HANDI-HOPD: HANDI open Standards Platform Software apps to support health and care - Supporting the app paradigm Creating a community of interest - That's HANDI www.handi-hopd.org
HANDI-HOPD:HANDI open Standards Platform
Software apps to support health and care - Supporting the app paradigm Creating a community of interest - That's HANDI
www.handi-hopd.org
Dr Ian McNicoll
HANDIHealthopenEHR FoundationfreshEHR Clinical Informatics
HANDI-HOPD techUK London August 2014INTRODUCTION2Ian McNicoll Former Glasgow GP
Health informaticsDirector openEHR FoundationfreshEHR Clinical InformaticsOcean Informatics UKHANDIHealth
Commercial software developerGP Accounts
openOpen dataAnalytics, quality monitoring
Open APIs / standards ITK, GP2GP SMARTPlatform, FHIR GPSOC-R
Open sourceopenEyes, openObsLeeds Care RecordSpine2, eReferralopenMaxims3
USA
SMARTPlatforms
Healthcare Services Collaboration PlatformIntermountainCernerHarris HealthcareHP
USA: time for open Platforms?4
SMARTPlatforms : Substitutable Apps5
clinical engagementFormal clinical ownershipJoint GP IT Committee (RCGP / BMA)RCP ITU / Professional Records Standards BodyUK increasing 4-countries engagement
Guerilla activityClinicians who code, #digidoc13NHS Hackday Renal PatientViewFeral departmental systemsMultiple MS Access databases6
clinicians who code7
Code4Health8
The HANDI Vision9AppsEPREHRPHRPHREMRMeds RepositoryDrug KBTerminologyServerServiceDirectoryCDS ServicePathways KBServices/RepositoriesInfrastructural ServicesPDS/Record DiscoveryEWSESB/SpineSecurity Broker
Closed eHealth PlatformProprietary Clinical Content / APIProprietary value-add componentsProprietary Querying and Persistence
TerminologyServerPathways KBESB/SpineITK Integration component An open standards platform?ClosedOSSClosedOSSVendor DVendor BVendor CVendor AAPI and messaging content based on open source clinical content definitionsOSS componentsVendor solutions
TerminologyServerPathways KBESB/SpineITK Integration component CommitRetrieveLeeds Care Record: open PlatformopenEHR Foundation accreditedOpen Standards CDR Service layerN3 hosted
ESB/SpineITK Integration component CommitRetrieveQuery
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 via SMARTPlatform APIs
OceanEHR Clinicaldata repository
13SMARTPlatformsPluggable WebappAPIHL7 Clinical Content Exchange NHS APIinVivoDatastore APIDetailed Clinical Content Development Clinical leadership PRSBTerminology CentreHSCICNonopenEHR systemsArchetype+ SNOMED Clinical Content definitions
A new mobile app developer requires plug in for care record to test pulse app functionality.
ITK+N3
Marand dev.ehrscape.com14
HOPD - restful API15
http://hopdscape-hopd.rhcloud.com/16
NHS Hackday - medsrecDIYPatient-driven medication reconciliation17
Professional meds reconciliation18
What did we set out to do?Create a patient-facing web-page for medication reconciliation
Populate existing medication list from GP system or other source Enable patient to mark each item asTaking as prescribed / Changed doseNo longer taking / Add new medication
Save reconciled record back to server for onwards transmission to GP19MedsRecDIY: http://diy-hopd.rhcloud.com/20
next tech steps for HANDI-HOPDSMART and HL7 FHIR support
More openEHR providersCross provider querying demosCross provider transfers
Terminology resources FirstDataBank drug database Indizen SnomedCT service 21
Interoperability is not a tech problemThe real barriers to practical interoperability are cultural and clinical
Diverse recording practice (sometimes arbitrary)Diverse recording requirementsComplexity / contextual nature of health data
Lack of clinical involvement in standards developmentToo technical, too philosophicalToo time-consuming, too slow22
Current clinical content standards methodologyAntithesis of agile development
Inaccessible to cliniciansSlow to develop, difficult to implement
SNOMED has key but only partial role
Uncontrolled methodology
Multiple definitions of technical messaging modelsApprox. 20 definitions of allergy across UK
No clear change request / problem report mechanism23
Formal standards developmentArguably standards can just get in the way Ewan Davis, HANDI
Technical (ISO / SCCI)Still largely a paper and committee- bound processNo clear problem report/change request mechanismSlow review cycles
Professional (PRSB) Valuable clinical requirements input but distant from implementation24
open, shared data models: ArchetypesClinically-led + collaboratively authoredopen-source crowd-sourcing methodologyShared open repository CC-BY-SA licence
Agility in response to continually changing clinical demandClear ownership, change request mechanismTight version control25
Web-based clinical review26
Archetypes: open source GitHub mirror27
https://github.com/ClinicalModelsUK/ckmIndustry / Profession-driven standardisationdistributed Governance28
Publish
ImplementationSecondary endorsement
Professional Endorsement29
FHIR + openEHR joint resource/archetype30
HSPC: SMART on FHIR on Clinical Models31
Linkstwitter: @ianmcnicoll
HANDI-HOPD: handi-hopd.orghttp://diy-hopd.rhcloud.com/ http://hopdscape-hopd.rhcloud.com
Marand Ehrscape API: dev.ehrscape.comLeeds Innovation Lab Health Platform : http://leedslabplatform.com
openEHR Foundation : www.openehr.orgSMARTPlatforms: smartplatforms.orgHL7 FHIR: hl7.org/implement/standards/fhir/
International archetype repository: www.openehr.org/ckmUK archetype repository: www.clinicalmodels.org.uk32