It’s encouraging to see Matthew Gould, the CEO of the newly formed NHSX is spending time at  

the clinical frontline before he formally starts in his post in July.  After reading Matthew Gould’s most recent blog, it’s clear his time so far with care professionals is helping inform his views; recognising that health IT is frustratingly clunky, siloed and way behind other sectors.

We recognise that there is some important new thinking and messages with his most recent welcome declaration;

“we’re going to focus on standards and platforms, keeping the centre as ‘thin’ as possible”. 

This shift is an acknowledgement that the health IT market is underperforming, one size doesn’t fit all and we need a new approach to health IT.

This latest initiative by NHSX, has a good deal in common with the work of the Ripple Foundation. In advocating user centred design, the use of open standards and open source for healthcare, and now this focus on the platform approach in healthcare, these principles resonate with us very much. This more open approach is a good fit with the clinical community too, where sharing knowledge and research for the betterment of health outcomes is understood as a public good. 

While we welcome this shift towards a healthcare platform by NHSX, our experience has taught us this is non-trivial challenge, so would urge NHSX to learn from others in this field tackling this same challenge, both in the UK and abroad such as the Global Goods initiative from Digital Square. 

The state has an important role to play in supporting companies tackle this fragmented market that is dominated by a few big tech players.  If done right, a platform based approach can help to stimulate new entrants to the market and drive innovation. 

One particular challenge NHSX will face will be finding the balance between coordination and control of platform development while letting innovators innovate at the frontline, to get the right information, at the right time, to help care professionals deliver the best possible care. 

What does the NHS mean by a platform in healthcare anyway?

We believe NHSX, should be working towards the definition of an open platform, as defined by Apperta Foundation and  therefore start the move away from closed platform/monoliths, which both Yorkshire & Humber LHCR and NHS Scotland are already working towards. 

Open platforms liberate both data and applications making them portable and interoperable across different platform implementations…. The open platforms approach is vendor and technology neutral, eliminates lock-in, facilitates innovation and competition, and forces vendors to compete on quality, value, and service”. 

Indeed the Apperta paper on Defining an Open Platforms, defines 8 core platform principles:

  1. Open Standards Based 
  2. Shared Common Information Models 
  3. Supporting Application Portability 
  4. Federatable 
  5. Vendor and Technology Neutral 
  6. Supporting Open Data 
  7. Providing Open APIs 
  8. Operability (as in DevOps) 

So as well as continuing to meet care professionals at the frontline, we, Ripple Foundation and Apperta Foundation, would welcome a conversation with Matthew Gould and NHSX colleagues to discuss our learnings and expertise in this field as well as to discuss strategic investment into open platform innovation via the 1% Fund to enable a small safe start, the iterative curation of common platform components and collaboration between the frontline and NHSX.

INTEROPen have launched a paper outlining the differing approaches and goals of FHIR and openEHR.  We highly recommend reading the attached to understand the differing approaches and goals of each standard, and why they both have a valid and complementary place in the challenges faced in digitising health and social care.  Please share with colleagues.

INTEROPen openEHR and FHIR

Authors: Dr Ian McNicoll of openEHR Foundation; Dr Amir Mehrkar of INTEROPen; Dr Tony Shannon of Ripple Foundation

 

Ripple Foundation is partnering with the Discovery Data Service (DDS) and driving success for the NHS by transforming digital healthcare and contributing to the interoperability agenda.  The cultural fit of working collaboratively with open source solutions has allowed the development and delivery of innovative solutions.

The DDS uses a publish and subscribe model. Subscribers are health and care organisations who express an interest in accessing a subset of data for a particular purpose. Publishers are health and care provider organisations who control their data and agree to publish their data once, in a way that can be accessed by many subscribers. Only systems can interact with the data service; users do not directly interact with the service and can only obtain data through the system(s) of their choice.

