handi open standards platform
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TIME FOR AN OPEN STANDARDS HEALTHCARE
PLATFORM?DR IAN MCNICOLL
CLINICAL MODELLING CONSULTANT, OCEAN INFORMATICS
DIRECTOR, OPENEHR FOUNDATION
INTRODUCTION
Dr Ian McNicoll
Former Glasgow GP
Director openEHR Foundation
Health informatics consultancy Ocean Informatics UK Clinical
Modelling Consultant NHS Scotland, CfH, GP2GP, RCP
health informatics consultancy HANDIHealth , BCS PHCSG
Commercial software development
TIME FOR ‘OPEN PLATFORMS’?
• USA
• SMARTPlatforms
• UK
• GP Systems of Choice (GPSOC) refresh
• Phase 1 GP systems open APIs
• Phase 2 GP systems Common APIs
• De-facto ‘open platform’
‘SUBSTITUTABLE’ APPS
‘small and agile’
• Resurgence in SME sector
• Role of Intellect
• Adaptable platforms
• IMS Maxims
• Black Pear Software
• Digital Spark
• MS Healthvault
• ‘Apps’ paradigm
• HANDIHealth
‘open’
• Open data
• Analytics, quality monitoring
• Open APIs / standards
• ITK, GP2GP
• GPSOC-R
• SMARTPlatform, FHIR
• Open source
• openEyes, Wardware
• Leeds Care Record
• Spine2
• “Safer Wards” Fund
‘clinical engagement’
• Formal clinical ownership
• Joint GP IT Committee (RCGP / BMA)
• RCP ITU / Professional Records Standards Body
• UK – increasing 4-countries engagement
• Guerilla activity
• ‘Clinicians who code’, DigiDocs
• NHS Hackday, openGPSOC
• DIY
• Renal PatientView
• Multiple MS Access/ Excel databases
THE ‘HANDI VISION’
Apps
EPREHR PHR
PHR EMRMeds
Repository
Drug KBTerminology
ServerService
DirectoryCDS Service Pathways KB
Services/Repositories
Infrastructural ServicesPDS/Record Discovery EWS ESB/Spine Security
Broker
‘CLOSED’ EHEALTH PLATFORM
Proprietary Clinical Content / API
Proprietary value-add components
Proprietary Querying and Persistence
TerminologyServer Pathways KBESB/Spine
ITK Integration component
‘OPEN SOURCE’ SILOED EHR ‘PLATFORM
Siloed Clinical Content / API
OSS Value-add components
Siloed Querying and Persistence
TerminologyServer Pathways KBESB/Spine
ITK Integration component
MULTIPLE CLOSED SILOS
NHS OPEN STANDARDS PLATFORM
Closed OSS ClosedOSS
Vendor DVendor B Vendor CVendor A
API and messaging content based on open source clinical content definitions
OSS components
Vendor solutions
TerminologyServer Pathways KB
ESB/Spine
ITK Integration component
Commit
Retrieve
OPENEHR DRIVEN STANDARDS PLATFORM
Closed source
Open source
Open source
openEHR CDR
Vendor DVendor B Vendor CVendor A
Open source Archetype-based clinical content information / querying model
OSS Value-add components
Vendor solutions
TerminologyServices Pathways KBESB/Spine
ITK Integration component
Commit
Retrieve
Query
GPSOC - OPENEHR
www.openehr.org
INTEROPERABILITY IS NOT A TECH PROBLEM
• Interoperability is a clinical problem• Diverse recording practice (sometimes arbitrary)
• Diverse recording requirements
• Complexity / contextual nature of health data
• Lack of clinical involvement in standards development
• Too technical, too philosophical
• Too time-consuming, too slow
OPENEHR ARCHETYPES: OPEN SOURCE CLINICAL INFORMATION COMPONENTS
• Clinically-led + collaboratively authored
• open-source ‘crowd-sourcing’ methodology
• democratised clinical content development
• Shared open repository CC-BY-SA licence
• Agility to respond to continually changing clinical demand
• Clear ownership, change request mechanism
• Tight version control
INDUSTRY/PROFESSION-DRIVEN STANDARDISATION‘OPEN GOVERNANCE’
Clinical Knowledge Administrators
Blood pressure Archetype Editors
Archetype Reviewer
Archetype Reviewer
Opthalmology Project Editors
Visual fields archetype
Visual acuity archetype
Reviewer Reviewer
Publish
Implementation
Secondary endorsement
OPENEYES GLAUCOMA : INITIAL AUTHORING
Gather evidenceFirst draft mindmap
Refine mindmap (inclusive dataset)Create /Upload Initial archetype
OPENEYES GLAUCOMA : IMPLEMENTATION
Template Data Schema
openEHR Repository(vendor #1)
openEHR Repository [10](open source)
OpenEyes(Moorfields)
Orsini
openEHR Repository(vendor #2)
openEHR APIopenEHR API openEHR APIopenEHR API
LocalSQL DB
openEHR APIopenEHR API
Wardware2 (Kings)
Orsini Clinical Content Service [4]
Persistence MgrPersistence Mgr
Industry :VistA, EMIS, TPP, HANDI
…
NHSvistaNHSvista
ESB / ITK / Spine components [2]
ESB / ITK / Spine components [2]
NHSvista Reporting API
[3b]
NHSvista Reporting API
[3b]
NHSvista Care API
[3a]
NHSvista Care API
[3a]
Leeds LCRLeeds LCR
LCR apps(Leeds)
OpenEyes/ openEHR Toolkit
[6]
OpenEyes/ openEHR Toolkit
[6]
openENT(UCLP)
[1] Clinical content
openEHR tech/spec dev. [5]
openEHR tech/spec dev. [5]
openEHR API integration [7]
EHRPaaS [9]
NHS vista- openEHR
Adaptors [8]
Professional RecordsStandards
Board
Professional oversight
LEEDS NHS CARE RECORD: OPEN PLATFORM
openEHR Foundation accreditedOpen Standards CDR Service layer
N3 hosted
ESB/Spine ITK Integration component
Commit
Retrieve
Query
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
Clinicaldata repository
LEEDS INNOVATION LAB: OPEN PLATFORM DEMONSTRATOR
openEHR Foundation accreditedOpen Standards CDR Service layer
N3 hosted
FHIR ITK Integration component
Commit
Retrieve
Query
OpenEHR open source 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
Clinicaldata repository
OPENEHR CLOUD ‘PLATFORM AS A SERVICE’
SQLServer NHS OSS? Postgres
SQLOracle
Code24Ocean openEyesMarand
openEHR Foundation accreditedImplementation-agnostic CDR Service layer
N3 hosted
Value-add components
CDRSolutions
TerminologyServer Pathways KB
ESB/Spine
ITK Integration component
Commit
Retrieve
Query
TIME FOR AN NHS OPEN STANDARDS E-HEALTH PLATFORM?
• Provide commoditised eHealth application services
• persistence/querying/audit/ connectivity
• Can handle rich, complex clinical information
• Vendor/technology stack neutral
• Add-on common services
• ITK, N3, Spine , APIs
• DSS, terminology services
• EHR PaaS model
• Platform as a Service
• Cloud-based ‘pay as you go’
• Choice of provider
• Solves the ‘MSAccess’ problem
LINKS
• twitter: @ianmcnicoll
• Leeds Health Innovation Lab : www.leedsinnovation.com
• openEHR Foundation : www.openehr.org
• International archetype repository: www.openehr.org/ckm
• UK archetype repository: www.clinicalmodels.org.uk
openEHR Solutions
QUESTIONS
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