from hack days to production the qewd health it platformec2.mgateway.com/qewd-hit-platform.pdf ·...

Copyright © 2016 M/Gateway Developments Ltd

From Hack Days to Production

The QEWD Health It Platform

Rob TweedDirector, M/Gateway Developments Ltd

Twitter: @rtweed


Some of the Problems

• NHS budgets stretched• NHS resources under pressure• Digital healthcare an essential solution• Inflexibility and Cost of Mega-Suites


NHS Hack Days

• Lots of enthusiasm• Lots of people willing to help• Lots of great ideas

• But solutions aren't:– Scalable for production– Technically suitable for production


NHSX

• Exciting and sensible vision• Setting standards and strategy

– Open Source– Security– NHS App– Re-usable common technologies and services


Key Infrastructure Components

NHSLogin

OpenId ConnectProvider

Master PatientIndex /

Demographics

GP SystemsGP SystemsGP SystemsGP SystemsEHRsEHRsEHRsEHRs

PHRsPHRsPHRs

NHS App



NHSLogin



Demographics


PHRsPHRsPHRs

NHS App

Feral SystemsFeral SystemsFeral SystemsFeral Systems


Interconnection?


Key Requirements• Modular, component-based solution

– Re-usable and re-purposable• Open Source "black boxes"

– Limited number of mainstream technologies• Ideally just 1

– Interconnectable– Secure– Work on Windows, Linux, OS X– Easy data interchange

• Including inevitable transformation


Data Standards, Open Technology

• FHIR• OpenEHR

– Peer-reviewed archetypes and standard templates

– Open Source specification– Open Source platforms now available

• Eg EtherCIS

• User authentication/SSO– OpenID Connect (OIDC)


QEWD Platform• Open Source modular API and application server platform• JavaScript / Node.js• Highly scalable, high-performance architecture• Embedded Open Source NoSQL database for JSON persistence

and session management• Dockerised "black box"

– Windows, Linux, OS X, hardware independent• QEWD modules can be interconnected as MicroServices• "JSON everywhere"• Secured using:

– JSON Web Tokens (JWT)– OIDC


QEWD MicroServices

MicroService

User Interface(browser)

Orchestrator

MicroService MicroService

Each is a QEWD Docker Container

Each can be customized to providespecific behavior

- self-contained functionality; or- interface to another system


QEWD MicroServices

MicroService


Orchestrator


Interconnections secured using JWTs

WebSockets

HTTP(S)REST

WebSockets


QEWD MicroServices

MicroService


Orchestrator


MicroServices can alsointeroperate

WebSockets

HTTP(S)REST

WebSockets


QEWD HIT Example

NHSLogin


QEWD-BasedMPI /

DemographicsFHIR Server

OpenEHR(EtherCIS)

PHR(PulseTile)

QEWD-BasedOrchestrator

QEWD-BasedOIDC Client

QEWD-BasedOpenEHRInterfaceService


Login: Get OIDC Redirection Info

NHSLogin


QEWD-BasedMPI /


OpenEHR(EtherCIS)

PHR(PulseTile)





User authenticates on NHS Login

NHSLogin


QEWD-BasedMPI /


OpenEHR(EtherCIS)

PHR(PulseTile)





User redirected back to Orchestrator

NHSLogin


QEWD-BasedMPI /


OpenEHR(EtherCIS)

PHR(PulseTile)




+ idToken


JWT created, includes idToken

NHSLogin


QEWD-BasedMPI /


OpenEHR(EtherCIS)

PHR(PulseTile)





Interact / integrate info

NHSLogin


QEWD-BasedMPI /


OpenEHR(EtherCIS)

PHR(PulseTile)




+JWT+JWT

+JWT


FHIR v OpenEHR etc?

