In our series of Indian Electronic Health Records posts, the next aspect we intend to analyze is about shared clinical information models for semantic interoperability. One of the major purpose that healthcare information systems should serve is the optimum delivery of healthcare services and treatment programs. Since healthcare is not just a temporary event or happening but a perpetual affair that covers the entire lifespan of a person, the need to bring in interoperability standards for healthcare information systems becomes paramount.
Interoperability of data in IT systems works on two levels – syntactic and semantic. The former is transactional and is defined at the interface layer and often as an afterthought to exchange information between independently designed systems, whereas the latter is achieved at the design stage of software and ensures a more meaningful data exchange that includes both information and the context of the information. A true EHR system should not just do the former, but should be designed to deliver the latter
The Ministry of Health and Family Welfare(MOHFW) has taken a staged approach to enhance large scale adoption of the EHR technology, provide optimum security of health information, implement specifications, consider factors to improve interoperability and ensuring semantically interoperable EHR for Indian citizens. The Indian EHR standards includes pointers, such as OpenEHR, to the direction that the country is projected to move.
Since there are many clinical systems already in place, the first phase in pushing for EHR adoption is to define an exchange format and convert the proprietary data into that format as needed. Here the focus is on the applications and interface design, with no thought given to the underlying data. The second phase should be to standardize models for health data first and build new EHR systems on top to avoid interoperability issues completely and achieve semantic information exchange. This entails defining a shared set of clinical data models for newer EHR systems as the starting point.
As the pace of EHR adoption picks up, most healthcare organisations are beginning to realise that their data is more valuable than their applications. Since good data is key to improving outcomes, managing chronic disease and enabling population health management, it is becoming the key asset in their armory of tools. This key asset needs to be managed for the lifetime of the patient, when we all know that applications are not going to last that long. The question all of them are asking is ‘what happens to health data when we switch applications?’
The solution to the above problem is to turning the focus from applications to data. Imagine if the proposed National Health Stack for India builds on it’s common resources to include shared clinical information models that cover varied aspects of healthcare to support an Integrative healthcare paradigm. Imagine if instead of building applications, the government were to standardise models for health data? While it is unrealistic to expect that any application could cover the diverse requirements of healthcare, it would be possible to define a common set of clinical information models to support several different solutions. This would provide different stakeholders with choice of applications and vendors while at the same time delivering on the goal of making health data interoperable by design. It would also prevent vendor lock-in by making healthcare applications easier to interoperate and replace, while eliminating the high costs of data migration.
Our EHR.Network platform has been designed with this philosophy of shared clinical information models. It has been designed in line with the OpenEHR Reference Model and is designed to work with any OpenEHR Archetypes & Templates. Applications built on EHR.Network will remain future proof, portable and interoperable. We already incorporate a large number of clinical models from the International community governed Clinical Knowledge Manager(CKM). Apart from the cloud hosted public platform, we offer EHR.Network for collaboration and co-creation to build modern healthcare applications. Please contact us to know more.
OpenEHR is a virtual community of technology and clinical domain professionals working on developing specifications for ensuring Universal Inter-operability of all electronic health data. It’s approach is multi-level, single source modelling within a service-oriented software architecture, in which dynamic models built by domain experts(Archetypes & Templates) and stable information model built by technologists exist at different levels within the application. Using OpenEHR specifications, it is now possible to build an EHR repository independently of content specifications enabling a new generation of EHR systems that routinely adapts to new requirements.