20210311

I veckans blogginlägg ställs frågan: Är ”openEHR”  framtidens IT-infrastruktur?
Hanna Pohjonen, med lång erfarenhet av IT-infrastruktur från en rad olika länder, menar att många av dagens Vårdinformationsmiljöer är gammalmodiga och låsta för både överföring av data mellan olika vårdgivare och regioner/kommuner och för nya innovationer. Hon menar att framtidens IT-infrastrukturer ska vara ”öppna miljöer” som både säkerställer säkerhet och flexibilitet. IT-miljöer där patienterna äger sin data, där det är lätt att koppla på olika moduler, regioner/nationer behöver inte vara beroende av ett företag eller en utvecklare. Blogginlägget är på engelska och väl värt att läsa!

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From monoliths to modules

Hanna Pohjonen

Traditional social and health care IT systems are not able to meet the ever-changing user needs or easily adjust to new ways of working. Novel and more flexible approaches are needed. Patient centricity and shared care require capabilities to build cross-organizational patient pathways, where data follows the patient and the progress of the pathway can also be followed. We need to be able to utilize data to its full extent in a semantically harmonized way across different systems and organizations: viewing document-based data from different sources is not enough anymore. The new needs include various clinical decision support, population level analytics and integration of social and health care data across all care delivery entities. There needs to be a possibility to acquire different parts of the system from different vendors, as no vendor can be an expert in all areas and regions prefer buying best-of-breed functionalities.

The vendor and technology neutral openEHR data model is revolutionary in the social and health care IT market: the openEHR data model makes applications semantically interoperable. The future social and health care records will not necessarily be vendor-specific monoliths, where the user interface, business logic, data repository, data model and workflow are bundled in the same proprietary software.  In the future it will be easier to split social and health care record functionalities to separate modules that can be provided by multiple vendors.  Each functional module stores the data to a shared openEHR data repository using standard APIs and the data are immediately available for another module – within data privacy and security rules.  A common user experience (UX) is often provided to get access to the functionalities of different modules. It feels as if you were using one system. A well-determined architecture and governance rules are important factors for ensuring a successful ecosystem. In open ecosystems the patient owns his/her data and can share them with the relevant parties: citizen apps can be built on top of the same open platform.

When modules are designed with the openEHR principles it is possible to add new modules when necessary or even replace a module with an equivalent one from same or another vendor. Social and health care records can be changed in a more controlled way without a cumbersome migration – resulting in remarkable time and cost savings. This approach also diminishes the risk for losing information. Furthermore development of smaller and specialized modules is faster and niche functionalities can be built. Any third-party vendor can be granted access to full data using their own tools. New ecosystem thinking boosts innovation and different vendors can complement each other.

openEHR-based projects typically start by building a regional or national openEHR data repository. Functional modules are built step-by-step, module-by-module utilizing the data repository and shared services on the open platform. Legacy systems stay active until all core functionalities exist as modules and legacy is not needed any longer. In reality there is a co-existence for a lengthy time period

A monolithic solution may seem lucrative unless there is sufficient understanding of the benefits of modularity and openEHR. A monolithic solution may seem easy to implement, when one vendor is responsible for all functionalities. Many functionalities are compromises however as no vendor is an expert in all areas. Changing of a monolith is cumbersome and the migration work is extensive. The data follows the patient only when he/she is treated inside the monolith: true cross-organizational patient pathways cannot be built.

It is important to discuss openEHR in an understandable way and to build awareness so that decision makers and politicians recognize the benefits of open ecosystems and make informed decisions.  Nordic countries are forerunners in the openEHR space.

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Om openEHR

Översatt från engelska-openEHR är en öppen standardspecifikation inom hälsoinformatik som beskriver hantering och lagring, hämtning och utbyte av hälsodata i elektroniska hälsoposter. I openEHR lagras all hälsodata för en person under en ”livstid”, leverantörsoberoende, personcentrerad EHR.

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