At last the “E” word is out in NZ! We have a national EHR project…Now what?

Dear all, it has been a while…A lot has happened since my last post which was from Medinfo 2015 conference in Sao Paulo. Well it was a blast (and I mean it!) for openEHR. Being a sponsor of the event and having our own booth it was a new milestone for our international community. You can check out the various activities and presentations from this link.


R>L: David Ingram (Emeritus Prof. UCL, openEHR President of Board of Governors; unbeatable Ed Hammond – father of HL7; Japanese colleagues (Dr Hiroshi Mizushima, Chief Senior Researcher of Center for Public Health Informatics in National Institute of Public Health and Shinji Kobayashi now joint-lead of openEHR Localisation Program; and myself)

The Brazilian national EHR project is strongly underpinned by openEHR and it was eminent during the whole event.

Before the conference I spent a whole week in Manaus, the capital of Amazonas state located in the middle of vast jungle! We are working with the State University of Amazonas (UEA) on a care integration project with some concrete telehealth and mobile technology demonstrators. We will be using openEHR for eliciting information requirements and for creating a core record structure.


Amazonas Project team meeting at a great venue: Samsung Ocean Lab

Now back to down under, our precious little big cute country…Yes at the recent HINZ 2015 conference the Minister has formally announced the national EHR project. Rumor has it that this particular acronym was a real tabu in the previous administration and I think it was a wise decision. Now that NZ has achieved a lot in the health IT space I think we can confidently say “we can do it mate!” and with classical Kiwi twist: in whooping 3 years and without major investment (that’s my guess!). The recent independent review report provides a great overview of where we are at the moment pointing out in good detail strengths and weaknesses of our current system. However can you believe there is no mention about standards – as I always try keyword searching in such documents: openEHR: none (well not a big surprise), FHIR: none (now that’s a surprise) and HL7: none (well wasn’t expecting that!). OK governments and their contractors a bit scared of interoperability standards but hey there’s the terminology standards: ICD and SNOMED: none! That is a bit odd and most probably deliberate.

Well I’m not going to bore you with more details – the full report is here.

My take on this is that the hospitals in NZ will need to step up and get decent EMRs and we will also have a single national EHR that will aggregate person centric data from various systems. Unlike many other nations our primary care health IT is in much better off than hospitals for various reasons and this report rightfully makes it clear there’s a lot to gain to lift the game in the secondary care sector. Nevertheless they prescribe one or two vendor products in this space (it doesn’t leave much to imagination who these could be 😉

Now final words: I firmly believe openEHR is well placed at the two opposite ends of the interoperability game (as opposed to what is commonly known as the middle-out approach in the HIE centric virtual EHR architectures).

  1. Bottom-up: working with clinicians and other stakeholders to elicit our national clinical information requirements, most probably providing input for FHIR profiling for Health Information Exchange.
  2. Top-level: the national EHR backbone should be openEHR based. We already have many national programs running scalable industry solutions – see this recent whitepaper for adoption patterns. Clearly there is no other standards based alternative. Of course we can also adopt a monolithic solution’s model and hope for the best…Now that’s a real danger.

This can happen while big-guys take on the hospitals and deploy their fully integrated EMRs. I say this often and I’ll say again: no matter which approach choose we will have to do our homework: define our clinical information requirements! It is utterly naive to expect a single vendor or government to do it for us. And that’s what openEHR is about. Stay tuned…

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Just presented 1 of 4 talks at medinfo 2015 in São Paulo.

Check out @siljelb’s Tweet:

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openEHR: A Game Changer Comes of Age | Open Health News

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Thank you for your support :) Read on…

I’ve been elected as a member of the Management Board, together with Ian McNicoll. I just wanted to say thank you. Here’s a news item from the University of Auckland you can get more details from:

NZ researcher elected to openEHR Management Board – The University of Auckland.

And the formal openEHR link

We had our kick-off meeting last week and the amount of activity is amazing. I’m really excited about this!

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Linking Health Information to Computational Models using openEHR – The University of Auckland

Linking Health Information to Computational Models using openEHR – The University of Auckland.

Hi everyone, here’s a recent prezo I gave at my own institute around integrating clinical and engineering worlds…With an embedded underwater adventure story in it 😉 Hope you’ll find interesting and even useful…

early 2000s submarine Caroline of Institute of Nautical Archaeology around Aegean coast of Turkey.

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A new hope: upcoming openEHR Elections (ACTION NEEDED!)

Dear openEHRers,

The Foundation is about to undergo a significant change shortly and will have first democratic elections to constitute a management board. Proper (still very short) anouncement here.

Basically 4 members will be elected (2 industrial and 2 individual) by members who sign-up to the members website (need to pay Euro 15). Nominations will be closing end of Jan 2015 and voting will open on the 1st Feb 2015 and close on the 28th Feb 2015. I have put my hand up and now asking you to support me.

Have a look at the list of nominees together with short bio and statement of intents.

