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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/8/12/2019 HANDI - Arctic Conf 2014
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INTRODUCTION
2
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/8/12/2019 HANDI - Arctic Conf 2014
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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/demo8/12/2019 HANDI - Arctic Conf 2014
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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/demoRecommended