HANDI-HOPD

:
What’s in the box?

Software apps to support health and care - Supporting the app paradigm –
Creating a community of interest - That's HANDI

www.handi-hopd.org

Dr Ian McNicoll

HANDIHealth
openEHR Foundation
freshEHR Clinical Informatics

HANDI-HOPD Planning meeting London Sept 2014
INTRODUCTION
2
Ian McNicoll

Clinician
Former Scottish GP

Health informatics
Director openEHR Foundation
freshEHR Clinical Informatics
Ocean Informatics UK
HANDIHealth
NHS Scotland SCIMP

Commercial software developer
‘GP Accounts’

3
SMARTPlatforms
Pluggable Webapp
API
HL7 FHIR
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
Apps developers
What is an API?
• „Application Programming interface‟
• allows one application to „talk‟
directly to another.
• The app world runs on APIs
• how Gmail calendar talks to
Apple Calendar
• how my Train app knows “my
next train home”
4
What is in an API
• Modern API „restful‟ requests look like web
page url
https://api.twitter.com/1.1/statuses/user_timelin
e.json?screen_name=twitterapi&count=2

• and carries some
sort of
structured content‟
5
SMARTPlatforms API
6
• Scopes and permissions: OAuth2

• Simple sign-in: OpenID Connect

• Lightweight UI integration: HTML5
via Pluggable app framework
SMARTPlatforms : ‘Substitutable’ Apps
7
SMART-on-FHIR
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HL7 FHIR
data model

replacing

SMARTPlatform
s
data model
(RDF)
HL7 FHIR API
9
What is FHIR good at?
• Communication of information between
systems with limited querying

• Strengths
• Developer friendly
• Lightweight approach
• Great documentation / community
10
Where might FHIR be weaker?
• Not designed for persistence
• can work but will it scale?
• partial querying only

• Resources will not work „out of the box‟ in
the real world
• Need local extensions and profiles
• Version control / governance of the profiles
11
openEHR API
12
• Designed for storing and querying
rich clinical dataset

• New content is defined directly
by clinicians and can be immediately
uploaded into the clinical data repository

• Vendor-neutral data models
Technology-neutral data models

• Vendor-neutral data querying
Technology-neutral data querying
openEHR
• Weaknesses
• Complex technology
• but new simplifying APIs appearing

• Strengths
• clinically-led data modelling
• sharing archetypes = interoperability
• Enterprise strength performance
• Mature versioning/governance
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dev.ehrscape.com
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MedsRecDIY: http://diy-hopd.rhcloud.com/

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Vendor-neutral querying
Vendor-neutral querying
Vendor/technology-neutral platform
19
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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SMARTPlatforms
Pluggable Webapp
API
HL7 FHIR
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
Apps developers
Interoperability is not a tech problem
“The real barriers to practical interoperability are
cultural and clinical”

–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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Traditional Standards Process
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Clinical stakeholders
engage through top-down
governance

Committee-based

Late vendor engagement

Fixed review cycles

Unclear / unresponsive
change request
mechanism
Formal standards process is a barrier
• “Standards can be a barrier to progress”
– Ewan Davis, HANDI
– http://www.woodcote-
consulting.com/farwell-to-ruthless-
standardisation/

• Technical (ISO / SCCI)
– Still largely a paper and committee-
bound process
• No clear problem report/change
request mechanism
• Slow review cycles

• Professional (PRSB)
• Valuable clinical requirements input
• but distant from implementation
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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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GP2GP medication archetype
Web-based clinical review
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Archetypes: open source GitHub mirror

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https://github.com/ClinicalModelsUK/ckm
FHIR + openEHR joint resource/archetype
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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
governance role
Evolutionary standardisation
‘distributed Governance’
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Implementers
Secondary
endorsement
Publication and Secondary Endorsement
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Project editors decide on
formal publication, acting as
“Benign Dictators”

Professional bodies, vendors
and PRSB may Endorse a
resource as a secondary
exercise

this does not restrain the
formal publication process
“By Royal Appointment”

PRSB hires and fires Editors
Blogs
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http://www.woodcote-
consulting.com/farwell-
to-ruthless-
standardisation/
http://coiera.com/201
3/11/01/are-
standards-
necessary/
… “That the fraction of standards
produced that are actually complied with,
will with time asymptote toward zero”
Links
• twitter: @ianmcnicoll

• HANDI-HOPD: handi-hopd.org
• http://diy-hopd.rhcloud.com/
• hopdscape-hopd.rhcloud.com
• minimal-hopd.rhcloud.com

• Marand Ehrscape API: dev.ehrscape.com
• Leeds Innovation Lab Health Platform : http://leedslabplatform.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.uk
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