HANDI Summit 18 - Introducing HANDI-HOPD - Dr Ian McNicoll

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HANDI-HOPD: What’s in the box? 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 HANDIHealth openEHR Foundation freshEHR Clinical Informatics HANDI-HOPD Planning meeting London Sept 2014

Transcript of HANDI Summit 18 - Introducing HANDI-HOPD - Dr Ian McNicoll

HANDI-HOPD:

What’s in the box?

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 Foundation

freshEHR Clinical Informatics

HANDI-HOPD Planning meeting London Sept 2014

INTRODUCTION

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Ian McNicoll

Clinician

Former Scottish GP

Health informaticsDirector openEHR Foundation

freshEHR Clinical Informatics

Ocean Informatics UK

HANDIHealth

NHS Scotland SCIMP

Commercial software developer‘GP Accounts’

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SMARTPlatforms

Pluggable Webapp

API

HL7 FHIR

Clinical Content

Exchange NHS API

‘inVivo’

Datastore API

Detailed

Clinical Content

Development

Clinical leadership PRSB

Terminology

CentreHSCIC

Non

openEHR

systems

Archetype+ SNOMED Clinical

Content definitions

Apps developers

What is an API?

• ‘Application Programming interface’

• allows one application to ‘talk’

directly to another.

• The app world runs on APIs

• how Gmail calendar talks to

Apple Calendar

• how my Train app knows “my

next train home”

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What is in an API

• Modern API ‘restful’ requests look like web

page urlhttps://api.twitter.com/1.1/statuses/user_timelin

e.json?screen_name=twitterapi&count=2

• and carries some

sort of

structured content’

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SMARTPlatforms API

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• Scopes and permissions: OAuth2

• Simple sign-in: OpenID Connect

• Lightweight UI integration: HTML5 via Pluggable app framework

SMARTPlatforms : ‘Substitutable’ Apps

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SMART-on-FHIR

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HL7 FHIR

data model

replacing

SMARTPlatform

s

data model

(RDF)

HL7 FHIR API

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What is FHIR good at?

• Communication of information between

systems with limited querying

• Strengths

• Developer friendly

• Lightweight approach

• Great documentation / community

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Where might FHIR be weaker?

• Not designed for persistence

• can work but will it scale?

• partial querying only

• Resources will not work ‘out of the box’ in

the real world

• Need local extensions and profiles

• Version control / governance of the profiles

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openEHR API

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• Designed for storing and queryingrich clinical dataset

• New content is defined directlyby clinicians and can be immediately uploaded into the clinical data repository

• Vendor-neutral data modelsTechnology-neutral data models

• Vendor-neutral data queryingTechnology-neutral data querying

openEHR

• Weaknesses

• Complex technology

• but new simplifying APIs appearing

• Strengths

• clinically-led data modelling

• sharing archetypes = interoperability

• Enterprise strength performance

• Mature versioning/governance

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dev.ehrscape.com

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MedsRecDIY: http://diy-hopd.rhcloud.com/

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Vendor-neutral querying

Vendor-neutral querying

Vendor/technology-neutral platform

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Building out the platform

• SMART and HL7 FHIR support

• BlackPear , Marand

• More openEHR providers

• Lockheed Martin - OceanEHR

• Medvision360

• Code24

• More demo apps

• LiveCode mobile App demo

• Knowledge resources

• FirstDataBank

• Indizen cloud terminology service

• CDS resources

• openClinical - PROFORMA

• Cambio GDL

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SMARTPlatforms

Pluggable Webapp

API

HL7 FHIR

Clinical Content

Exchange NHS API

‘inVivo’

Datastore API

Detailed

Clinical Content

Development

Clinical leadership PRSB

Terminology

CentreHSCIC

Non

openEHR

systems

Archetype+ SNOMED Clinical

Content definitions

Apps developers

Interoperability is not a tech problem

“The real barriers to practical interoperability are

cultural and clinical”

–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

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Traditional Standards Process

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Clinical stakeholders

engage through top-down

governance

Committee-based

Late vendor engagement

Fixed review cycles

Unclear / unresponsive

change request

mechanism

Formal standards process is a barrier

• “Standards can be a barrier to progress”

– Ewan Davis, HANDI

– http://www.woodcote-consulting.com/farwell-to-ruthless-standardisation/

• Technical (ISO / SCCI)

– Still largely a paper and committee-bound process

• No clear problem report/change request mechanism

• Slow review cycles

• Professional (PRSB)

• Valuable clinical requirements input

• but distant from implementation

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open, shared data models: Archetypes

• Clinically-led + collaboratively authored

– open-source ‘crowd-sourcing’ methodology

– Shared open repository ‘CC-BY-SA’ licence

• Agility in response to continually changing clinical

demand

– Clear ownership, change request mechanism

– Tight version control

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GP2GP medication archetype

Web-based clinical review

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Archetypes: open source GitHub mirror

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https://github.com/ClinicalModelsUK/ckm

FHIR + openEHR joint resource/archetype

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Clinically-led Content Service

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Clinical content

service

Clinical stakeholders,

vendors engage directly with

clinically-led content service

Continual dialogue with all

stakeholders via web-based

collaborative tooling

No fixed review cycles

On-demand change request

directly to clinical content

service

PRSB has high-level

governance role

Evolutionary standardisation

‘distributed Governance’

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Implementers

Secondary

endorsement

Publication and Secondary Endorsement

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Project editors decide on

formal publication, acting as

“Benign Dictators”

Professional bodies, vendors

and PRSB may Endorse a

resource as a secondary

exercise

this does not restrain the

formal publication process

“By Royal Appointment”

PRSB hires and fires Editors

Blogs

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http://www.woodcote-

consulting.com/farwell-

to-ruthless-

standardisation/

http://coiera.com/201

3/11/01/are-

standards-

necessary/… “That the fraction of standards

produced that are actually complied with,

will with time asymptote toward zero”

Links

• twitter: @ianmcnicoll

• HANDI-HOPD: handi-hopd.org

• http://diy-hopd.rhcloud.com/

• hopdscape-hopd.rhcloud.com

• minimal-hopd.rhcloud.com

• Marand Ehrscape API: dev.ehrscape.com

• Leeds Innovation Lab Health Platform : http://leedslabplatform.com

• openEHR Foundation : www.openehr.org

• SMARTPlatforms: smartplatforms.org

• HL7 FHIR: hl7.org/implement/standards/fhir/

• International archetype repository: www.openehr.org/ckm

• UK archetype repository: www.clinicalmodels.org.uk

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