An open digital health platform: standards and interoperability
This is part one of a three-part series on why and how we should be building an open digital health platform in Wales.
This part is a high-level overview of how standards and interoperability are critical in building a digital ecosystem. Part two assesses our current messaging-based architecture and highlights the benefits of an API-first enterprise architecture together with the new technologies that have facilitated the move to cloud computing in other industries. Part three ties together these strands into a manifesto for phase 1 of building our open platform.
I firmly believe that Wales has potential to be the best place in the World for digitally-enabled healthcare and innovation.
But we need to change what we have been doing. We need to move away from the single portal approach advocated by some and move to building an open platform, as I have previously discussed.
Standards and interoperability
Our “Once-for-Wales” task and finish group has finished its work and we have recommended a new Welsh Technical Standards Board (WTSB) be set up to define and mandate the technical and semantic standards for interoperability across our principality. We have recognised that there are many services and system functions, such as patient demographics and identity, that should be provided nationally for every citizen in Wales across all of our health and social care organisations.
Likewise, we recognise that we must be able to exchange information with others, within Wales and without; including organisations outside of Wales. The latter is vital for patients who live on the border between Wales and England, and for those specialist service providers who care for patients from a different region. For instance, many specialist services in North Wales are provided from Liverpool, and we send patients from South Wales to either Bristol, Birmingham or London for highly specialist support.
But information exchange is not simply limited to health. We need to communicate with and build workflows across multiple disciplinary ‘borders’ including social care, the third-sector, academic researchers and service planners. Such communications must be acceptable to citizens, requiring implicit or explicit consent depending on purpose and level of aggregation.
Some people think we should write national one-size-fits-all applications and think about the interoperability aspects later. I would argue that interoperability is not something that can be “added later on” but must be designed at the outset, understanding that we must not only support technical interoperability but exchange semantically-meaningful information within a broader legal data sharing environment:
Legal interoperability covers the broader environment of laws, policies, procedures and cooperation agreements needed to allow the seamless exchange of information between different organisations, regions and countries.
Semantic interoperability refers to the ability to ensure that the precise meaning of exchanged information is unambiguously interpretable by any other system, service or user.
Technical interoperability means the ability of two or more information and communication technology applications, to accept data from each other and perform a given task in an appropriate and satisfactory manner without the need for extra operator intervention.
from eHealth Governance Initiative - Discussion paper on semantic and technical interoperability
The important standards that should underpin our new open platform are SNOMED CT and HL7-FHIR. I have covered both of these technologies at length previously including a simple overview in this post.
At the same time, many of us in Wales recognise the need to prioritise our limited resources and form partnerships with others. We cannot do everything ourselves and we should bring in partners who have strengths to complement our own.
In keeping with this view, Welsh Government have funded a new Digital Health Ecosystem bringing together the Life Sciences Hub in Cardiff with the NHS Wales Informatics Service to:
- accelerate the delivery and adoption of the latest digital solutions to improve patient outcomes and reduce costs
- create a pathway for access to health and care data
- foster innovation from all stakeholders, encouraging cross sector cooperation and implementation
- support the development of new products and services to drive business growth, job security and creation, ensuring prosperity for all.
In essence, we are starting the journey towards opening up our architecture in order to make it easier to work in partnership with others. We need to identify the strengths and weaknesses across both the public and private sectors and create an ecosystem that permits us to leverage the strengths of both.
The question is, how can we build healthcare information technology architectures that can connect with external systems and data sources outside of our traditional walls? It should not be surprising that robust interoperability is essential to delivering a working digital ecosystem in Wales.
In essence, interoperability isn’t something to think about later, it should be how we build our systems today.
The next question to ask is, do we currently have an architecture that can enable robust interoperability and satisfy our ambitions for our digital health ecosystem, and if we don’t, then we must also ask what we need to do in order to do so? Some of the answers are in the next post.
Part two assesses our current messaging-based architecture and highlights the benefits of an API-first enterprise architecture together with the new technologies that have facilitated the move to cloud computing in other industries. Part three ties together these strands into a manifesto for phase 1 of building our open platform.