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 HANDIHealth openEHR Foundation freshEHR Clinical Informatics

INTRODUCTION 2 Ian McNicoll Former Glasgow GP Health informatics Director openEHR Foundation freshEHR Clinical Informatics Ocean Informatics UK HANDIHealth Commercial software developer GP Accounts

HANDI Health CIC A not-for-profit Community Enterprise Company There to support: Developers Health and care professionals Patients, service users and carers

Apps: Lightweight Digital Tools Not just about mobile Narrow scope,a connected thing Makes heavy use of pre-existing components and services Built using a well defined development and deployment framework Order of magnitude(s) faster and cheaper to develop and deploy Allows niche solutions and fail fast

What does HANDI do? Lobby for an environment (technical, cultural and commercial) in which apps can flourish interoperate and be orchestrated

HANDI is agnostic About Platforms Business models Standards Tools, services and approaches Show the community the possibilities and let individuals decide

open Open data Analytics, quality monitoring Open APIs / standards ITK, GP2GP SMARTPlatform, FHIR Open source openEyes, Wardware Leeds Care Record Spine2 Safer Wards Fund 7

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 8

SMART : Substitutable Apps 9

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, #digidoc13 NHS Hackday Renal PatientView Feral departmental systems Multiple MS Access databases 10

clinicians who code 11

Code4Health 12

The HANDI Vision 13 Apps EPR EHR PHR PHR EMR Meds Repository Drug KB Terminology Server Service Directory CDS Service Pathways KB Services/Repositories Infrastructural Services PDS/Record Discovery EWS ESB/Spine Security Broker

Closed eHealth Platform Proprietary Clinical Content / API Proprietary value- add components Proprietary Querying and Persistence Terminology Server Pathways KBESB/SpineITK Integration component

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 KB ESB/SpineITK Integration component Commit Retrieve

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/SpineITK Integration component Commit Retrieve Query

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 17

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 18

Formal standards development Arguably standards just get in the way Ewan Davis, HANDI Technical (ISB / ISO) Still largely a paper and committee- bound process No clear problem report/change request mechanism Slow review cycles Professional (RCP ?PRSB) Aspirational guidelines Divorced from implementation 19

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] NHS Reporting API NHS Care API LCR apps (Leeds) openENT (UCLP) Clinical content openEHR API integration [7] EHRPaaS [9] NHS API- openEHR Adaptors [8] Professional Records Standards Board Professional oversight

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 21

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) SMARTPlatforms Open APIs: Leeds Clinical Portal via SMARTPlatform APIs OceanEHR Clinical data repository

NHS HSCIC 13606 archetypes 24

25 SMARTPlatforms Pluggable Webapp API HL7 Clinical Content Exchange NHS API inVivo Datastore API Detailed Clinical Content Development Clinical leadership PRSB Terminology Centre HSCIC Non openEHR systems Archetype+ SNOMED Clinical Content definitions A new mobile app developer requires plug in for care record to test pulse app functionality. ITK+N3

dev.ehrscape.com 26

handi-hopd.org/demo 27

NHS Hackday - medsrecDIY Patient-driven medication reconciliation 28

NICE guidance on medicines reconciliation Medication data models (RCP / GP2GP based) Dummy Patient Health Record with realistic data Data accessible via RESTful API

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 as Taking as prescribed / Changed dose No longer taking / Add new medication Save reconciled record back to server for onwards transmission to GP 30

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HOPD in EhrExplorer

openEHR composition 37

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 38

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 39

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