ian presentation

7/31/2019 Ian Presentation

1/18

Interoperability:

Data for apps-

Apps for data?

Dr Ian McNicoll

openEHR Foundation

Ocean Informatics

www.handihealth.org


2/18

Interoperability: Data for apps

Platform/infrastructure/API

To move information between systems

or even within complex systems

Tocommunicateclinicalcontent

Technical interoperability

Standardised transport = just a pdf

Syntacticinteroperability

Standardised format = .xls

Semanticinteroperability

Standardised computable meaning


3/18

Lesson 2: UK is not a coherent

space English NHS

The Spine, SNOMED, HL7v3, some CDA

Celtic NHS

Spineless, SCI-XML, SCI-Gateway, Ensemble Welsh / NI/ Scottish variants

No formal commitment to SNOMED (yet)

Lesson 1: Interoperability - Its not

easy

Lesson 3: There is no simple, single

solution

Complexity is to IT as gravity is to space-rockets

Clinical recording requirements must reect highly

contextual, culturally-dependent clinical practice

Innovation at the heart of clinical practice and

change is a constant

Butweknowwhatdoesnotwork


4/18

Ruthless top-down standards Clinical domain is just too complex

Top-down cannot move fast enough

Lets just start with the important stuff? One professional groups minimum dataset is

anothers needless complexity

Standards must emerge

to meet a business case


5/18

Leave it to the experts

Clinicalexpertgroups

Diabetes, IHD, Stroke datasets

ClinicalProjectsgroups Discharge, Emergency summaries, GP2GP

Technicalmodellingexperts

Tend to want to impose abstract patterns to promote

technical re-use at expense of clinical/human

understanding


6/18

Ruthless Ontology ? SNOMED-CT

Wejustneedtounderstandallthethingsinour

worldandtherelationshipsbetweenthem

Workswellforreal-worldentities Drugs, diseases, procedures, organisms

for inferencing and authoring

Criticalpartofthestory

But not the whole story


7/18

What does a HANDI App need?

Anenvelope

Push (Message envelope)

Pull (API)

Terminologycodes

Existing, New

Richstructuredcontent

Existing, New

Persistenceformat

Local Long-term queryable storage the EHR

So whats out there? Push (Message) envelope

Pull (API) envelope

Codes / Terminology

Rich structured clinical content Persistence format


8/18


9/18

SNOMED-CT

Pre-coordination

Widespread GP use via Read codes

Post-coordination

Powerful but can hurt your brain

Codesmustlivewithinstructure

Context : Who, what, where, why

Often more subtle

e.g. End of Life Care plan

Codes / Terminology


10/18

Structured clinical contentMSHealthvault

Proprietary, limited content, PHR focus

HL7v3templates

Difcult to author, understand, limited content

NHS England, CCD / CCDA (epSoS/ US)

Archetypes

openEHR / ISO13606 / CIMI

Clinically authored, governed

Open specication licensing

Designed to be plug and play


11/18

What is openEHR?Not-for-prot Foundation based at UCL delivering Open

specications for a clinical information model allowing

commercial and open source use www.openehr.org

Collaboratively develops open-source clinical content

specications based on

Archetypes

Templates

Termsets

www.openehr.org/knowledge

Archetypes

Computablemodelsofdiscreteclinicalconcepts

Maximal data set, Universal use case

Include bindings to terminology

Familiarcomponentsofahealthrecord

Blood pressure, Body weight

Medication order, Family history Prostate cancer histopathology result

Designedforpersistence

Use within apps as well as between apps


12/18

Archetypes: Apps for data

Clinicallyandcollaborativelyauthored

Direct governance by clinical informaticians

Open standards CC-BY-SA licence Secondary assurance by professional standards

groups

Agilitytorespondtochangingclinicaldemand


13/18

Adverse Reaction archetype


14/18

Structured clinical content


15/18

Archetype re-use in openEHR

Template


16/18


17/18

Whats next?

Push (Message) envelope

Pull (API) envelope

Codes / Terminology

Rich structured clinical content

Persistence format


18/18

JOIN US!

Come and help us

Join our local clusters Follow us @handihealth

Watch #handihealth

ian presentation

Documents