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

HANDIHealth
openEHR Foundation
freshEHR Clinical Informatics
INTRODUCTION
2
Ian McNicoll

Former Glasgow GP

Health informatics
Director openEHR Foundation
freshEHR Clinical Informatics
Ocean Informatics UK
HANDIHealth

Commercial software developer
GP Accounts
HANDI Health CIC
A not-for-profit Community Enterprise
Company
There to support:
Developers
Health and care professionals
Patients, service users and carers
Apps: Lightweight Digital Tools
Not just about mobile
Narrow scope,a connected thing
Makes heavy use of pre-existing components
and services

Built using a well defined development and
deployment framework
Order of magnitude(s) faster and cheaper to
develop and deploy
Allows niche solutions and fail fast
What does HANDI do?
Lobby for an environment (technical, cultural
and commercial) in which apps can flourish
interoperate and be orchestrated
HANDI is agnostic
About
Platforms
Business models
Standards
Tools, services and approaches
Show the community the possibilities and let
individuals decide
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
UK increasing 4-countries engagement

Guerilla activity
Clinicians who code, #digidoc13
NHS Hackday
Renal PatientView
Feral departmental systems
Multiple MS Access databases
10
clinicians who code
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Code4Health
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The HANDI Vision

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Apps
EPR
EHR PHR
PHR
EMR
Meds
Repository
Drug KB
Terminology
Server
Service
Directory
CDS Service
Pathways KB
Services/Repositories
Infrastructural Services
PDS/Record Discovery EWS ESB/Spine
Security
Broker
Closed eHealth Platform
Proprietary Clinical Content / API
Proprietary value-
add components
Proprietary Querying and Persistence
Terminology
Server
Pathways KB
ESB/Spine
ITK Integration component
An open standards platform?
Closed OSS Closed OSS
Vendor D
Vendor B
Vendor C
Vendor A
API and messaging content based on open
source clinical content definitions
OSS
components
Vendor
solutions
Terminology
Server
Pathways KB
ESB/Spine
ITK Integration component
Commit
Retrieve
openEHR open Standards platform
Closed
source
Open
source
Open
source
openEHR
CDR
Vendor D
Vendor B
Vendor C
Vendor A
Open source Archetype-based clinical
content information / querying model
OSS Value-add
components
Vendor
solutions
Terminology
Services
Pathways KB
ESB/Spine
ITK Integration component
Commit
Retrieve
Query
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 the
way
Ewan Davis, HANDI

Technical (ISB / ISO)
Still largely a paper and
committee- bound process
No clear problem
report/change request
mechanism
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]
NHS Reporting
API
NHS
Care API
LCR apps
(Leeds)
openENT
(UCLP)
Clinical content
openEHR API integration [7]
EHRPaaS [9]
NHS API-
openEHR
Adaptors [8]
Professional
Records
Standards
Board
Professional oversight
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)
SMARTPlatforms
Open
APIs:
Leeds Clinical Portal via
SMARTPlatform APIs
OceanEHR Clinical
data repository
NHS HSCIC 13606 archetypes
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25
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
dev.ehrscape.com
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handi-hopd.org/demo
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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
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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HOPD in EhrExplorer
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
38
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
39
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