My experience in eHealth started as a suburban General Practitioner using an EHR application for prescribing and clinical notes, and then I moved sideways, becoming involved in building proprietary clinical software and a Personal Health Record. From 2000 I worked for 4 years in a single company that owned that PHR plus a primary care clinical application and a hospital application – the intent being that data created in one could be transferred between the systems, but we found it wasn’t that easy – for various reasons they all had different database structures, even within the same vendor! So if we have to do the same thing between disparate vendors in an environment that is more competitive than collaborative, the picture becomes infinitely more complicated.
In more recent years, I have had my world view shifted from the traditional application-drive EHR to a data driven health record (note the deliberate lack of capitalization) – see my previous blog posts. Once we focus on getting the data right, capturing it or displaying it in the applications are just one of the many things we can do with the data.
Why? I first heard about openEHR nearly 10 years ago. I didn’t understand openEHR at all initially, but there was something in the commonsense of getting the foundation data defined and standardized that resonated with me. Over time I have become convinced that openEHR provides an orthogonal approach to eHealth that has a very reasonable chance of success, and more importantly, of making a difference. I no longer believe that the traditional application-driven approach to electronic health information management is effective, economic or sustainable.
Think of openEHR as the open source health equivalent of the iPod/iPhone platform – a technical framework which will allow any compatible application, organization or provider to share ‘plug and play’ access to standardized data. This is openEHR’s innovation – the focus on ensuring that the underlying health data is correct, robust and trustworthy!
Rich health data definitions known as archetypes, are defined and agreed by the clinicians themselves to ensure that each piece of health information is unambiguously understood, ‘fit for purpose’ and can be dynamically used & reused to support wise and safe health choices, now and into the future. These same archetypes are also computable, so that when these common data definitions are shared, they act as a ‘lingua franca’, making it much simpler to capture, store, aggregate, query and exchange health information – effectively making the data ‘sing and dance’ and to flow according to privacy and access rules.
Developed over more than 15 years through international research, community input and implementations, openEHR is purpose-designed as a non-proprietary universal health record: application independent, yet supporting accurate and safe health information exchange between software programs, consumers, health care providers, organisations and researchers; and across the diverse requirements of private/public providers and regional, national and international jurisdictions.
- It is open source – break down the proprietary silos of data created by application vendors.
- It is the basis for the recently published ISO13606 standard for EHR extract. openEHR evolved and grew away from 13606 approx. 5 years ago as 13606 entered the CEN and ISO standards approval process; openEHR has subsequently progressed and developed as a direct result of implementation experience. At present openEHR is the commonest implementation pathway for nations mandated to adopt the 13606 standard.
- It is driven by an international open source community.
- It has been developed using a robust engineering process.
- The clinical content is driven by the domain experts – usually, but not limited to the clinicians themselves – through the Clinical Knowledge Manager.
- Archetypes are designed as maximal data sets for the universal use-case so the same data definitions can be used in any software application – whether a PHR, EHR, research project, clinical decision support system or running population queries.
- It is purpose-designed as a shared health record.
- The structured archetype definitions complement other standards-related work – for example the recent announcement of a collaborative work program between the openEHR Foundation and IHTSDO to explore how the SNOMED-CT and openEHR archetypes can be combined to provide a strong semantic solution for health information.
Who is using openEHR?
Current eHealth developments are progressing at a glacially slow rate because we are trying to develop interoperability by traditional and incremental methods. I’m increasingly sceptical that this is effective, economic or sustainable. And in fact, though direct experience I have become convinced that openEHR’s orthogonal approach can make a significant difference. I now work with openEHR every day, including:
- alongside an international group of like-minded clinicians collaborating in their spare time in a Web2.0 application to develop, publish and govern the archetypes;
- with national eHealth programs who are seeking to build a library of clinical content definitions as a ‘single source of truth’ to mandate for use by vendors;
- with vendors who no longer have to reinvent the wheel but can take the published archetypes and re-use them within their systems; and
- with researchers trying to aggregate and integrate disparate data from multiple sources into one cohesive repository on which they can query their valuable data.
I’m not trying to sell you a software application like everyone else claiming an ‘eHealth solution’; I’m trying to persuade you to take a look at an alternative approach to eHealth, to share a little of my vision and my passion!
Consider becoming part of an international open source community. Contribute and collaborate alongside other clinicians, informaticians and techies to build something bigger than all of us. Share a vision of how eHealth could work better and more effectively if we get the foundations for a universal health record consistent and solid.
It. is. all. about. standardizing. the. data.