Regionally based data sharing agreements match multiple publishers to one or more subscribers for particular pre-agreed purposes. Data cannot be provided without adherence to a set of rules derived from the data sharing agreement. The data service receives data from a number of publisher systems; the data is either sent automatically or transmitted on request by the service. The data within the service remains under the direct control of the data controllers with each item of data stamped by the data controller. The data is then converted to a common format that is directly compatible with FHIR and Snomed-CT. Depending on the data sharing rules, prior to transmission, the service links the data at a patient level by NHS number. A subset of the data, for example a cohort of patients, is then made available to subscriber systems. Data is provided either in an identifiable form for direct care, or is de-identified for secondary uses, depending on the agreement. Person level consent is managed according to GDPR and Caldicott policies.

The DDS team is working with the Ripple Foundation to deliver patient level data from a single source, in order to populate the Helm Patient Portal.

For more information see discoverydataservice.org/Content/Home.htm

We are pleased to update the openEHR community on the outcome of our EtherCIS international camp held over 3 days in London, December 2018.

A group of 12 individuals, representing 8 nationalities from academia, commercial and non-profit sectors came together to explore, discuss and plan the growth of EtherCIS and the open source openEHR community via an EtherCIS MkII plan. See here for the related roadmap that was agreed by the group as the way forward.

EtherCIS Camp attendees (left to right): Ricardo Goncalves, Jake Smolka, Birger Haarbrandt, Thomas Beale, Stefan Spiksa, Christian Chevalley, Ralf Schneider, Ian McNicoll, Stefan Schraps, Phil Barrett, Seref Arikan, Tony Shannon

We are grateful for the help and support of Tom Beale (Ars Semantica & openEHR Foundation) who is now leading an EtherCIS MkII subgroup, working to coordinate this effort towards the public open release of EtherCIS MkII within the next few months.

More information on EtherCIS is available at  http://ethercis.org/ , https://github.com/ethercis and https://gitter.im/Ripple-Foundation/EtherCIS

We welcome interest and involvement from any others who wish to get more involved in this important effort. If you are interested in becoming involved please contact us at info@ripple.foundation

Dr Tony Shannon

Hello and welcome to our Digital Commons Academy, a set of open access videos, which you are free to use and and share with colleagues.

At Ripple Foundation we appreciate that digital advancement in health and care is complex so we’ve broken down the issues into a series of short but thorough videos for you to explore.  Our hope is that by watching the films on your own or as part of training within a team we can help to share our learning with you.

Each film is less than 5 minutes and covers a range of topics including clinical leadership, implementing change and the state of the current market place.  We hope that they provide you with information and raise discussions for you to debate as a team, board or organisation. Full list of videos is available here or on vimeo.

We are a non-profit making organisation that was established a few years ago to support the adoption of an open platform for health and care.  We believe that the future of digital health and care is not one single technology firm providing all the solutions but a vendor neutral market place where organisations large or small can compete fairly because they are developing solutions that meet a set of open standards in pursuit of an open platform.

We hope you enjoy the topics covered and please do get in touch with your feedback – we are always learning and developing at Ripple Foundation so we welcome your views.  

It was a great pleasure to meet the Health Secretary on his recent visit to Leeds after launching his new “tech vision” for the health service. I met Matt Hancock MP at the ODI in the centre of Leeds on Friday 19 October 2018 and talked him through our development for Helm – an open platform solution for a person held record.

I was able to share with him the UI/UX experience of Helm as it looks right now and was pleased to hear very positive responses both from the Health Secretary and his Chief Technology Advisor, Hadley Beeman.  Helm has been in development for a number of months to ensure that we’ve got strong foundations for people accessing and contributing to their own health and wellbeing information. It has involved passionate work from a number of highly experienced technical people as well as clinically direction from Dr Tony Shannon, along with strong creative development from Simon Gamester.

 

Helm benefits from a number of innovative technologies supported by Ripple Foundation, namely, PulseTile, QEWD.js and EtherCIS and is underpinned by the internationally leading open standard for healthcare,  openEHR.  It also conforms to the well received paper “Defining an Open Platform” by Apperta Foundation.  

The exciting journey of Helm being tested by people in Leeds starts very shortly.  People are at the heart of this product and they will now lead the way in its future development.  Users of Helm will be able to tell us what works and what doesn’t, what would be useful, what is missing and Ripple Foundation is very excited to be a large part of this new innovation with the city of Leeds, led by Leeds City Council.  The plans for Helm are for rapid expansion into the Yorkshire and Humber region. We will keep posting news on the Ripple Foundation website but do get in touch if you would like to understand more about our open platform approach for addressing some of the issues faced by Health IT.  

