openEHR Task Planning – progress update

In openEHR, we’ve neatly sidestepped the issue of ‘workflow’ by using the term  task planning, which I think better corresponds to the scope we think we can manage. If we were to say we were writing a specification for workflow, it’s like someone in the construction industry saying, hey, we’re writing a spec for architecture, it’s going to be great … because workflow is sort of everything, or at least everything that moves.

Along with colleagues at Marand (Slovenia), DIPS (Norway) and Lanit (one of the Moscow mega-EHR implementer companies), I’ve been working fairly constantly on the new specification. The others all bring knowledge of use cases, current challenges and of course many great ideas on how to specify a Task Planning framework, while I bring some of what I have learned with the Activity-Based Design (ABD) team at Intermountain Healthcare, where I also work, as well as about a year’s worth of background literature research.  The guys at DIPS in particular have a lot of knowledge on concrete scenarios because of the close relationship DIPS has with the clinical sector in Norway, and their long-term experience in full EMR implementation, which is proving to be extremely useful.

The work is still in its early stages, and we aim to get anyone with experience and ideas involved. Nevertheless, our teamwork so far has helped knock out some errors from my original design, and show up limitations that have required further modelling.

We are starting to build formal Task Plans based on the specification, for particular use cases, including parts of Stroke management, R-CHOP (5 drugs x 5 days) chemo, routine in-patient drug admin, surgery follow-up and various other scenarios – this can be done as archetypes based on the new model, UML object diagrams, JSON text or by various other means. At some point we may think of a dedicated tool…

Some of the things we’ve added include:

  • new Task types like Sub_plan, Handoff, External_request;
  • form / data-set references for Tasks, to enable an engine to display forms that are required for Tasks;
  • context-switching semantics, for handling Handoffs and External_requests;
  • decision tree semantics.

The following is a sketch of part of a Task plan that deals with the seemingly trivial generic problem of when a clinical variable is needed (e.g. BMI CHADVASC) for making a decision, but the variable’s input parameters (e.g. weight) are not up to date.

This kind of thing is conceptually simple, but hard to express clearly in workflow languages like BPMN (YAWL does better, but still not ideal). There’s no guarantee we’ll get this or other challenges right either, but we’re looking very carefully at everything that has gone before, and trying to think outside the box. Similarly to the ABD group at Intermountain, we are relying on incremental implementation experience to prove the models properly as we go.

There is of course much more, which can be found in the specifications, or on the wiki pages (latest workshop notes, main page), if you really have no other life.

Feel free to join us by following these pages and the openEHR mailing lists.

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FHIR compared to openEHR

openehrvfhir

Ler en Español (traducción – Diego Boscá Tomás)

日本語で読むShinji Kobayashi による翻訳)

I see a growing number of organisations and individuals posing the old standards comparison question, today, in the form of: how does HL7 FHIR compare to or relate to openEHR?

It’s always fun to revisit this question from time to time, especially as some of the questioners are fortunately young enough not to know too much of the history of e-health standards. To understand the question requires looking at a few basic health informatics concepts. Below I’ve tried to do this as objectively as possible, but of course I know more about openEHR than FHIR at the detail level.

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Initial foundations for clinical workflow

Over the last 6 months or so I have been working on two projects, but one theme: implementing computable clinical workflow. For as long as I can remember, ‘workflow’ and ‘process’ are the main words that excite most clinical professionals in health informatics. They get mildly enthused about data, modelling tools, and applications, but what they really want is for the IT layer to help them work with other clinicians and the patient through time. From my point of view, they’ve always been right, but I’ve also thought we needed to get something working in the data layer to even have a chance at solving process.

elisabeth_geetruida_wassenbergh_doctors_visit

Elisabeth Geetruida Wassenbergh – The Doctor’s Visit

Today I think we have enough going in terms of a semantic health data platform in openEHR, and some of the smarter EMR systems, such as at Intermountain, Kaiser etc to consider the next layer. Serendipitously, I’ve recently had the chance to concentrate on the process question.

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Future of the EHR: adaptive clinical workflow support

In the time since I left Ocean Informatics (the company I started with Dr Sam Heard and others in the late 1990s), I have been working with Intermountain Healthcare as well as various other openEHR vendor companies, notably DIPS (Norway) and Marand (central/south-east Europe). With both groups I am working on what could be described as the next layer of the open EHR: process.

nice_chf_pathway

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openEHR technical basics for HL7 and FHIR users

openEHR_what_is_it

Recent discussions on the FHIR chat forum with various HL7 people around the topic of how openEHR and other architectural frameworks (e.g. VA FHIM, CDISC) could work with FHIR led to a realisation that some people in HL7 at least don’t understand some of the technical basics of openEHR. This might simply because they have not been involved enough to learn them, but now that we appear to be in the era of FHIR, in which no e-health solution can be without FHIR (according to the now pervasive FHIR hype), I would argue that HL7 now needs to understand some of the basics of the other major architectural frameworks and model-based platforms in e-health – all of which precede FHIR.

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e-Health standards – beyond the message mentality

thalori_monks_retreat

[a monk’s retreat near Thalori village]

I just spent a few days in Crete at an experts workshop of the European e-Standards project that aims to bridge well-known gaps in e-health standards and SDOs. I’ll comment on that effort in another post, for now I will just say thanks to Catherine Chronaki for the invitation, wonderful choice of venue and excellent workshop.

As is usual in these situations, being present in a beautiful place (Thalori village, southern Crete) with many interesting people (some old friends, others new acquaintances) and especially that vital ingredient: a world-class traditional band of musicians who played the paint off the walls of the Taverna until 3:30 am Saturday morning led to some new thoughts on standards (as well as a vastly improved appreciation of Cretan music).

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The e-Health platform as a standards integration project

platform_pontoon
[image: (c) 2014 Imogen Brand Rakers Photography]

I have argued for an open platform approach in e-Health for some years now, as have others (Ewan Davis’s Nobody Can Own the Platform post is a nice summary of the issue). It’s clear that the idea is starting to resonate in some places like the NHS, bits of ONC thinking, the VA, and in some other countries. But how can governments and other fund-holders go about realising an e-Health platform?

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