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Interoperability:
Data for apps-
Apps for data?
Dr Ian McNicoll
openEHR Foundation
Ocean Informatics
www.handihealth.org
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Interoperability: Data for apps
Platform/infrastructure/API
To move information between systems
or even within complex systems
Tocommunicateclinicalcontent
Technical interoperability
Standardised transport = just a pdf
Syntacticinteroperability
Standardised format = .xls
Semanticinteroperability
Standardised computable meaning
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Lesson 2: UK is not a coherent
space English NHS
The Spine, SNOMED, HL7v3, some CDA
Celtic NHS
Spineless, SCI-XML, SCI-Gateway, Ensemble Welsh / NI/ Scottish variants
No formal commitment to SNOMED (yet)
Lesson 1: Interoperability - Its not
easy
Lesson 3: There is no simple, single
solution
Complexity is to IT as gravity is to space-rockets
Clinical recording requirements must reect highly
contextual, culturally-dependent clinical practice
Innovation at the heart of clinical practice and
change is a constant
Butweknowwhatdoesnotwork
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Ruthless top-down standards Clinical domain is just too complex
Top-down cannot move fast enough
Lets just start with the important stuff? One professional groups minimum dataset is
anothers needless complexity
Standards must emerge
to meet a business case
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Leave it to the experts
Clinicalexpertgroups
Diabetes, IHD, Stroke datasets
ClinicalProjectsgroups Discharge, Emergency summaries, GP2GP
Technicalmodellingexperts
Tend to want to impose abstract patterns to promote
technical re-use at expense of clinical/human
understanding
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Ruthless Ontology ? SNOMED-CT
Wejustneedtounderstandallthethingsinour
worldandtherelationshipsbetweenthem
Workswellforreal-worldentities Drugs, diseases, procedures, organisms
for inferencing and authoring
Criticalpartofthestory
But not the whole story
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What does a HANDI App need?
Anenvelope
Push (Message envelope)
Pull (API)
Terminologycodes
Existing, New
Richstructuredcontent
Existing, New
Persistenceformat
Local Long-term queryable storage the EHR
So whats out there? Push (Message) envelope
Pull (API) envelope
Codes / Terminology
Rich structured clinical content Persistence format
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SNOMED-CT
Pre-coordination
Widespread GP use via Read codes
Post-coordination
Powerful but can hurt your brain
Codesmustlivewithinstructure
Context : Who, what, where, why
Often more subtle
e.g. End of Life Care plan
Codes / Terminology
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Structured clinical contentMSHealthvault
Proprietary, limited content, PHR focus
HL7v3templates
Difcult to author, understand, limited content
NHS England, CCD / CCDA (epSoS/ US)
Archetypes
openEHR / ISO13606 / CIMI
Clinically authored, governed
Open specication licensing
Designed to be plug and play
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What is openEHR?Not-for-prot Foundation based at UCL delivering Open
specications for a clinical information model allowing
commercial and open source use www.openehr.org
Collaboratively develops open-source clinical content
specications based on
Archetypes
Templates
Termsets
www.openehr.org/knowledge
Archetypes
Computablemodelsofdiscreteclinicalconcepts
Maximal data set, Universal use case
Include bindings to terminology
Familiarcomponentsofahealthrecord
Blood pressure, Body weight
Medication order, Family history Prostate cancer histopathology result
Designedforpersistence
Use within apps as well as between apps
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Archetypes: Apps for data
Clinicallyandcollaborativelyauthored
Direct governance by clinical informaticians
Open standards CC-BY-SA licence Secondary assurance by professional standards
groups
Agilitytorespondtochangingclinicaldemand
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Adverse Reaction archetype
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Structured clinical content
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Archetype re-use in openEHR
Template
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Whats next?
Push (Message) envelope
Pull (API) envelope
Codes / Terminology
Rich structured clinical content
Persistence format
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