1. Thomas Beale CTO, Ocean Informatics Copyright 2012 Ocean Informatics Tromso 27 May 2014

2. Copyright 2012 Ocean Informatics

3. Good European Health Record: requirements and EHR architecture 1992 2004 Synapses: FHR and Clinical Object Dictionary SynEx: middleware component architecture Medicate: remote asthma monitoring and alerts 6WINIT: wireless IPv6 EHCR SupA: revised requirements and architecture Good Electronic Health Record mNET: wireless demonstrator GPGC projects (1) EHR kernel services (2) legacy data transformation (3) diabetes extraction and merge Formal Archetype approach Release 1 Feb 2006 Release 1.0.1 15 Apr 2007 ADL -> CEN, ISO, 2008

4. Non-profit organisation based at UCL Established by UCL and Ocean Informatics in 2000 to own the IP Converted to a NFP owned by UCL 800+ Members from 71 countries All specifications & schemas publicly available Software open source (GPL, LGPL, MPL) Now Apache 2.0 Archetypes – CC-BY-SA

5.  Sep 2001 Specification development starts  Feb 2003 Formal Change Request system ◦ …196 CRs…initial schemas, implementations  10 Feb 2006 Release 1.0  2007 Release 1.0.1  2008 Release 1.0.2  2008 ADL spec  ISO 13606-2  … a lot of implementation  2014 ◦ ~8 commercial vendors ◦ CKMs in 5 countries + openEHR.org/ckm

6. Copyright 2013 Ocean Informatics

8. Copyright 2012 Ocean Informatics

9.  Platform-based consortia starting to appear ◦ Open health-services platform consortium  Harris, Intermountain, Cerner, VA,… http://healthcaresoa.org/ http://healthcaresoa.org/ ◦ CommonWell Alliance  Allscripts, Cerner, Athenahealth, …  App-oriented standards / specifications ◦ HL7 FHIR ◦ Harvard SMART  Large turnkey procurements still occurring, e.g. Denmark Copyright 2012 Ocean Informatics

10. http://tbkconsultblog.com/2014/01/08/why-the-e135m-deal-went-to-epicnnit/

11.  FHIR is the new hype ◦ FHIR evangelists say that CDA is dead in 2 years ◦ But where is the ‘EHR’ in FHIR?  IHTSDO ◦ SNOMED being re-oriented; ontological underpinning being added ◦ Agreement with LOINC ◦ ICD11 mapping  CIMI – clinical models Copyright 2012 Ocean Informatics

12.  openEHR.org ◦ 10 years early! ◦ The only platform today with a solid information model and system for content definition and terminology binding ◦ ADL 1.5 chosen by CIMI ◦ Tenders now starting to include openEHR ◦ 6 countries with CKMs (including Norway) Copyright 2012 Ocean Informatics

13.  These things no longer owned by 1 company: ◦ Public platform definition - ??? ◦ Public terminology definition – IHTSDO, WHO, … ◦ Public content definition - archetypes  How procurement can work ◦ Control points are now with procurement, if they want them ◦ If industry wants to be an active player, it needs to help build platform specifications  What’s missing: a common forum for platform definition Copyright 2012 Ocean Informatics

14. specify mandate implement procure deploy support develop procure deploy PLATFORM APPS SDOs, de facto NHS, MoH industry provider org industry app developers provider org confidence Representation of domain needs openEHR community

15. Copyright 2012 Ocean Informatics Apps EPR EHR PHR EMR Meds Repository Drug KB Terminology Server Terminology Server Service Directory Service Directory CDS Service Pathways KB Services/Repositories Infrastructural Services PDS/Record Discovery EWS ESB/Spine Security Broker

16. Copyright 2012 Ocean Informatics Apps EPR EHR PHR EMR Meds Repository Drug KB Terminology Server Terminology Server Service Directory Service Directory CDS Service Pathways KB Services/Repositories Infrastructural Services PDS/Record Discovery EWS ESB/Spine Security Broker

17. Copyright 2012 Ocean Informatics App dev 1 App dev 2 App dev 5 Apps Company A Company B Company D Company E Company F Company C Company H Open source C Company A Company D Company A Services/Repositories Infrastructural Services Open source A Company B Company E Company M

18. Buyer Copyright 2012 Ocean Informatics App dev 1 App dev 2 App dev 5 Apps Company A Company B Company D Company E Company F Company C Company H Open source C Company A Company D Company A Services/Repositories Infrastructural Services Open source A Company B Company E Company M

19. Copyright 2012 Ocean Informatics

20. Copyright 2013 Ocean Informatics Implementation Interface Proc (arg1: INFO_TYPE, ….) Func (arg1: String, arg2: Uid): INFO_TYPE 1. Service Interface 2. Information model 3. Semantic models ARCHETYPE TERMINOLOGY GUIDELINE

21. Copyright 2013 Ocean Informatics

22. Implementation Interface Implementation Interface Implementation Interface Implementation Interface Implementation Interface Implementation Interface Implementation Interface Implementation Interface Implementation Interface Implementation Interface Implementation Interface App-facing APIs FHIR? SMART? openEHR?

23. Copyright 2012 Ocean Informatics

24.  A semantic architecture designed to flexibly standardise: ◦ Data, Content structures, Terminology use, APIs  Content developed by clinicians  Build adaptive systems – software not dependent on content models  Make querying based on content, not physical databases Copyright 2013 Ocean Informatics

25.  A Services-oriented Architecture (SOA) designed to standardise how applications talk to systems ◦ APIs  And how systems talk to each other ◦ EHR Extracts ◦ Generated message schemas ◦ Generated document schemas Copyright 2013 Ocean Informatics

26. Concrete: GUI, messages, documents Use-case specific data sets - Templates Data Representation and sharing - Reference Model Theme-based models of content – Archetypes (library of content definitions) Querying Terminology Interface Discharge summary UI form Discharge summary content model HbA1C, phys. exam, meds list, vital signs etc Observation, Quantity, coded text etc Copyright 2013 Ocean Informatics

27. Copyright 2012 Ocean Informatics Terminology Reference Model Bindings RefSets ArchetypesTemplates Queries

28. Copyright 2012 Ocean Informatics Terminology Reference Model Bindings RefSets ArchetypesTemplates Queries Operational Template Java API C# API XSD Forms Message Def Document Def

29. Copyright 2012 Ocean Informatics Deployed system consumes new content definitions... forever Forms and messages formally based on content models