The document discusses challenges with achieving interoperability in healthcare systems. It notes that interoperability is difficult to achieve due to clinical ego, vendor lock-in, and differences in how information is structured between organizations. The document advocates for a more open and collaborative approach to developing clinical standards that involves stakeholders from all levels and allows for diverse models to be captured and incorporated over time through consensus building. This evolutionary approach could help address interoperability challenges by democratizing how clinical content is modeled to reflect real-world practice.
2. Why is interoperability so hard?
The ‘usual suspects’
Clinical ego, technophobia, vendor lock-in
Innovation, research
The consultant’s MS-Access database
Information granularity
‘Family history of breast cancer’
GP, Breast Cancer unit, Research Genetics Unit
Organisational constraints
Financial, Legal, Project timescales
3. interoperability
“It must be kept in mind that
interoperability implementation also
depends on social, cultural and human
factors within each organisation, region
and country, each system and each time
period.”
SemanticHealth EU report
10. Copyright 2012 Ocean Informatics
The maximum dataset: e-Cardiology record
Tertiary
Centre
Regional
Hospital A
Regional
Hospital B
eCardiology
RecordDiagnosis
BP
ECG
12. Building consensus
Diagnosis
BP
ECG
Diagnosis
Date of Diagnosis
BP
Systolic
Diastolic
Coded finding – “normal”
Exertion level
Cuff size
Position
ECG
Multimedia
Automated report
Regional
Hospital A
Regional
Hospital B
Tertiary
Centre
eCardiology
Record
13. Building consensus
Diagnosis
BP
ECG
Diagnosis
Date of Diagnosis
BP
Systolic
Diastolic
Coded finding – “normal”
Exertion level
Cuff size
Position
ECG
Multimedia
Automated report
Regional
Hospital A
Regional
Hospital B
Tertiary
Centre
eCardiology
Record
Diagnosis
Date recorded
BP
Systolic
Diastolic
Cuff size
Position
ECG
Automated report
14. Building consensus
Diagnosis
BP
ECG
Diagnosis
Date of Diagnosis
BP
Systolic
Diastolic
Coded finding – “normal”
Exertion level
Cuff size
Position
ECG
Multimedia
Automated report
Regional
Hospital A
Regional
Hospital B
Tertiary
Centre
eCardiology
Record
Diagnosis
Date recorded
BP
Systolic
Diastolic
Cuff size
Position
ECG
Automated report
Diagnosis
Event Date
BP
Systolic
Diastolic
ECG
Heart rate
PR interval
QRS interval
15. Building consensus
Diagnosis
BP
ECG
Diagnosis
Date of Diagnosis
BP
Systolic
Diastolic
Coded finding – “normal”
Exertion level
Cuff size
Position
ECG
Multimedia
Automated report
Regional
Hospital A
Regional
Hospital B
Tertiary
Centre
eCardiology
Record
Diagnosis
Date recorded
BP
Systolic
Diastolic
Cuff size
Position
ECG
Automated report
Diagnosis
Event Date
BP
Systolic
Diastolic
ECG
Heart rate
PR interval
QRS interval
MAXIMAL DATASET
Diagnosis
Date of Diagnosis (Event Date)
Date Recorded
BP
Systolic
Diastolic
Coded finding – “normal”
Exertion level
Cuff size
Position
ECG
Multimedia
Automated report
Heart rate
PR interval
QRS interval
17. Positively manage diversity
Democratise clinical content modelling
widest natural community possible
Web 2.0 “social network” applications
Capture content at all organisational levels
Include diverse models
Today’s outlier may be tomorrow’s standard
20. Publication and Secondary Endorsement
Project editors decide on formal
publication, acting as “Benign
Dictators”
Professional bodies, vendors
and PRSB may Endorse a
resource as a secondary
exercise
this does not restrain the formal
publication process
“By Royal Appointment”
PRSB hires and fires Editors
21. Publication and Secondary Endorsement
Project editors decide on formal
publication, acting as “Benign
Dictators”
Professional bodies, vendors
and PRSB may Endorse a
resource as a secondary
exercise
this does not restrain the formal
publication process
“By Royal Appointment”
PRSB hires and fires Editors
22. Clinical modelling core
Core modelling team with clinical informatics
leadership
Good understanding of openEHR paradigm and
appropriate use of terminology
Close involvement with international modelling
efforts
Web- based collaborative authoring
Formal tooling - ‘CKM’
Informal tooling - Wiki, GitHub
23. Building modelling capacity
Vendors (esp. clinical champions/ designers)
Professional clinical bodies
Academic units
Public health and reporting bodies
Ground level clinicians
build informatics expertise
Agile change request mechanism
Who do I contact if I need new content?