

Company C

Company H

Open source C

Company A

Company D

Company A


Infrastructural ServicesOpen source A

Company B

Company ECompan

y M


Buyer

Platform ecosystem - buyer

App

dev 1

App

dev 2

App

dev 5

Apps

Company A Company

B Company D

Company E

Company F

Company C

Company H

Open source C

Company A

Company D

Company A


Infrastructural ServicesOpen source A

Company B

Company ECompan

y M


What is an open Platform?


Simple definition…

Implementation

Interface

Proc (arg1: INFO_TYPE, ….)

Func (arg1: String, arg2: Uid): INFO_TYPE1. Service Interface

2. Information

model

3. Semantic models

ARCHETYPETERMINOLOGY

GUIDELINE


Layers


Simple definition…

Implementation

Interface

Implementation

Interface

Implementation

Interface

Implementation

Interface

Implementation

Interface

Implementation

Interface

Implementation

Interface

Implementation

Interface

Implementation

Interface

Implementation

Interface

Implementation

Interface

App-facing APIsFHIR?SMART?openEHR?


Architecture basics


A semantic architecture designed to flexibly standardise:◦ Data, Content structures, Terminology use, APIs

Content developed by clinicians Build adaptive systems – software not

dependent on content models Make querying based on content, not

physical databases

The openEHR approach


A Services-oriented Architecture (SOA) designed to standardise how applications talk to systems◦ APIs

And how systems talk to each other◦ EHR Extracts◦ Generated message schemas◦ Generated document schemas

The openEHR approach


Levels of Information Semantics

Data Structures

Data Types

DemographicEHR

Security

EHR Extract

virtual EHR

Archetype OM

Support (identifiers, terminology access)

AM

RM

SMEHR

servicearchetype

servicedemographic

serviceterminology

service

{core

Common{patterns

{domain{ }Integration

Composition openEHR Archetype Profile

Template OM

Concrete: GUI, messages,documents

Use-case specific data sets - Templates

Data Representation andsharing - Reference Model

Theme-based models of content – Archetypes(library of content definitions)

Querying

TerminologyInterface

Discharge summary UI form

Discharge summary content model

HbA1C, phys. exam, meds list, vital signsetc

Observation, Quantity, coded text etc


Models...

Terminology

Reference Model

Bindings

Ref

Sets

Archetypes Templates

Queries


And downstream artefacts

Terminology

Reference Model

Bindings

Ref

Sets

Archetypes Templates

Queries

Operational Template

Java API

C# API

XSD

Forms

Message Def

Document Def


Development Ecosystem

Deployedsystem consumes newcontent definitions... forever

Forms and messages formallybased on contentmodels

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Thomas Beale CTO, Ocean Informatics Copyright 2012 Ocean Informatics Tromso 27 May 2014.

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