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DHACA Keynote:Avoiding duplication in Health and Social Care

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

[email protected]

[email protected]

HANDIHealth

openEHR Foundation

freshEHR Clinical Informatics

DHACA meeting Jan 2015

Introduction

• Dr Ian McNicoll

• Clinician

• Former Glasgow GP

• Health informatics

• Director HANDIHealth

• Director openEHR

Foundation

• freshEHR Clinical

Informatics

• Commercial software developer

• ‘Clinical Hacker’

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HANDIHealth CIC

• A not-for-profit Community Enterprise

Company

• There to support:

– Developers

– Health and care professionals

– Patients, service users and carers

HANDI is agnostic

• About

– Platforms

– Business models

– Standards

– Tools, services and approaches

• Show the community the possibilities and let individuals

decide

• Lobby for an environment (technical, cultural and

commercial) in which apps can flourish interoperate and

be orchestrated

“Avoiding Duplication in Health and Social Care”

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“Making the impossible very difficult”

So what’s wrong with “Duplication” then?

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Duplication unhelpful: Me-too Drugs?

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Duplication helpful: Better Drugs?

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Duplication unhelpful: Me-Too Apps?

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Duplication helpful: Better Apps?

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Duplication unhelpful: Care Records

• Multiple copies of same information

• Patients asked same questions repeatedly

• Devices do not talk to records

• Systems do not talk to each other

• Re-entry of data ++++

• No “Data Liquidity”

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Duplication helpful: ’standardisation’?

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http://cyber.law.harvard.edu/research/interoperability

Avoiding unhelpful duplication:

Towards an Open Digital Care Ecosystem

Megasuite

Best of Breed

Platform

Open Ecosystem

“One system to rule them all”• NPfIT• Enterprise/GP Systems• Limited external integrations

Many systems ~ 100• Portals• Integration engines• Bespoke integrations

“Own the Platform”• Health Vault, Apple, Lorenzo, etc• ~1000 apps• Partner interfaces (Woodcote L3)

The “Internet “of Digital Health• HANDI-HOPD• The Healthcare Services Platform Consortium

An open Ecosystem 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

TerminologyServer Pathways KB

ESB/SpineITK Integration component

Commit

Retrieve

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

•New content is defined directlyby stakeholders and can beused technically immediately

• Recently adopted by HSCIC for content modelling

•Vendor-neutral data modelsTechnology-neutral data models

•Vendor-neutral data queryingTechnology-neutral data querying

openEHR API

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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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NHS Code 4 Health

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

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Rapid connected health app development

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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”

Healthcare records are not just

buckets of biological facts

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Healthcare Information Standards Process #FAIL

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Clinical stakeholders

engage through top-down

governance

Committee-based

Late vendor engagement

Fixed review cycles

Unclear / unresponsive

change request

mechanism

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 4-

country governance role

Medication ‘archetype’

Web-based ‘democratised’ collaborative review

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Evolutionary standardisation

‘distributed Governance’

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Implementers

Secondary

endorsement

Avoiding Duplication?

• Not always desirable

• Not always possible

• Learn from

• The internet

• Open source software

• Evolution

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openEHR Foundation openehr.org

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Links

• twitter: @ianmcnicoll

• HANDI-HOPD:

• handi-hopd.org

• minimal-hopd.rhcloud.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.uk32

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