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The future of digital health depends on it being open

By Rachel Dunscombe, CEO of openEHR International

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With healthcare systems so pressured for time and clinical capacity, we need a digital health future that enables fast and precise decisions about a patient’s care.

Most agree the future of digital health largely rests on making joined-up data available.

Integrated data is also going to play a vital role in propelling tech innovations forward.

And, as we are hearing and experiencing from all corners of the industry, we need to leverage AI to unlock its full potential.

The consensus is getting effective data foundations firmly in place is a prerequisite to support these types of innovations, while recognising there are some barriers to work through first. 

NHS England shares the same views.

The Operational Planning Guidance released in April places a key emphasis on implementing strong digital foundations.

Just weeks before that it agreed to increase productivity in return for an additional £3.4bn investment for digital transformation in the spring Budget.

Traditionally, to risk stratify a patient, health professionals rely on hundreds of transposed data sources.

This is an incredibly complex undertaking which is costly, time consuming, and difficult to scale up.

I have experienced the complexity while being a chief information officer (CIO) and I have big reservations that continuing with the same approaches will undoubtedly delay progress, despite it being imperative that the NHS expediates digital programmes to relieve current pressures.

It’s time for a new approach using architectures that are built differently to solve the mounting capacity issues. 

A citizen-led approach that benefits everyone

openEHR enables healthcare systems to move away from organising records around systems to data that is centred around the person.

The powerful architectural concept accelerates digital transformation by securely separating patient data without the frictions of disparate data silos.

The result is one consistent longitudinal patient record that improves care coordination, outcomes, and population health.

Health and social care systems are realising that the longitudinal record or digital twin is the key to getting healthcare right for the individual and the population.

The development of the NHS App has encouraged citizens to start thinking in this way, too.

They expect to have access to their data, and they want to receive it in a unified way.

Evergreen growth and standards co-exist

openEHR is the best standard for data persistence and provides a platform for evergreen growth. 

What is recorded today will be data that health and social care professionals can still use in 10 or 100 years to risk stratify and manage long-term conditions through a person’s lifetime. 

My observations as a CIO were that systems weren’t evergreen because the data was hardcoded. With every new application, we had to start again with the data or rescue bits and put in a new data layer, causing huge frictions and costs to the trust’s overheads. openEHR is far more cost-effective because it is additive and can accommodate future technologies, but underneath, the data will remain valid and useful. 

There are many data standards in use across healthcare and they must work together to provide a functional system.

I used them together as an information practitioner, such as FHIR, SNOWMED, and OMOP.

I feel quite passionate about this area, and we’ve been doing lots of work to make improvements.

For instance, openEHR International has been working closely with HL7 on a number of FHIR projects including connecting smart FHIR and openEHR data sources together to surface in patient/clinician-facing apps.

In a recent joint announcement with Chuck Jaffe, CEO of HL7, we signalled our ambition to align some of our standards and specifications for the global good.

We hope this will enhance the choice and power of available software.

In the spirit of the two open communities, we’re looking forward to the discussion this signalling of intent will bring.

Supporting advanced healthcare systems in Europe

Europe is leading the way with the use of openEHR.

The interesting theme is that advanced healthcare systems are adopting the open approach because they are able to separate their data more easily and leverage it.

Catalonia is a flagship example of a bi-directional regional unified record.

The region has taken a semi-academic approach looking at the target architecture and how they should use it.

Academics from around the world collaborated to review the outcomes and openEHR was chosen as the data layer.

Now there are future plans to implement openEHR in other Spanish regions as well.

It’s been a rigorous process, but rather than a reflection on the pain of fragmented systems and data, it’s a reflection on what suitable architecture should be, and it’s been a pleasure to be part of it.

In the Nordics, there is a long tradition of openEHR, which is growing with lots of vendors.

Seven regions in Sweden are using it, and the Karolinska University Hospital has published a framework with an open approach.

It’s steeped in the country but with a variety of approaches and other regions are set to embark on their own transformation journey with openEHR. 

Slovenia has been using openEHR for nearly 13 years, and the most recent country to follow suit is Greece, which has signed an agreement to implement a shared care record for the entire country. 

openEHR in practice across the UK

Closer to home, we’ve been able to facilitate integrated care through read/write care coordination across OneLondon using the Better openEHR-based digital health platform.

It amounts to a footprint covering approximately 10 million people, five Integrated Care Systems, 1400 general practices, over 40 NHS Trusts, and 33 local authorities.

There are some really exciting things happening in Scotland and Wales too, where they are using openEHR for various use cases at a national level.

Certainly in the UK, we are seeing an increase in people moving towards openEHR and hearing more senior people within the NHS talking about architectural patterns for openEHR and the advantages based on experience.

It’s encouraging to see this shift in conversation at a time when the NHS is nearing breaking point and services need rapid transformation.

openEHR is the fastest approach to achieve it and put digital health on the path to a sustainable and promising future.  

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