Dispatches from the hi-blogs.info krew

OpenHealth, Belfast – morning keynotes January 21, 2010

The first keynote talk of the morning session is from Joseph dal Molin, on “Open and connected health: a North American perspective – it’s time for the new paradigm”. Joseph is President of e-cology corporation and Director of WorldVista (http://www.worldvista.org/); he is also adviser to the Jordanian government on EHR implementation using Vista. Joseph began by saying that an open and connected health model is a patient-centric ecosystem; there is a great deal of complexity that must be taken into account; holistic perspective is needed, and all domains affecting care must be taken into account. A simple industrial model does not work; much of current health system is based in silos of information etc.

Joseph says that the US VA ecosystem delivers high quality care, and is very cost-effective; number of veterans treated from 1996 to 2003 rose by 75% (with increasing complexity of care), but the budget only rose by 32% in total over that period. Barcode medication administration has virtually eliminated medication errors in their system, and there have been many other high standards in quality indicator achievement. In most other places, legacy software industry models (based in proprietary systems) have failed to deliver, he says – reinventing the wheel is a pandemic.

Joseph outlined a summary of the open source development model, and likened it to the cycle of evidence-based medicine leading to exploration and improvement of the software. Among open source applications used in health in North America are VistA, OSCAR as EHR solutions; Indivo and MyOSCAR as personally controlled health records; NHIN CONNECT Gateway in USA is an open source project, sponsored by US Health and Human Services Department; Open Health Tools (http://www.openhealthtools.org/). But, he says, open isn’t enough, and semantic interoperability is needed, and is essential for comparability of data. Costs are often a barrier here at present, but there are open source terminology projects seeking to address the issues.

Challenges for open connected health include governments not knowing how to accept free software, not invented here syndromes, procurement processes being based in expensive proprietary software and being hindrances to innovation.

The second keynote presentation of the morning is from Gerald Hurl, from the Health Services Executive (HSE) in the Republic of Ireland, and chair of Health Informatics Society of Ireland (HISI) talking on ‘Delivering connected health in a national context’. Gerald began with an overview of the changes in delivery of health and social care in Ireland, and intentions to move from episodic to holistic care, with the implications for where health service staff may work in the shift from institutional to community-based health and social care services. This has implications for ICT, if services are integrated around the patient, and requires a focus on connectivity and connected health. The new ICT strategy reflects this new model/paradigm of care. But a key challenge will be the lack of ICT staff with the domain knowledge and expertise to support the delivery of the necessary ICT.