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