• QEWD Platform turns it into a JSON transformation exercise

• qewd-transform-json– JSON syntax for specifying JSON

transformations• FHIR to/from OpenEHR

– Re-usable standard templates• UI format to/from OpenEHR


OpenEHR "Rosetta Stone" format

• "Flat JSON"– But unflattened into standard JSON

• Every OpenEHR system:– Allows data to be input as Flat JSON– Can output data as Flat JSON– Can be interrogated to find out the Flat JSON

format for any template


OpenEHR "Rosetta Stone"

TransformationTemplate

JSON

FHIRAllergyIntolerance

ResourceJSON

OpenEHRAllergy

Template"Flat JSON"


Allergies OpenEHR to FHIR{"resourceType": "AllergyIntolerance","identifier": [{"system": "http://ethercis.org/compositionId","value": "{{adverse_reaction_list._uid}}"

}],"onset": "=> getDate(start_time)","recordedDate": "=> getDate(start_time)","recorder": {"reference": "Practitioner/id","display": "{{adverse_reaction_list['composer|name']}}"

},"patient": {"reference": "Patient/{{patientId}}","display": "{{patientName}}"

},"substance": {"coding": [{"system": "http://snomed.info/sct","code": "{{adverse_reaction_list.allergies_and_adverse_reactions.adverse_reaction_risk[0]['causative_agent|code']}}","display": "{{adverse_reaction_list.allergies_and_adverse_reactions.adverse_reaction_risk[0]['causative_agent|value']}}"

}]

},"status": "active","type": "allergy","category": "other","reaction": [{"substance": {"coding": [{"system": "http://snomed.info/sct","code": "{{adverse_reaction_list.allergies_and_adverse_reactions.adverse_reaction_risk[0]['causative_agent|code']}}","display": "{{adverse_reaction_list.allergies_and_adverse_reactions.adverse_reaction_risk[0]['causative_agent|value']}}"

}],"text": "{{adverse_reaction_list.allergies_and_adverse_reactions.adverse_reaction_risk[0]['causative_agent|value']}}"

},"certainty": "confirmed","manifestation": [{"coding": [{"system": "http://snomed.info/sct","code": "{{adverse_reaction_list.allergies_and_adverse_reactions.adverse_reaction_risk[0].reaction_details.manifestation[0]['|code']}}","display": "{{adverse_reaction_list.allergies_and_adverse_reactions.adverse_reaction_risk[0].reaction_details.manifestation[0]['|value']}}"

}],"text": "{{adverse_reaction_list.allergies_and_adverse_reactions.adverse_reaction_risk[0].reaction_details.manifestation[0]['|value']}}"

}],"description": "{{adverse_reaction_list.allergies_and_adverse_reactions.adverse_reaction_risk[0].reaction_details.manifestation[0]['|value']}}"

}],"note": "{{adverse_reaction_list.allergies_and_adverse_reactions.adverse_reaction_risk[0].reaction_details.comment}}"

}


Allergies OpenEHR to FHIR"substance": {

"coding": [{

"system": "http://snomed.info/sct","code": "{{adverse_reaction_list.allergies_and_adverse_reactions.adverse_reaction_risk[0]['causative_agent|code']}}","display": "{{adverse_reaction_list.allergies_and_adverse_reactions.adverse_reaction_risk[0]['causative_agent|value']}}"

}]

}

{"adverse_reaction_list": {"allergies_and_adverse_reactions": {"adverse_reaction_risk": [{"causative_agent|code": "304270095","causative_agent|value": "Erythromycin","causative_agent|terminology": "SNOMED-CT",


Solves a major OpenEHR Issue• AQL to get data out• Flat JSON to put data in• No obvious similarity• Needed expert input• Major learning curve barrier

• Now all you need to know is the Template Id• QEWD looks after the rest




JSON


ResourceJSON

OpenEHRAllergy

Template"Flat JSON"

Simple formatfor UIJSON


JSON




JSON


ResourceJSON

OpenEHRAllergy

Template"Flat JSON"

Other SystemProprietary

JSON


JSON


Hack Days?• The QEWD platform can be used to create a

usable hacking environment– Just a set of Docker containers

• Dockerised version of EtherCIS is also available• QEWD-based OIDC Provider container can be

used to simulate NHS Login• Can even run QEWD Containers on Raspberry

Pis!


Hack Days

• Applications developed at Hack Days are no longer throw-away ideas

• Can be built on using the same platform tocreate enterprise-scale solutions that will interoperate with anything else using the platform



NHSLogin



Demographics


PHRsPHRsPHRs

NHS App

Feral SystemsFeral SystemsFeral SystemsFeral Systems


Key Infrastructure ComponentsNHSLogin


LHCREFHIR Server

DSS Discovery

FHIROther EHRsVia FHIR

OpenEHR

PHR -PulseTile

NHS App

HackDaySystems

OpenEHR &QEWD

from hack days to production the qewd health it platformec2.mgateway.com/qewd-hit-platform.pdf ·...

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