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eStandards @ ConHIT

Next steps for standardisation in health information

sharing

Clinician viewpoint

Prof Dr Dipak Kalra

EuroRec

Dipak Kalra

•GP for 12 years

• deprived part of east London

• high ethnic mix, many refugees and migrant workers

•Health informatics (EHRs) 23 years

• clinical requirements, patient requirements

• information models, clinical models, standards development

• privacy protection and access controls, consent

• reuse of EHRs for research and learning health systems

• increasingly: the socio-technical and business models needed to scale

up interoperability

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What connectivity and computability

are clinicians impatient for?

•Connectivity: shared care (co-morbidity), safety (medication list!, allergies!), including patient and family

• Smartness: overviews and trends (heart failure), risk stratification (heparin), prescribing DS (inc OTC), care pathway steps (escalation), referral DS (FH breast cancer), workflow support (team orchestration), (not form filling)

• Learning: clinical audit, care pathway optimisation, outcomes optimisation, avoidance of safety issues (pharmacovigilance), support with research (own, multi-centre, cross-border, sponsored clinical trials)

•Cross border shared care - not only EU - reflecting the population of modern cities

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What gaps do clinicians find in standards?

• Still an over-focus on engineering and technical matters (of little interest

to us)

• Semantic standards (clinical models and term lists) - multi-professionally

driven, involve the patient

•Guideline and DS rules that can be applied equally across systems and

settings

•Quality metrics that truly reflect outcomes oriented care (not the crude

benchmarks of today, which have multi-factorial determinants)

•Access policies that can truly scale across care settings and borders

• Connectivity with personal health records and systems

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The clinicians wish-list to eStandards,

and to decision makers

• Standards and nomenclatures should not impose an unreal precision on the interpretation of clinical statements

•Applications and medical terminologies must reflect the words and phrases of the clinicians, and the patients

•We collect too much irrelevant data: involve clinicians in defining what data are really needed to support decision making

• Provide benefits to clinicians from good documentation such as contextual advisory systems, support learning health systems including research

• Procurement contracts for health ICT services need to prioritise interoperability, to stimulate industry adoption of standards and profiles

•Health ministries, insurers and commissioners should promote contracts endorsing person centred care, i.e. requiring healthcare providers to collaborate, to co-ordinate care and to engage patients

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