The approach that Moscow City Council has adopted to create an open platform to support health and social care services in Moscow which uses some of the same technology as the Code4Health platform would seem to have relevance to the UK and in particular is a good fit for the needs of emerging new approaches to the integration of health and social care like that recently announced for Manchester.
Many of you will know about HANDI-HOPD the HANDI Open Platform Demonstrator that we have been working on for the last few months, this has now morphed into the NHS Code4Health Platform launched by NHS England during eHealth Week in London this week (5th March 2015). However, what you probably won’t know is that one of the key pieces of technology available on the platform is the same as that which is currently powering the whole of the eHealth system in Slovenia and even more impressively Moscow.
The Platform deployed in these two places brings together OpenEHR www.openehr.org and IHE XDS in a very impressive way. And I believe provides a model for what we might do in the UK and even more interestingly aligns with the thinking in a number of UK city regions who are already looking at IHE XDS and/or OpenEHR and who in a number of cases have already implemented one or the other. However, the UK initiatives appear to know little of what’s been done in Slovenia and Moscow and in particular how XDS has been successfully integrated with OpenEHR, which I believe takes the capabilities of the platform to a new level – This blog aims to put this right.
One of our key partners in the Code4Health Programme who have provided the core of platform and open source components for the OPENeP Project www.openep.org are Marand, and they are also the company who provided the platform for both Slovenia and Moscow and it is from their charismatic CEO Tomaž Gornik that I draw much of my inspiration and information.
Before turning to some of the technical details I’d like to describe a little of what I understand of the somewhat different approaches in Slovenia and Moscow and the motivations behind them, as while both use what is fundamentally the same technical platform they came to the solution from different directions in ways which graphically illustrate the flexibility of the underlying technology.
Moscow City Council is responsible for pretty much all of the health and social services serving Moscow’s 11 million citizens covering broadly what we call primary, community and social care and outpatient clinics. Moscow is a complex environment and has large number of siloed legacy systems, which made interoperability difficult and created significant vendor lock-in of data and systems. Moscow wanted to separate data from applications and store its data in a vendor and technology neutral format and chose OpenEHR to do this. They piloted this approach using the Marand Think!EHR OpenEHR implementation (which is one of the components on the Code4Health Platform) and IHE XDS components from www.forcare.com. The same basic technology as Marand had already successfully implemented in Slovenia where the IHE componets were supplied by www.tiani-spirit.com . The pilot was successfully and the platform is now rolling out across the City.
While both Slovenia and Moscow have ended up with broadly similar solutions they reached this point from opposite directions. Slovenia started simply wanting to implement IHE XDS to allow sharing at a document level, but came to realise that this did not support their need for fine-grained structured data to support big data analytics. They solved this problem with the integration of OpenEHR. Moscow on the other hand started with a view they just needed OpenEHR, but were persuaded of the quick wins IHE XDS could bring with document level sharing and in particular its ability to mobilise documents already produced by legacy systems that would take some time to be replaced or upgraded to take full advantage of the power of OpenEHR.
In both Moscow and Slovenia the same proprietary components have been used to implement both XDS and OpenEHR. However, both have the comfort that because the data is stored in an open format, these components can easily be replaced if alternatives emerge which appear to offer better performance or value. Indeed this portability of data is something that HANDI have already proven in the creation of the Code4Health platform which required the data to be moved between two competing OpenEHR implementations.
Requirements and technology will evolve, but for me for now and the foreseeable future the approach taken in Moscow seems like the best bet for the integration of systems and information in the complex environment of health and social care across a city region. It brings the long-term benefits of OpenEHR, which has the capacity to put data into an open, fine grained, structured format that is technology and vendor neutral, with the tools to easily engage frontline clinicians and other Health and Care Professionals in its curation while delivering the quick wins with XDS that can ensure the right document is available in the right place at the right time to support safe, efficient care.