Open Data and Digital Technology as Enablers for Better Care

Health and care providers are under increasing pressure to improve patient flow, reduce patient risk, and deliver better patient care. With the COVID19 situation, the care system is also under even greater pressure to change the current models of care. In order to support that, medical teams are consistently under stress to make timely, accurate, and safe decisions. However, IT can help…

The Gartner Hype Cycle for Healthcare Providers, 2020, report stated that the COVID19 pandemic “exposed significant gaps in EHR capabilities related to adapting and scaling new ways of working like integrated virtual care. To compensate, the vast majority of providers have adopted solutions outside the EHR to respond.”

These solutions are not connected with existing ones, and it is now apparent that integration needs to happen at the data layer. This is the only way that healthcare will achieve full data-fluidity, vendor independence, and be able to rapidly assemble a fully connected digital ecosystem in order to address both current needs and new, unexpected situations.

We have been working with care providers around the globe to help them set up and assemble data-driven digital health ecosystems based on open-data platforms for a decade. Similar solutions to meet our current needs – for a data-driven healthcare platform to support the more integrated multidisciplinary approach to health and care – were already proposed back in 2013 by Michael E. Porter and Thomas H. Lee in the Harvard Business Review article The Strategy That Will Fix Health Care.* In their opinion, the health-data platform is among the six key areas that are crucial for a more patient-centred strategy in healthcare. The authors state six essential elements which they identified as crucial to support the change towards more integrated, regional health and care:

• A digital health platform, centred on patients: data should be aggregated around patients, not departments, units, or locations.
  Better has already deployed solutions that have enabled the creation of life-long, patient-centred electronic health records based on Better Platform with several customers, such as Somerset NHS Foundation Trust in the UK, University Medical Center, Ljubljana – Division of Paediatrics in Slovenia, and HiGHmed Consortium in Germany.
  
  
• Common data definitions: terminology related to all diagnoses, lab values, treatments, and other aspects of care should be standardised so that the data can be understood, exchanged, and queried across the system. 
  Today, openEHR specifications offer the most comprehensive semantic framework available in digital health, combining formal clinical modelling, terminology, and a service-based infrastructure. Furthermore, a worldwide network of openEHR clinicians are actively contributing to it, and building additional executable clinical content. Better’s digital data-driven health ecosystems are fuelled by openEHR, which enables everyone in the ecosystem to easily share and immediately use all of the clinical content created by the local or global community, such as decision support, guidelines, forms, patient pathways, assessments, and more.
  
  
• Encompassing all patient data: data should be stored in a single place so that everyone participating in a patient’s care has a comprehensive view.
  Better addressed this challenge by providing a structured and vendor-neutral clinical data repository (CDR) which is compliant with openEHR specifications. Therefore, data-points are not fragmented or multiplied, and all health data is stored independently of applications. This also enables the creation of a best-of-breed ecosystem made up of connected applications which can be developed by various vendors. Whenever you change an application, you no longer have to migrate the data, and each new solution that you add to the ecosystem can immediately leverage and rely on all the other data stored in the common CDR.
  
  
• Accessibility of medical records to all parties involved in care: sharing information among various care team members needs to become a routine.
  A digital health platform allows data to be accessible and exchanged among all members of medical teams involved in the care processes. This is done under strict security and access rules, and through an ecosystem of various clinical applications connected to the central CDR.
  
  
• Templates and expert systems for each medical condition: they make it easier and more efficient for care teams to enter and find data, execute procedures, use standard order sets, and measure outcomes and costs. 
  There is a growing global community around the openEHR approach, and on a daily basis it is building new best-practice and directly executable knowledge artefacts, such as guidelines, decision support, procedures, order-sets, pathways, etc. Better’s digital health platform enables the immediate use of these knowledge artefacts across the digital ecosystem so it can be used immediately by clinicians.
  
  
• The system architecture makes it easy to extract information: the data needed for measuring outcomes, tracking costs, and controlling risk factors can be readily extracted.
  Better’s digital health platform provides the capability of integrating different data sources to a common CDR, as well as the tools to manage and export that data. The data is structured and clearly documented, which enables our clients to independently access and use the data for various secondary use cases, such as clinical dashboards, outcome tracking, research, new knowledge discovery, etc.

It is becoming obvious that current monolith-type and individual solutions are not ready for the future needs of health and care. I believe that having the ability to assemble more personalised healthcare IT solutions based on an open-data digital health platform is the key to supporting medical teams and help them make better decisions in our complex and ever changing healthcare environment. I will explain more about how this approach was successfully leveraged in Somerset NHS Foundation Trust during the COVID19 outbreak.

* Michael E. Porter, Thomas H. Lee: The Strategy That Will Fix Health Care, retrieved on 11 November at: https://hbr.org/2013/10/the-strategy-that-will-fix-health-care