HANDI-HOPD

HANDI Open Platform Demonstrator
www.handihealth.org
www.woodcote-consulting.com
ewan@handihealth.org
ewan.davis@nhs.net
Ewan Davis – Director HANDIHealth Community Interest Company, Director
Woodcote Consulting, Consultant to NHS England Open Source Programme,
Member Health and Social Care Council TechUK

The Changing Landscape
• An imperative to harness digital
technology and Big Data to address health
and care challenges
• The Internet revolution
• A proliferation of apps and devices
• A consumer health revolution
• From organisational to patient centred

The Changing Landscape
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
Ecosystem Features
• Operates under shared Governance (nobody owns it – Like the
Internet)
• Based on open interfaces, open standards and open content
• A new “Open Source” approach to clinical content standards
• Facilitates clinical and frontline engagement
• Vendor and business model neutral but naturally avoids lock-in
• Separates Information and knowledge from apps
• Allows evolution, survival of fittest, hybridisation and speciation
• Creates a new culture, new approaches and new commercial
opportunities
HANDI-HOPD
• A learning and experimental platform to
explore the ecosystem
• A platform for agile user-centred design,
clinical engagement and Code4Health
• No live use, using only fictitious personal data
• Based on open standards and proven
industrial strength components
• Open to all-comers – No religious wars
• Transferable to operational use by others
• Consistent with global developments

HANDI-HOPD – Simplified Archetecture
HSPC: SMART on FHIR on Clinical Models
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Currently Implemented
• OpenEHR repository (Marand)
• Open source OpenEHR archetypes
• Test data from Leeds Lab
• Open source API supporting OpenEHR
service API, SMART and HL7 FHIR
• ITS terminology server (Indezen)
• Live Code open source app development tool
• Support for PRSB Headings
• Demo apps built at NHS Hackday
Commitment to Implement
• Open Clinical – Open source CDS based on
Proforma
• FDB Multilex drug knowledgebase
• OpenMaxims – Open source EHR
• Black Pear – Open Source FHIR engine on
MongoDB
• Our Mobile Health – Enterprise and consumer App
store and QA system
• Open Source ITK components
• Open source ePrescribing and meds management
suite
Proposed Implementations
• Alternate OpenEHR repositories (open
source and proprietary)
• GPSoC-R – APIs and test instances
• OpenEyes
• eObs
• IHE – XDS
• Alternate knowledge sources
• SPINE 2 and eRefferal test instances
• VistA
• Blue Button
Next Steps
• Building integrated frontend and user
workspace environment on Open Shift
• Implementation of additional components
• Create on prototype ePrescribing and meds
management apps as a further proof of
concept and demonstration of agile user-
centred design approach.
• Launch of HANDI-HOPD instance as platform
for Code4Health and open source system
showcase at NHS Open Source Open Day
26 November – Newcastle.

HANDI-HOPD
HANDI Open Platform Demonstrator
www.handihealth.org
www.woodcote-consulting.com
ewan@handihealth.org
ewan.davis@nhs.net
Ewan Davis – Director HANDIHealth Community Interest Company, Director
Woodcote Consulting, Consultant to NHS England Open Source Programme,
Member Health and Social Care Council TechUK
Woodcote Open Interface Definitions
www.woodcote-consulting.com/open-interfaces-open-standards-and-open-source/
1 Open
Standard
2 Open
3 Partner
4 Private
5 Closed

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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
Centre
HSCIC
Non
openEHR
systems
Archetype+ SNOMED Clinical Content
definitions
A new mobile
app
developer
requires plug
in for care
record to test
pulse app
functionality.
ITK+N3
Marand dev.ehrscape.com
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http://hopdscape-hopd.rhcloud.com/
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NHS Hackday - medsrecDIY
• Patient-driven medication reconciliation
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What did we set out to do?
• Create a patient-facing web-page for medication
reconciliation

• 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 onwards
transmission to GP
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MedsRecDIY: http://diy-hopd.rhcloud.com/

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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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Interop
Current clinical content
standards methodology
• Antithesis of „agile‟ development

– Inaccessible to clinicians
– Slow to develop, difficult to implement

– SNOMED has key but only partial role

• Uncontrolled methodology

– 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
• “Standards are a Barrier to innovation”
– Ewan Davis, HANDI

• 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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Web-based clinical review
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Archetypes: open source GitHub mirror

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https://github.com/ClinicalModelsUK/ckm
Industry / Profession-driven standardisation
‘distributed Governance’
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Implementation
Secondary
endorsement
Professional Endorsement
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FHIR + openEHR joint resource/archetype
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Links
• HANDI: www.handihealth.org @handihealth
• HANDI-HOPD: handi-hopd.org
• http://diy-hopd.rhcloud.com/
• http://hopdscape-hopd.rhcloud.com
• Marand Ehrscape API: https://dev.ehrscape.com/
• Leeds Innovation Lab Health Platform : http://leedslabplatform.com
• openEHR Foundation : www.openehr.org
• SMARTPlatforms: smartplatforms.org
• HL7 FHIR: www.hl7.org/implement/standards/fhir/
• International archetype repository: www.openehr.org/ckm
• UK archetype repository: www.clinicalmodels.org.uk
• My Blog Woodcote Consulting www.woodcote-consulting.com/blog
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