The public release of cityEHR 1.5 has been made today on sourceforge. This is the version of cityEHR installed at NHS hospitals in Q1 2017 and follows the first public release made in March 2015.
The 1.5 release is made as a single war file which can be deployed directly into Apache Tomcat and used ‘out of the box’ with the bundled demonstration application.
New features include upgraded cohort search, reporting and export facilities, notifcations, In-Tray, improved patient search and a wealth of new administration features.
Naveed Dogar has started research for her PhD at the University of Oxford, with her project on “Internationalisation of Electronic Health Records: Implementation and Evaluation of Specialised Musculoskeletal Systems”. Her research will focus on the implementation of cityEHR for Fracture Liaison Services and for club foot clinics and will seek to develop a set of key performance indicators for measuring the effectiveness of those systems. Using the KPIs, she then aims to measure the effectiveness of systems deployed in different international settings to determine whether a single information model can be made sufficiently adaptable to local clinical and cultural practices so that the same system remains effective across all deployments, whilst generating a standard set of clinical data.
Naveed is based at the Botnar Research Centre at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences. She is a member of St Hilda’s College.
Results of a study into the scalability of the cityEHR database have been published in the proceedings of XML London, 2016. This conference is an annual two-day gathering of prominent XML practitioners and is the perfect forum to present and discuss methods for implementing large scale XML database systems, such as cityEHR.
In his paper entitled “Scalability of an Open Source XML Database for Big Data”, John Chelsom described experiments that evaluated the performance of the eXist database (the open source database used by cityEHR) when loaded with records for up to 20,000 patients and described the implementation of a federated search across multiple database nodes, allowing cityEHR to scale up potentially to millions of patient records.
The Elfin system, which manages the process and clinical data for Fracture Liaison Service has started live operation at the Oxfordshire FLS, based at the Nuffield Orthopaedic Centre. Elfin is now being used by two administrators and up to eight nurses, following a successful period of pilot running which started in December 2014.
Elfin uses cityEHR with an information model developed by Consultant Rheumatologist, Dr Kassim Javaid, with input from nurses and practitioners from Fracture Liaison services across the south of England. Elfin gathers clinical information about the patients seen by the service, tracks the process of treatment and monitoring and can generate reports required for national audit. Elfin generates letters for patients and GPs and can be used to query and extract data for research studies.
Prof John Chelsom presented the principles of Open Health Informatics and the cityEHR health records system at the NHS Open Source Open Day on 26th November in Newcastle, UK. (See his presentation slides here)
The event was attended by over 120 people with an interest in promoting the use of open source software in the NHS. A variety of approaches and applications were presented and it looks as if the drive for open source in the NHS may now be reaching critical mass.
John picked up on some interesting themes introduced by Dr Marcus Baw who is a keen advocate of all things open in health informatics. One theme challenged by John was the suggestion that open source / open standards can be used to prevent wasting time on ‘re-inventing the wheel’.
Whilst this is a laudable goal in many cases, there are also many examples where clinicians should be encouraged and enabled to re-invent wheels – open standards provide the opportunity for clinicians to make exactly the wheels they need for their own work and then share them with others who have similar, but not identical, requirements and goals.
Open standards can be used to enable diversity and interoperability between diverse systems – too often they are used to enforce uniformity which can then go on to stifle innovation
The first cityEHR User Group Meeting was held at St Edmund Hall, Oxford on Friday 19th September 2013 as part of the XML Summer School which was running at the college all week.
The meeting was attended by representative from all three NHS pilot sites – Chelsea and Westminster, Nottingham University Hospitals and Oxford University Hospitals.
The day included some background history to cityEHR, a demonstration of current features and a discussion of the future product roadmap.
The Ponseti Database system has won a Directors’ Den Innovation Award at Chelsea and Westminster NHS Trust.
The Ponseti method is used to treat children born with club foot and the unit at Chelsea and Westminster is one of the leading centres for ttreatment in the UK. The Ponseti Database is designed to collate clinical information on club foot so that those data are available for studies and trials and can be aggegated with research data from other centres in the UK.
The system was the first to pilot the use of the cityEHR open source health records system and the award has recognised both the innovation of its approach and the opportunity to improve patient services at the hospital.
The award was made by Axel Heitmueller, Director of Strategy and Service Planning to Denise Watson, Paediatric Orthopaedic Physiotherapist and Ponseti Team Lead. This followed an innovation competition judged by the Trust Chief Executive, Tony Bell and other key Directors.
A proposal was submitted for a paper titled ‘Clinician-led development of electronic healthcare record systems’ authored by Professor John Chelsom and Naveed Dogar (both City University London). The Paper was accepted and presented at the Information Technology and Communications in Healthcare (ITCH) 2013 Conference in Victoria, British Columbia.
The Ponseti clinic system at Chelsea and Westminster Hospital was used to demonstrate the development process of the system and more importantly, the refinement of the CityEHR toolkit. There was a lot of positive feedback about the usability of the toolkit and how the XML structure of the model ensured inter-operability.
Clinician-Led Development of an EHR system
The 2013 International ITCH (Information Technology and Communications in Healthcare) conference took place in Victoria, Canada from 21st to 23rd February. A hands on workshop demonstrated the ontology driven configuration of EHR systems using the CityEHR toolkit. All attendees were handed a portable version of CityEHR on a USB stick, and all were successfully able to run a platform independent version on their laptops.
The project undertaken at the Chelsea and Westminster Hospital UK aims to streamline the current paper-based practices in the Ponseti Clinic. The vision is to capture the maximum number of clubfoot patients (nationally) to monitor and report progress and success of the Ponseti casting treatment. The database based on the cityEHR toolkit will act as an audit tool. The London and Manchester sites will pilot the database with the aim to roll it out to the maximum number of Ponseti clinics across the UK and Internationally.
The conference was attended by specialist clinicians and charity representatives. This provided an excellent opportunity to discuss the ways in which we can make cityEHR toolkit accessible to international clubfoot clinics (especially in Africa and Asia). Several charities expressed a great interest in providing the toolkit and the model to international clinics through their websites.