INTEROPen: A Year in Review

Earlier this month, INTEROPen delivered an interoperability update to the Royal College of GPs, looking at the work and progress made by the INTEROPen community, including FHIR curation with the RCGP Health Informatics Group, over the last year. The result is this link-packed review, including considerations, challenges and next steps.

​FHIR Curation: creating open standards since 2017

• FHIR Curation Timeline
• FHIR Curation uses a multidisciplinary co-production method to create UK localised “CareConnect” FHIR profiles to support semantic interoperability
• Provides clinical and technical assurance to ensure CareConnect FHIR profiles support the information exchange needs for clinical use cases

INTEROPen FHIR Curation Team

FHIR Curation evolving methodology

• Co-production philosophy: shared responsibility; everyone equal partners
• INTEROPen co-produced first set of national FHIR open standards
  Appendix A lists all curated CareConnect Curated FHIR as of Dec 2018
• Open + Transparent Values; Virtual: increased participation & pro-sustainability
• Nurtures learning culture: submitted for NHS Digital collaboration award
• Working with vendors to understand data constraints, with over 150 IT supplier member organisations, including Cerner, DXC, Emis, Epic, IMS Maxims, InterSystems, Microtest, OpenEHR, Orion Health, Stalis, TPP, Vision
• Supporting Secretary of State 5 principles of tech Standards Framework

Method improved using participant feedback and Lessons Learnt sessions

FHIR Curation Achievements

• Transfer of care Acute, A&E, Mental health discharge / Outpatients
• GP Connect [Structured medication and allergies
• Digital medicines Emergency medication supply and immunisations
• NEWS2 [basic observations (e.g. blood pressure, oxygen sats, etc.)
• Reasonable Adjustments being developed as an NHS Spine service
• CareConnect API in national interoperability contract requirements
• Informing Policy e.g. Interoperability Priorities webex & feedback

Community Achievements, Education & Events

• INTEROPSUMMIT 2017
• 2 Clinicians-on-FHIR training events
• Education hackathon (summary & feedback) followed by ‘FHIR Hack’ blogs produced by hackathon teams
• Blogs on Representing a Patient’s Problem List in FHIR; Digitising Medications & Allergies; CareConnect & Dev’s on FHIR; IHE, HL7 FHIR & OpenEHR
• Interactive Case Study Portfolio
• Co-production (collaboration) method recognised by Secretary of State publication
• Championing Local OneLondon LHCRE-INTEROPen-NHS Digital project
• Developing INTEROPen standards into practice model
• Openly & collaboratively tackling ‘wicked problem’ of interoperability
• Developing INTEROPen collaboration platform & partnership with Digital Health

INTEROPen End-to-End Standards into Practice model

(description for model can be found here)

NHS Digital programmes requesting FHIR curation:

• Basic Pathology (in progress) – National CCIO 7 priority
• OneLondon LHCRE – INTEROPen – NHS Digital tripartite project
• GPConnect – remaining GP record
• GP2GP – to create a FHIR version
• Digital Medicines
• Ambulance to Emergency Care handover
• Appointments

Interoperability Challenges & Considerations

• No formally “agreed” national interoperability curation BAU service –
  need trusted co-production partnership with NHS Digital, NHS England, PRSB and INTEROPen
• No published / overarching governance model for maintenance and life-cycle management for CareConnect FHIR profiles –
  limited development tools (could use OpenEHR CKM)
• Need investment in education and hackathons
  e.g. Open Platform, OpenEHR, FHIR – synergies, differences
• Work with PRSB to enhance professional standard definitions
  e.g. heart rate vs pulse rate
• Slow uptake by First of Type sites – need to Improve demand-pull and supplier-push together
• Need for adaptive leadership to solve the wicked problem of interoperability

Next Steps

• Champion Local Initiatives OneLondon LHCRE-INTEROPen-NHS Digital project
  • Prioritise adoption of standards into the service: invite other regions / vendors / providers to implement FHIR CareConnect profiles as part of a local information sharing project; colleagues need to commit funding and resources

• Finalise INTEROPen board 2019 priorities at March 2019 board
• Support educational events Share2Care and Digital Health Rewired
• Progress NHS Digital, INTEROPen and PRSB consultation to develop standards into practice model; identify roles and responsibilities and trusted collaborative working relationships