{"id":7130,"date":"2022-09-13T12:06:43","date_gmt":"2022-09-13T12:06:43","guid":{"rendered":"http:\/\/orionhealth-blog.local\/?p=7130"},"modified":"2023-10-18T18:46:21","modified_gmt":"2023-10-18T18:46:21","slug":"orioncc22-evolving-your-shared-care-record","status":"publish","type":"post","link":"https:\/\/orionhealth.com\/uk\/blog\/orioncc22-evolving-your-shared-care-record\/","title":{"rendered":"OrionCC22: Evolving your shared care record"},"content":{"rendered":"

The Orion Health UK and Ireland Customer Conference 2022 is taking place in Bristol. Its theme is how to build on the basic shared care records in place in England in order to make healthcare more efficient for organisations and clinicians, to coordinate care for patients, and to move towards population health management approaches. So, one of the big sessions of the morning was \u201cevolving your shared care record.\u201d<\/p>\n

Big news about a big standard<\/h3>\n

Oliver Lake, deputy chief executive, the Professional Record Standards Body, opened the session by explaining its role. The PRSB<\/a> is an independent, not for profit, membership body that is responsible for developing standards for UK healthcare, maintaining them, and encouraging their use. With the support of a four-year contract from NHS England, it is PRSB standards that increasingly define the content of healthcare records in the UK.<\/p>\n

Oliver told the conference that there are 20 standards in place at the moment, of which the biggest and most important to shared care records is the Core Information Standard<\/a>, which defines the information that can potentially be shared between systems at different sites and between the professionals using them. The process for deciding whether a supplier has conformed with the standard is \u201ctough.\u201d In fact, it\u2019s so tough that only one supplier has passed the conformance process \u2013 Orion Health.<\/p>\n

\u201cThis happened just this week, and it is a landmark process for us,\u201d Oliver said. \u201cThere are more than 1,600 items in the standard and it has taken more than 20 meetings between Orion Health and ourselves to achieve this. It has been a really collaborative process, and now we want this to be an industry movement. We want people to see this as the start of a movement towards everybody thinking about how to implement standards in their systems correctly.\u201d<\/p>\n

Rethinking shared care record design principles<\/h3>\n

Ben Wilson, product solution director, Orion Health, said it had taken a year to reach this milestone. \u201cAt some points, it felt like I was working for the PRSB, we spent so much time on it,\u201d he joked. \u201cSome of the standard was very familiar, but some took a lot of work.\u201d The work was worth it, he said, because it needs to be easier for organisations and their IT systems to share information, and for clinicians and patients to be able to find what they need, safely and easily. \u201cIt is the national dataset that all shared care records should adopt.\u201d<\/p>\n

Orion Health has also been doing a lot of work on the design of its shared care record, with a view to creating a consistent design framework for use in different use cases. \u201cWhat is fascinating about designing a shared care record is how you pull all this information together and present it in a meaningful way,\u201d Ben said. \u201cWe have come up with the idea of making sure that the most important information is presented first, with an option to drill down for more, and making sure it is really clear what the user is looking at and not looking at.\u201d<\/p>\n

So, he said, clinicians now see data in \u2018comfortable view\u2019 by default. This shows the provenance of all the data in the record, but users can expand or contract data, to see the information they need at a glance, or find more detail. Some key data, such as safeguarding information, or emergency admissions, has been badged and colour coded, to give users a better story about the patient in front of them.<\/p>\n

At the same time, Ben said, Orion Health is determined to introduce more personalisation. The system will \u2018remember\u2019 whether clinicians use the comfortable, contracted or expanded data view, and open with those settings the next time they use the record. While changes have been made to the document tree, to make it easier for users to find documents, and to surface the documents they use most the next time they login.<\/p>\n

Orion Health has also adopted progressive web app technology, so the shared care record can size for use on a computer or laptop, a mobile, or even smaller devices. While another area of focus has been building integrations with GP, hospital, community and mental health systems; and some specialist systems such as BadgerNet Maternity Notes. \u201cWe think this is quite important, because it really encourages adoption of the shared care record,\u201d Ben said. \u201cIf there are any other systems out there that you think we should be integrating with, we are really keen to hear about that.\u201d<\/p>\n

Social care systems are likely to be top of many shared care record system lists, and Ben said Orion Health has been going through the LiquidLogic system that is used by many local authorities for social care and child protection to work out what is recorded and how it can be included within a shared care record, \u201cof course taking account of the security and sensitivity concerns around that.\u201d<\/p>\n

