I’ve been silent for a while, but luckily an excellent paper on one of my favourite topics – the open platform for e-health has appeared. It comes from the Apperta Foundation, and is called “Defining an Open Platform”; you can get the PDF and also comment here.
We’ve made a lot of progress since my last post on this topic. We have published a 1.0.0 version of the openEHR Task Planning specification, which will go into implementation immediately in the City of Moscow e-health project. The current version will certainly be changed by that experience, but we believe is good enough for use in implementation, having been reviewed and worked on by our development team, including people from Marand (provider of the Moscow EHR platform implementation), DIPS (largest EMR vendor in Norway) and others from Tieto (Finland) and Moscow.
We are currently looking at creating a visual language for it, of which the above diagram contains initial ideas for the TP conditional structures on the left, with BPMN equivalents on the right.
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:
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.
Ler en Español (traducción – Diego Boscá Tomás)
日本語で読む（Shinji Kobayashi による翻訳）
中文 (Lin Zhang)
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.
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 – 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.
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.
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.
wolandscat