Among other things I will work hard to move forward interests of New Zealand health IT Sector with my other hats as vice-chair of HL7 New Zealand and a member of Health Information Standards Organisation (HISO) and the Sector Architects Group.

May be force be with us all!

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Season’s greetings for 2014 – End of year news

Hi everyone,

While packing my luggage for a family holiday in Oz I felt the urge to celebrate end of this year with you and share some news and wishes for 2015.

People keep asking me why such a great thing like openEHR hasn’t taken on the world. Fair enough – I hear repeatedly from people new to openEHR approach and mostly those coming from other sectors. I feel this is mostly akin to our community not being as commercially focussed as similar other SDOs and, to be honest, it has some learning curve. The best anti-example would be FHIR’s amazing success and adoption: simple to learn (I mean it!) and governed by HL7 (do I need any further qualifier here?). Well I have some good news, the openEHR community is bootstrapping itself and now preparing for first democratic elections. Under the hood a much more industry-driven and commercially sensible composure is being adopted and the four programs (specification, software, modelling and localisation) are putting in considerable effort to kick start some good work. Indeed some great work have already started mid year – thanks to funding from our industry partners there is intense Archetype development in progress. I think these are good first steps in the right direction.

What’s happening in New Zealand? I have previously posted (more than enough maybe!) quite a lot about the Gestational Diabetes Registry (an end-to-end openEHR implementation in collaboration with Counties Manukau DHB and Diabetes Projects Trust) and some modelling work with the National Cardiac Registry. Apart from these nothing much (that I’m aware of) really. Since the publication of the Interoperability Reference Architecture which depicted use of Archetypes to create a reference library of clinical concepts (called the Exchange Content Model) initial plans to share NEHTA CKM instance with Aussies didn’t happen. According to this any wire format, such as HL7 v2 message or CDA, would be derived from single source of truth: the Content Model. This would practically be a Kiwi CKM environment where we adopt existing international models and then adapt or create our own content. All I can say is the government is currently waiting to see what comes out of the collaborative effort (to work out a common Allergy/Intolerance Model) between FHIR and openEHR. Obviously the Exchange Content Model can be expressed by FHIR Resources and Profiles too. But I think the right way to approach this would be to use openEHR modelling for logical representation of the kiwi health record and then create corresponding FHIR Profiles (including Resources of course but also terminology bindings and other context constraints) from openEHR machinery. FHIR will be the wire format like v2 or CDA.

***Some FHIR musings below*** These are my personal thoughts

FHIR faces the same modelling challenges as openEHR but I think less equipped (from a modelling perspective) than openEHR. For example the distinct separation of Reference Model and Archetypes is traded-off for simplicity and in FHIR you’d see Resources (roughly corresponding to Archetypes) like Composition, List etc. which are expressed at RM level in openEHR. So you can still express stuff but when it comes to dealing with longevity and complexity of clinical information openEHR’s multi-level modelling is a more elegant approach. But having implemented FHIR myself this year at the HL7 New Zealand FHIR event I must say it is SO attractive! First of all the “implementer friendly” motto is not a lip service (which I thought it was before) and what is astonishing is any Web developer who’s comfortable with modern web development tools etc. can just do it. They indeed become fanatical about it. How cool is that?

So my take from this year is that FHIR is a great way to implement health information exhange and I think openEHR better suits to health IT environments where a high level of semantic precision is needed – such as advanced decision support or an integrated health information system or research/population health platform. This view has matured a lot since I got into Biomedical research – some of you may already have noticed I started a new role at Auckland Bioengineering Institute (while still part-time with NIHI). There is fascinating work going on, both in NZ and around the world, what I’d describe as Virtual Physiological Human. Basically to create a digital representation of human including ALL processes. I would strongly advise that you have a peek at this video. Digital Patient is also a related and popular topic where openEHR can be a good fit. Indeed the VPH-Share project funded by the European Comission has made extensive use of Archetypes to link biomedical domain with clinical data.

This brings the crucial importance of aligning content between FHIR and openEHR communities – having experienced the joint Allergy/Intolerance modelling effort and after a chat with Grahame Grieve this week it is clear it is not the technical differences of the two formalisms but the way their communities approach to modelling can be a real problem. So what I’m saying is if clinicians agree on a certain way to model things both FHIR and openEHR can accommodate it – no big deal. The issue is how to get the two organisations to the same requirements – this would be a challenge. Obviously CKM is a great tool for this and I hope FHIR community will realise it. I decided to put some effort in mapping existing Archetypes to FHIR resources in parallel with joint modelling efforts. If we fail to achieve this alignment, a golden opportunity will be lost – forever…Therefore my wish is to set openEHR on FHIR this year!

Featuring Grahame Grieve, David Hay, David Fallas and Koray Atalag

Unofficial Auckland HL7 – openEHR Summit: Featuring Grahame Grieve, David Hay, David Fallas and Koray Atalag

Merry Xmas and a very happy new year indeed…

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