\"\"<\/p>\n

Opening up on APIs<\/h3>\n

Nicole Allan, global solutions director, Orion Health addressed one of the technical issues involved in creating shared care records, by talking about the role of application programming interfaces, or APIs. Orion Health has a suite of APIs that use international standards, such as FHIR, to make sure that data is shared safely and consistently. When plugged into Amadeus, these make it \u2013 relatively! \u2013 simple to integrate data from different systems.<\/p>\n

Orion Health also has an API framework and list of adaptors or standardised data providers, who can \u2013 relatively! \u2013 easily share data through APIs. There are challenges. One is that FHIR comes in many versions or flavours \u201cso it is hard even for vendors like ourselves to keep up with them.\u201d So, \u201cbehind the scenes\u201d Orion Health has decided to \u201ceat its own dogfood\u201d and to check that its own APIs work by using them for its own portal.<\/p>\n

Meanwhile, Orion Health has split the API framework into levels, which focus on issues like security and authentication \u2013 and how these are audited. For example, she said two Orion Health users, The Dorset Care Record and the Care and Health Information Exchange in Hampshire, are looking to exchange data within the Wessex Local Health and Care Record Exemplar. They are looking to use the API framework to support this; but they have found that they authenticate data providers in different ways. In future, the framework will make sure that both have full access to authentication information.<\/p>\n

Despite this kind of technicality, Alan stressed that the whole point of APIs and standards like FHIR is to make it easier for shared care records to \u2018plug and play\u2019 new data feeds and to create a single, unified view for a user or clinician. So, although some early shared care records, like Connecting Care, had to do a lot of work in their early years to get point to point integrations in place, newer Orion Health customers should have a set of APIs, and a list of adaptors available to them \u201cout of the box.\u201d<\/p>\n

\"\"<\/p>\n

Eating the dog food \u2013 or APIs in action<\/h3>\n

Aaron Jackson, product director, Orion Health, gave some concrete examples. He started with a view of unstructured data and then gave an example of a consolidated view \u2013 Medications Viewer. \u201cMedications information is complex,\u201d he said; it comes from a lot of places \u2013 from GPs, hospitals and pharmacies \u2013 but standards like FHIR \u201callow us to bring it all together.\u201d<\/p>\n

In England, this can be made available to GPs using the GP Connect standard, while in Scotland it can be mediated through the API framework into GP systems. Another viewer that uses FHIR adaptors is the Immunisation Viewer that was developed at speed for Scotland during the Covid-19 pandemic, and that has now been retained to record and display immunisation information across the country. Jackson said Orion Health is making \u201ca big investment\u201d in the structured data required to develop similar viewers in the future.<\/p>\n

Chris Lucas, vice president, clinical portals, Orion Health, rounded out the session by outlining even more developments coming in the future. \u201cNicole talked about APIs, and it is quite dry, but we have been developing something called SMART on FHIR,\u201d he said. \u201cThis enables a third party app to call data from the data platform, using those APIs. \u201cThat might also sound quite dry, but if you think about a clinician carrying out a symptom assessment with an online tool such as Ada\u2019s symptom checker, we are able to pass along all of the information from the data platform so the clinician can focus on answering questions, instead of working with the information that the platform has.<\/p>\n

\u201cAnother great example of this is Boston Children\u2019s Hospital growth chart app, which visualises a growth chart for a child, out of our observations FHIR APIs. The big picture is it means that people can look to build their own applications without worrying about integration between application A and application B.\u201d Chris said there would also be developments in personalisation. For example, he said Orion Health is working on enabling clinicians to personalise their own views of data \u201cso they can do that without a developer being involved.\u201d<\/p>\n

Smart search: not just a great idea, but ready to pilot<\/h3>\n

And, he said, \u201cI am really excited about the Smart Search project\u201d that had already been referred to by Southern Cross Healthcare. Smart Search aims to solve the problem of clinicians going into the shared care record and the document tree, conducting a search, skimming a document, and doing it again. \u201cWe are looking to use natural language processing capabilities to search the record and to pull information out of it in a much more natural way,\u201d Chris said.<\/p>\n

This is hard, because the system will need to be able to \u2018understand\u2019 that terms such as \u2018heart attack\u2019 and \u2018MI\u2019 are the same thing; and to know that \u2018no history of heart disease\u2019 is not a data item that should be returned to a clinician looking for the causes of a patient\u2019s heart disease. Nevertheless, he said, a pilot product is in place at Southern Cross Healthcare \u2013 and will be available for delegates to the conference to see tomorrow.<\/p>","protected":false},"excerpt":{"rendered":"

The Orion Health UK and Ireland Customer Conference 2022 is taking place in Bristol. Its theme is how to build on the basic shared care records in place in England in order to make healthcare more efficient for organisations and clinicians, to coordinate care for patients, and to move towards population health management approaches. 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