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Rong Chen, MD, PhDopenEHR Management Board
Co-lead, openEHR Specification Program
CMIO, Cambio Healthcare Systems
Copyright 2015 openEHR Foundation
Thomas BealeopenEHR Management Board
Co-lead, openEHR Specification Program
CTO, Ocean Informatics
"eHealth is just healthcare management of the 21st century. It's not an ICT project.”◦ Madis Tiik, CEO, Estonian E-Health Foundation
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
Open or closed?
Retain or cede control?
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
govpayers
vendors
provider institutionssolutions
builddeploy care
SDOs
?
Q:How much influence
does the buyer really have?
A: control points
are usually limited to
Function points, limited
standards conformance
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
govpayers
vendors
provider institutionssolutions
builddeploy care
SDOs
?
How much influence
Government?
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
govpayers
vendors
provider institutionssolutions
builddeploy care
SDOs
e-health programme
?
Technical requirements
based on?
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
e-health programme
govpayers
vendors
provider institutionssolutions
builddeploy care
SDOs
? integrate
PLATFORM
Now procurement
has a means of
requiring
conformance –
a fully defined set
of specifications
Copyright 2015 openEHR
1. Standard Information model
2. Standard content
definitions
Service API
B2B Service API
Service API
Service API
B2B Service API B2B Service API
Service API
Service API Service API
Service API
4. Standard
interfaces
3. Open terminologies
5. Semantic Querying
app app
other system
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
e-health programme
govpayers
vendors
provider institutionssolutions
builddeploy care
SDOs
? integrate
PLATFORM
Except the
buyer side has
no means of
influence
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
e-health programme
govpayers
vendor
provider institutions
builddeploy care
SDOs
?
solution
PLATFORM
And no visibility
Primarily the Patient data (EHR/CDR)◦ Want to use as needed, including unplanned uses
◦ Value of data relies on its computability
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
And ways of interacting with it◦ Open application APIs - Enable new apps to be
added at any time in a known way, e.g. care planning
◦ B2B service interfaces - e.g. lab data, EHR extract to DW, quality registers
And open knowledge engineering – develop microbiology result definition and terminology subsets…. Once, for the whole jurisdiction
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
Environment with (un-?)controlled cost characteristic
Cost characteristic is based on ability to modify the environment in a relatively fine-grained way, with the price relating to the true underlying cost of the component in question◦ Add / remove apps
◦ Change / add back-ends
◦ Add / modify connection points
◦ Reprocess data at will
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
With monolithic supplier, not only are the technical details outsourced, so too is the ability to control costs of incremental change◦ The cost of a change is what the supplier says it is
You are now invested in the supplier’s development path, not your own
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
No vendor lock-in
Free access to, use & reuse of data… forever
Incremental deployment of components according to customer timeline
Direct clinical engagement (ask Norway!)
Control over costs
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
Copyright 2015 openEHR
1. Standard Information model
2. Standard content
definitions
Service API
B2B Service API
Service API
Service API
B2B Service API B2B Service API
Service API
Service API Service API
Service API
4. Standard
interfaces
3. Open terminologies
5. Semantic Querying
app app
other system
We don’t propose a ‘bag of standards’
Instead we propose a coherent platform definition, managed by a single .org entity◦ That defines many key elements – information
models, content models, guidelines,
◦ And sources others from elsewhere, and integrates them properly
IHE.net with openEHR profiles
IHTSDO, WHO, WONCA, LOINC etc
HL7 FHIR? CDA?
OMG RLUS, EIS
etc
Copyright 2015 openEHR
Most of the semantics come from clinical models (‘archetypes’ and ‘templates’) and terminology
These are built by clinical people (e.g. Norway MoH / Bergen…) in a crowd-sourced fashion
They ultimately define data-sets & value-sets
Which can be used to generate usable software artefacts
we no longer wait for some SDO to produce a standard for ‘discharge summary’
Copyright 2015 openEHR
Non-profit organisation based at UCL
1300+ Members from 71 countries
All specifications & schemas publicly available
Software open source (GPL, LGPL, Apache2)
Is to define (parts of) a health computing ‘platform’ that addresses these challenges:◦ Information and workflow complexity
◦ Constantlychanging clinical requirements
◦ A long-lived patient-centric EHR
◦ Enables diverse e-health vendor components and products to work together
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
The clinical domain generates most of the requirements◦ And is changing all the time
We therefore need to model the clinical domain to do sustainable ICT◦ Terminology models the ‘facts’
◦ We still need to model the information & workflow
openEHR enables a model-based tool chain for building sustainable software solutions
Copyright 2014 openEHR FoundationCopyright 2014 openEHR Foundation
Nr semantic definitions huge and constantly growing – O(1E6)
Nearly all semantic definitions only doable by domain professionals◦ Not IT people
Number of technical expressions substantial and always changing – O(1E2)◦ Prog langs, various XSD, JSON, UI, …
Copyright 2014 openEHR Foundation
We need to enable domain professionals to do the semantic modelling directly◦ special tools and formalisms
We need to do the models upstream of the technical representations◦ requires model software transform tools
We need to build systems that accept generated model artefacts… forever
Copyright 2014 openEHR Foundation
Copyright 2012 Ocean Informatics
Deployed
system
consumes new
content definitions
... forever
Forms and
messages formally
based on content
models
Copyright 2015 openEHR
1. Standard Information model
2. Standard content
definitions
Service API
B2B Service API
Service API
Service API
B2B Service API B2B Service API
Service API
Service API Service API
Service API
4. Standard
interfaces
3. Open terminologies
5. Semantic Querying
app app
other system
The road ahead is a process not a product
It’s an ecosystem not a monoculture
Copyright 2014 openEHR Foundation
http://www.openEHR.org
http://www.openEHR.org/ckm
Copyright 2014 openEHR Foundation