Stars begin to align for electronic health records

When Ed Hammond first began thinking about electronic health records, it was 1970 and he was working on a minicomputer.

At the time, he thought EHRs would be something that could be developed in a couple of years, would come into widespread use very quickly and then the healthcare industry could move on to solving other problems.

Forty-two years later and we are still struggling with the complexities of EHRs, but according to Dr Hammond, the stars are now starting to align. The EHR is now set to be “the killer app of the future”, he says.

Dr Hammond, professor emeritus and director of the Duke Center for Health Informatics at Duke University in the US, is widely considered “the father of HL7”, the organisation responsible for managing standards for electronic messaging and clinical document architecture, amongst others.

Dr Hammond was in New Zealand this week as a guest of the University of Auckland and Health Informatics New Zealand (HINZ), and he is paying a brief visit to Sydney on Monday, July 2, to give a talk at HL7 Australia's seminar on the future of eHealth standards.

Despite those 40-odd years of hiccups and slow progress, Dr Hammond said he believed we are now reaching the point where the EHR can begin to have a significant impact upon an individual's health and quality of life.

“We are expanding the community, starting with genomics, through clinical trials, through patient care and public health to population health,” he said. “A killer app is when all of that comes together and we are going to see a much more satisfied population, a much more informed population, a population that is aware of the importance of behaviour changes.

“The killer app for EHRs should accelerate our ability to solve problems and make the use of technology ubiquitous so that it becomes part of how we work as clinicians and manage our own health."

Dr Hammond said better connectivity is part of this momentum, as is an increased awareness from consumers but also other stakeholders such as payers and providers of care, managers and administrators of the importance of healthcare information. "All of that is coming together and we are beginning to understand that having data collected once but used for many and continuing purposes is extremely important," he said.

At the HL7 Australia seminar, Dr Hammond will talk about new developments in healthcare standards such as the openEHR movement, the Clinical Information Modelling Initiative (CIMI) and FHIR, the fast healthcare interoperability resources developed in the last year or so by Health Intersections consultant Grahame Grieve.

FHIR – which seminar organiser and former chair of HL7 Australia Klaus Veil calls “the latest trending interoperability technology that has taken the eHealth world by storm” – was developed by Mr Grieve as a new strategy to make using interoperability standards faster and easier.

Mr Grieve said FHIR defines a set of “resources” for health which represent granular clinical concepts that can be exchanged.

“It's an IT term which just means a piece of known content that has its own meaning,” Mr Grieve said. “HL7 has done a lot of past work on figuring out what information is required for exchange within the different parts of the health industry. We just have to figure out the best way of packaging them up.”

Mr Grieve believes the real target for FHIR will be in the work being done on mobile applications for healthcare using devices such as the iPad and Android. “Right now there is no standard way for them to talk to the back-end servers in the cloud, so I think ideally that is where we will first make an impact, providing something easy for them to use in developing mobile platforms.”

Mr Grieve and his colleagues are organising a connectathon in Baltimore this September to explore the potential of FHIR with vendors. “One of the problems that HL7 has had for 15 years is that the government projects and the academics have become too influential in the specification design,” Mr Grieve said.

“All of these problems are real problems but you have to solve them with real solutions. If we think we are producing a specification that is easy to use we had better make sure of that by using it. So that's the grounds for having the connectathon.

“It is not to prove that we have solved problems, because we haven't done that yet, but it is just to prove that the framework is easy to make work. There is a bunch of people around the world who are pretty excited about this and they are coming along to prove whether it is easy or not and we'll make sure that what we deliver back to the users is what they can easily make to work.”

Also being discussed at the seminar is openEHR, which is developing specifications, open source software and tools to develop a knowledge-oriented computing framework for healthcare.

Dr Hammond believes the movement is hugely important, particularly for its role in helping to develop a semantically enabled health computing platform in which complex meaning can be represented and shared.

“I have long thought that creating a terminology set that really was understood by the people who were using it was extremely important,” Dr Hammond said. “For example, in 2000 we were trying to create a disease registry for patients at Duke University Medical Centre who had diabetes so that we could make sure they received the appropriate testing, care and control of diabetes.

“In 2000 we were finding it impossible to create that registry simply because we didn't have a common set of terminology for data elements. We are still struggling with making that happen. I think that with openEHR, the major contribution now is a very rich toolset, a very rich model that really begins to allow us to create not only the data elements – they use the word archetypes – but they are beginning to add other attributes to the archetypes that I think make the beginning of interoperability possible.

“If we don't solve the problem we will never have the sort of interoperability that makes the EHR a killer app. I think they have made very good progress and what I'm hoping will happen in the future is that many of us will take advantage of the work that has been done, and openEHR will take advantage of some the other environments created by other groups, and together we can begin to solve the initial problem of language and communication in healthcare.

“If we do that, then I think a lot of the other things will follow, everything from clinical guidelines to decision support to knowledge extraction from clinical data warehouses – for all that it is necessary to have the right building blocks. There has to be the solid foundation if we are building a house that will stand. And I think that openEHR is a leader in this field.”

The HL7 seminar on eHealth standards of the future will be held at the offices of Standards Australia in Sydney. Register online at HL7's website.

Posted in Australian eHealth

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