handi - arctic conf 2014

8/12/2019 HANDI - Arctic Conf 2014

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Supporting the health apps revolution

Software apps to support health and care - Supporting the app paradigm

Creating a community of interest - That's HANDI

www.handihealth.org

Dr Ian McNicoll

HANDIHealthopenEHR Foundation

freshEHR Clinical Informatics
http://www.handihealth.org/http://www.handihealth.org/


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INTRODUCTION

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Ian McNicoll

Former Glasgow GP

Health informaticsDirector openEHR Foundation

freshEHR Clinical Informatics

Ocean Informatics UK

HANDIHealth

Commercial software developer

GP Accounts


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HANDI Health CIC

A not-for-profit Community Enterprise

Company

There to support:

Developers

Health and care professionals

Patients, service users and carers


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Apps: Lightweight Digital Tools

Not just about mobileNarrow scope,a connected thingMakes heavy use of pre-existing componentsand services

Built using a well defined development anddeployment framework

Order of magnitude(s) faster and cheaper to

develop and deployAllows niche solutions and fail fast


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What does HANDI do?

Lobby for an environment (technical, cultural

and commercial) in which apps can flourish

interoperate and be orchestrated


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HANDI is agnostic

About

Platforms

Business models

Standards

Tools, services and approaches

Show the community the possibilities and let

individuals decide


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open

Open data

Analytics, quality monitoring

Open APIs / standards

ITK, GP2GP

SMARTPlatform, FHIR

Open source

openEyes, Wardware Leeds Care Record

Spine2

Safer Wards Fund

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Time for open Platforms?

USA

SMARTPlatforms

Healthcare Services Collaboration Platform

Intermountain, Cerner, Harris Healthcare

GP Systems of Choice (GPSOC) refresh Phase 1 GP systems open APIs

Phase 2 GP systems Common APIs

De-facto open platform

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SMART : Substitutable Apps

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clinical engagement

Formal clinical ownership Joint GP IT Committee (RCGP / BMA)

RCP ITU / Professional Records Standards Body

UKincreasing 4-countries engagement

Guerilla activity Clinicians who code, #digidoc13

NHS Hackday

Renal PatientView

Feral departmental systems Multiple MS Access databases

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clinicians who code

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Code4Health

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The HANDI Vision

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Apps

EPR

EHR PHR

PHR EMRMeds

Repository

Drug KBTerminology

ServerService

DirectoryCDS Service Pathways KB

Services/Repositories

Infrastructural ServicesPDS/Record Discovery EWS ESB/Spine

Security

Broker


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Closed eHealth Platform

Proprietary Clinical Content / API

Proprietary value-

add components

Proprietary Querying and Persistence

Terminology

ServerPathways KBESB/Spine

ITK Integration component


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An 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

Terminology

Server Pathways KBESB/SpineITK Integration component

Commit

Retrieve


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openEHR open 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

Terminology

Services Pathways KBESB/Spine

ITK Integration component

Commit

Retrieve

Query


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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

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Current clinical content

standards methodology

Antithesis of agile development

Inaccessible to clinicians

Slow to develop, difficult to implement

CDA implementation mostly dumb documents

SNOMED has key role but ? oversold as whole solution

Uncontrolled

Multiple definitions of technical messaging models

Approx 20 definitions of allergy across UK

No clear change request / problem report mechanism

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Formal standards development

Arguably standards just get in theway

Ewan Davis, HANDI

Technical (ISB / ISO)

Still largely a paper andcommittee- bound process

No clear problemreport/change requestmechanism

Slow review cycles

Professional (RCP ?PRSB)

Aspirational guidelines

Divorced from implementation

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openEHR

Repository

(vendor #1)

openEHR

Repository [10]

(open source)

openEyes

(Moorfields)

Safer Wards Orsini

openEHR

Repository

(vendor #2)

openEHR API openEHR API

Local

SQL DB

openEHR API

Wardware2

(Kings)

NHS API

ESB / ITK / Spine components [2]

NHSReporting

API

NHS

Care API

LCR apps

(Leeds)

openENT

(UCLP)

Clinical content

openEHR API integration [7]

EHRPaaS[9]

NHS API-

openEHR

Adaptors [8]

ProfessionalRecords

StandardsBoard

Professional oversight


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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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Leeds NHS Care Record: open

Platform

openEHR Foundation accredited

Open 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 via

SMARTPlatform APIsOceanEHR Clinical

data repository


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NHS HSCIC 13606 archetypes

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SMARTPlatforms

Pluggable Webapp

API

HL7

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

A new mobile appdeveloper requires

plug in for care

record to test pulse

app functionality.

ITK+N3


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dev.ehrscape.com

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http://dev.ehrscape.com/http://dev.ehrscape.com/http://dev.ehrscape.com/


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handi-hopd.org/demo

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http://handi-hopd.org/demohttp://handi-hopd.org/demohttp://handi-hopd.org/demohttp://handi-hopd.org/demohttp://handi-hopd.org/demo


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NHS Hackday - medsrecDIY

Patient-driven medication reconciliation

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NICE guidance on medicines reconciliation

Medication data models (RCP / GP2GP based)

Dummy Patient Health Record with realistic data

Data accessible via RESTful API


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What did we set out to do?

Create a patient-facing web-page for medicationreconciliation

Populate existing medication list from GP system or

other source

Enable patient to mark each item as Taking as prescribed / Changed dose No longer taking / Add new medication

Save reconciled record back to server for onwardstransmission to GP

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HOPD in EhrExplorer


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openEHR composition

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next tech steps for HANDI-HOPD

SMART and HL7 FHIR support

More openEHR providers

Cross provider querying demos

Cross provider transfers

Focus for openEHR in-vivo API alignment

discussions

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next steps for HANDI-HOPD?

Direct discussion with NHS England

possible use by Code4Health

possible direct support for the open

standards platform approach

HOPD-HACKD hackday event in

September

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Links

twitter: @ianmcnicoll

HANDI-HOPD handi-hopd.org/demo

Ehrscape: dev.ehrscape.com Leeds Innovation Lab Health Platform : http://leedslabplatform.com

openEHR Foundation : www.openehr.org

International archetype repository: www.openehr.org/ckm

UK archetype repository: www.clinicalmodels.org.uk
http://handi-hopd.org/demohttp://leedslabplatform.com/http://www.openehr.org/http://www.openehr.org/ckmhttp://www.clinicalmodels.org.uk/http://www.clinicalmodels.org.uk/http://www.clinicalmodels.org.uk/http://www.openehr.org/ckmhttp://www.openehr.org/http://leedslabplatform.com/http://handi-hopd.org/demohttp://handi-hopd.org/demohttp://handi-hopd.org/demo

handi - arctic conf 2014

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