Composable Architecture for Health and Care

Instead of improving the care process, current electronic health record (EHR) systems are increasing the burden of work for doctors and other care team members. EHRs are seen as a major cause of professional burnout among health and care personnel,² and according to a Stanford poll, half of all doctors asked (49%) agreed that using an EHR detracts them form their clinical effectiveness.¹ Taking that into account, it is no surprise that 59% of doctors are calling for a complete overhaul of EHR systems.¹

Clearly, the work of care teams needs to be simplified, but how? Currently, hospitals procure systems as whole bundles which may come with many useful features, but also include some that they actually don’t need. A more suitable option would be for them to only buy or develop the solutions they need. In the short run, this can be more expensive, but the long-term cost would be lower, and the application range would be far more suitable for a specific hospital’s needs. This is the essence of composable architecture – it allows healthcare organisations to design technology, organisation and partnership ecosystems, and business models in a modular manner, so that everything can be quickly adapted at any moment of need. 

There are two important factors which make composable architecture work:

1. The data layer: applications need to start speaking to the same data. Otherwise, the integration process will be overwhelming.
2. The user experience: when managing a single patient, health and care teams need the applications to provide a similar user experience.

A composable architecture is built on top of a digital health platform (DHP). It includes data as a part of longitudinal health records, legacy data that is integrated into the platform, and even data collected by patients at home.

On top of the platform, there is a layer that holds applications, algorithms, and workflows. Some of these are pre-existing, and new ones can be added later. Additionally, through the APIs exposed by this layer, and by using low-code tools, hospitals can now design, build, and assemble personalised experiences to provide integrated care. This composable architecture is suitable for an acute or mental-health community healthcare organisation, an integrated care system, or a government platform.

If you would like to learn more about composable architecture in healthcare, you can watch a recording of Tomaž Gornik, Better’s CEO and Co-Chair of openEHR International, at the openEHR 2020 Digital Event: DATA FOR LIFE. His presentation, Composable Applications Based on Vendor-Neutral Data Persistence, is a part of the session titled How Industry Supports New Models of Healthcare, and it also featured:

• OpenEHR & Bi-Modal EHR Market Engagement, by James Hodgin and Michael Chapman (from the company Allscripts). The presenters highlight examples of developing and supporting solution implementations that have made use of Bi-Modal approaches to system development.
• Lifecare openEHR – Powered by AI, by Kalle Vuorinen and Marko Pyy (from the company TietoEVRY). They discuss how to address challenges related to integrated care chains and interoperability between vendors, technologies, and applications. They argue that truly effective and sustainable architectures need the capability of vendor-neutral data persistence, such as being able to utilise a common schema or set of archetypes and rules for managing structured and unstructured data (openEHR). This can support the development of innovative smart health applications powered by real-life innovations, like speech recognition and AI.
• How the Lab Can Drive Digital Transformation through openEHR, by Davide Pedrazzini (from the company Inpeco). He describes a new business model for clinical labs which would encompass process control from end to end, inside and outside of the lab, and facilitate the information journey to the upper levels of the EHR. The new business model is about a multidisciplinary utilisation of big data, genomic mapping, and the use of biometrics for positive patient ID as mechanisms to help health systems drive quality and cost efficiencies within predictive, proactive, and preventive health care models.

1: How Doctors Feel About Electronic Health Records: National Physician Poll by The Harris Poll, accessed 28 January 2021 at: https://med.stanford.edu/content/dam/sm/ehr/documents/EHR-Poll-Presentation.pdf

2: Robert Wachter and Jeff Goldsmith: To Combat Physician Burnout and Improve Care, Fix the Electronic Health Record, accessed 28 January 2021 at: https://hbr.org/2018/03/to-combat-physician-burnout-and-improve-care-fix-the-electronic-health-record