Healthcare change: why “Open Source” is part of the recipe..
We have explored the key elements required for healthcare reform, the critical role of health IT therein.
We have also noted the challenge in aligning clinical process improvement efforts with the right service oriented architecture for healthcare.
We have noted that important international interoperability standards are emerging, while aware that real change and innovation must be fostered from the bottom up. After some recent efforts attempting to bridge this important gap, my conclusion is that there is now an important role for open source IT to support health IT. Let me explain…
Having begun my work within the NHS CfH National Programme for IT usability testing within a Model Community, then exploring generic clinical processes to identify common generic health IT requirements… my work then evolved into clinically leading an effort focussed on “clinical content” within the health record and related standards.
Though the scale of the challenge was large, in Cynefin terms considering the almost chaotic state of clinical documentation in an health system as large as the NHS, the solution was simply to take a lead and look amidst the complexity for some important patterns that should be harnessed.
Those key patterns were quickly evident thanks to the important work that had begun by the Royal College of Physicians (in conjunction with the Academy of Medical Royal Colleges) around Clinical Record Keeping standards. In achieving professional consensus around the headings that should be used for 3 key clinical documents, i.e. admission, handover and discharge documentation across the NHS, the focus of our efforts towards supporting key clinical processes with clinical information standards was clear.
We took those clinical headings and over a series of iterative workshops with frontline clinicians developed a maximal dataset that detailed related common clinical statement patterns.
Following earlier work on best fit between clinical process and health information architecture standards, we then passed these clinical standards to our technical standards team who dutifully took our requirements and design and built related openEHR archetypes and templates to match these requirements.
These nationally agreed clinical and technical standards were then passed to the vendors so they could consume them within their own systems, so they could be used at the frontline….
..Which is where the cycle of development stalled..
The fact that this single professionally led, process improvement effort with IT stalled tells us several very important things about the current state of health IT;
That efforts to follow a waterfall approach to requirements, design and build of health IT standards get you so far. but a paper based standard is of limited value.. the challenge is in the implementation.. i.e. “the last mile”.
..As while your vendor may promise “interoperability” and adherence to important standards, their currently proprietary architectures make it challenging for them to reuse those emerging components from international standards efforts (e.g. archetypes, terminology etc). They may not be able to, they may not want to ..either way it reflects the current state of the market…
..Therefore those clinicians looking to innovate at the frontline, showcasing healthcare IT with related standards and pioneering semantic interoperability in action are also constrained..
Therefore.. it is my considered view that to address these key challenges, a radical shift in the health IT industry may be required.. which may be facilitated by emerging developments from the open source world.. While I understand that this is, at the present time, an uncommon view, let me return to where I started…
Healthcare needs to change, with clinical leaders tackling process improvements, supported by information technology and standards that add value. .
Equally Healthcare IT also needs to change, away from competing with proprietary technologies , towards an open architecture and platform for healthcare innovation…so that the industry moves to competition based on the services that are provide and the value that they add.
While this change will affect the international standards bodies, commercial partners and frontline innovators, it may emerge from several directions. We have already noted a gap between the aspirations of the international standards bodies and the realities of interoperability at the frontline. Therefore it would appear that greater collaboration between the international health IT standards community and those attempting process improvements at the frontline via a shared open source effort could be fruitful next step for all concerned..
With that in mind, I have in most recent times taken a clinical lead on two open source health IT projects which I should mention…
The first named Opereffa (openEHR REFerence Framework and Application) which, via my research links with the openEHR Foundation and UCL in London, is an open source effort aiming to showcasing openEHR archetypes, templates, SNOMED terminology and HL7 messages in action within a web-based UI environment.
The second, codenamed Prottean, is an open source clinical portal effort based in Leeds Teaching Hospitals NHS Trust which is being developed as part of a broader service improvement with informatics strategy. Aimed as the key user interface for clinical users it will provide the frontline with an iterative approach to systems integration and addressing the “clinical 5”.
Both are leveraging the open source Eclipse platform.. a close relation of the important openHealthTools.org initiative which I believe offers a very important opportunity to support the healthcare reform challenges ahead…
NHS eHealth open source ecosystem
Open Health Tools
RCP/AoMRC Clinicians guides to medical record standards