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 NHSÂ 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.
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.
The CityEHR toolkit was demonstrated at the e-Health and Telemedicine conference at the Royal Society of Medicine (RSM), London. The Ponseti Portal project at Chelsea and Westminster Hospital was used for feature demonstration.
The basic design and modeling process was outlined to the attendees and much interest was generated about the expandability and integration options that CityEHR provides.
This was an excellent opportunity to liaise with Health Informaticians from different countries and discuss how CityEHR can provide cost-effective long term solutions.
Naveed Dogar has completed her MSc in Health Informatics at City University, London with the examination of her final project thesis entitled “Evaluation of cityEHR toolkit through development of an open-source departmental system”. The full text of her thesis is available online.
Naveed’s project was an evaluation of the first full implementation of a cityEHR system, in the Ponseti Clinic at Chelsea and Westminster Hospital. The focus of the evaluation was on the development of the information model for recording data in the clinic which uses the Ponseti method of treatment for children born with club foot. Initial work on the information model led quickly to the conclusion that more user-friendly tools would be required, if clincians were to be able to develop the ontology models used by cityEHR.
During the course of the project we embarked on development the first version of spreadsheet tools for the development of models, which proved to be a more successful approach, compared to the original use of the Protege ontology modeling tool.
The British Computer Society Open Source Specialist Group held a one-day conference on open source health informatics on 27th October 2010. The event was well attended and sparked some lively discussion.
Prof John Chelsom presented an overview of Open Health Informatics – see the slides here.
It was interesting that the audience generally seemed to equate open source software with communty-led collaborative development and perhaps some education is needed about the types of (ofter commercially-backed) professional development teams that lie behind much successful open source initiatives.
Derek Meyer (St George’s Hospital, London) had some interesting ideas and a follow up meeting was arranged with him to discuss ideas around a next generation of the NHS Data Spine as the backbone for open access to Personal Health information.
At a time when the NHS is facing radical change and is seeking opinions on how to push back on the centralised approach to IT that has been adopted since 2003, this Challenge Paper is designed as a proposal for a fresh approach to NHS IT. We welcome responses, or indeed counter-challenges, to its content.
Executive Summary
The NHS is just emerging from a decade of wasted opportunity in the development of clinical information systems, particularly Electronic Health Records.
The National Programme for IT was a centralised approach to information sharing that has failed on a number of levels. This has delayed the introduction of new systems, weakened the commercial supplier base and disheartened many IT professionals in the service. The NHS needs a fresh approach to clinical IT.
Some have called for the use of more open source software, and it is true that open source and open standards can go some way towards providing long term solutions for the NHS.
Putting good quality toolkits into the hands of developers at the grass roots of informatics in the NHS could help to harness the enthusiasm of local clinicians and developers, channelling their solutions towards interoperable, extensible systems built using open standards and open source.
But just introducing open source software risks repeating many of the mistakes that have dogged the National Programme – lack of involvement of practitioners, protection of the vested interests of product vendors, reliance on large-scale service providers and over-complicated solutions to immediate and very practical problems.
Open Health Informatics introduces two new dimensions to the open standards / open source landscape. Firstly, the use of open interfaces so that every component of a solution can be plugged in and out at will, enabling a ‘best of breed’ approach to open source and eliminating, once and for all, the product-centric culture that has held back the NHS.
Secondly, the use of open development processes – agile development that involves users and other stakeholders at every step of the way. Agile, open processes also eliminate the pretence that users know exactly what they want at the start of development, or that the solution provider knows exactly how to deliver it.
Using open source and open standards can solve some of the problems in the delivery of information systems for the NHS; also using open interfaces and open development processes can ensure that the next generation of systems delivers the effective solutions that service users will demand.
