Standards or toilet paper? A Linus Torvalds reality check

Linus Torvalds, rightly praised for his literary flair and subtlety, serves up a classic today, on the topic of standards and when to just forget about them.

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Major German research project chooses openEHR

I just returned from Heidelberg, where another very successful ‘openEHR day’ was held, this time by the HiGHmed research consortium, with 100 attendees. HiGHmed is funded with 20m€ by the German Federal Ministry of Education and Research (BMBF) under the “Medical Informatics” funding scheme, and has as its goal (my bolding):

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Will the tech giants ever succeed at e-Health?

Amazon, Apple, and Google are all having another go at e-Health. But we have been here before: remember Microsoft HealthVault? It’s still around, and still hasn’t taken off. Google Health went live in 2008, but was retired at end of 2011, due to ‘lack of adoption’.

Fast forward to 2018, and we see Apple, Amazon, Google and Uber making new e-Health plays. Initially each corporation will probably work from its strengths – retail delivery for Amazon, booking for Uber, data for Google, and devices for Apple. In the US at least, some of them will build their own healthcare providers for the workforce, and use the environment as a place to work on next-generation health IT solutions. Some challenges, particularly in the devices area, will undoubtedly see progress – there is no doubt that the tech giants do some things really well.

But I remain sceptical about overall success.

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openEHR REST API 0.9.0 out for comment

The REST API Team (Bostjan Lah, Erik Sundvall, Sebastian Iancu, Heath Frankel, Pablo Pazos, and others on the openEHR SEC and elsewhere) have made a 0.9.0 Release of the openEHR ITS (Implementation Technology Specifications) component, in order to make a pre-1.0.0 release of the REST APIs available for wider comment.

LINKS: The generated Apiary documentation can be found here, while the .apib files are here in Github (see mainly the includes directory).

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The open e-health platform, coming to an economy near you

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.

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openEHR Task Planning – heading for implementation

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.

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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


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.

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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 – 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.


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