Thank you to ODI Leeds for supplying the photos taken during the session with the Health Secretary.

By Phil Barrett

Director

Ripple Foundation

 

Ripple Foundation is delighted to announce we have been officially approved as a supplier for cloud support on the UK government framework called G-Cloud 10.  It is a national framework that shares the agreement between the government and suppliers who provide cloud-based services.

To be accepted onto G-Cloud framework we have provided information about the company and the way we work, we also added information about the services we offer.  

Phil Barrett, Director at Ripple Foundation said, “Our open source and open standards based work within Ripple Foundation is very well aligned to the GDS design standards so this is a natural fit for us. To be on the G-Cloud framework is an important step in the UK market by removing perceived barriers to procuring services and further realising our mission for the adoption of an open platform in health and care.  We support three open source technologies with our open standards based approach:

  • a leading edge UX/UI framework in both Angular.js and React.js – PulseTile.
  • incredible versatility Node.Js based middleware – QewdJS
  • plus the powerful openEHR compliant backend of EtherCIS

“We are looking forward to hearing from buyers within the public sector that would like to use our range of support services.” Click here to find out more Digital Marketplace G-Cloud 10 services 

For further information about the Ripple Foundation please contact info@ripple.foundation.

ENDS

  1. Ripple Foundation is a community interest company that is supporting the adoption of an open health and care platform.  It is a clinically led team that working with communities to support using an integrated digital care platform for today and the future. Open source, open standards and underpinned by an open architecture that can be used worldwide.

For media enquiries about Ripple, please contact info@ripple.foundation or visit the website for more information www.ripple.foundation

We are proud to be supporting Yorkshire and Humber’s successful bid to become a Local Health and Care Record Exemplar with our technical solution for a Person Held Record called Helm. This is a credit to their national and international leadership in this field and a sign of a change in the health IT marketplace.  

The delivery of an open standards and open platform based person held record was originally supported by the city of Leeds thanks to the leadership of Dylan Roberts, Chief Digital and Information Officer at Leeds City Council, but will now be made available to the geographical footprint that makes up Yorkshire and Humber, involving over 70 organisations.  It is also being discussed in other Local Integrated Care Record Exemplar areas including Greater Manchester with Salford Royal GDE moving to explore the technology.

The benefits of supporting an open platform approach allows Helm to be built in such a way so that it will becomes accessible across geographies and care providers regardless of the clinical system in use.

Helm puts users in control of their own health and care data by allowing them to view and add to key information, starting with medical data and growing to include wider public services. For the first time, the public will be able to see and interact with their own records and data on an easy to use, secure, online platform that encourages them to take control of their own health and wellbeing.  Helm reflects this new position with a “Take Control, Take the Helm” strapline and call to action.

Dr Tony Shannon, Director at Ripple Foundation added, “Over the past few months we’ve noticed a real shift in emphasis within the Health IT sector towards adopting an open platform with open standards.  At Ripple Foundation we truly believe this is the only way to stop the mediocrity of an underperforming health IT sector. By building Helm on an open platform, in line with the international openEHR standard, we are working to support a transformative move to future proof healthcare IT systems.

Tony continued, “Ripple Foundation’s mission is to improve the care of patients and citizens alike by providing technology that supports their needs and delivers easy to use systems that are scalable and cost effective.”

Helm will adopt the Ripple Foundation’s showcase stack which can be broken into three levels:

PulseTile – leading edge UX/UI framework developed by Ripple Foundation

QewdJS  – versatile middleware led by Rob Tweed of MGateway Ltd

EtherCIS – powerful openEHR compliant backend/data repository led by Christian Chevalley of ADOC Software Development.   

Each component harnesses the power of open source and aims to demonstrate open standards in action to show that there is a different way to provide technology into the health and care systems and ultimately to the users of Helm.

For further information about the Helm and open platform technology please contact info@ripple.foundation.

 

ENDS

  1. Ripple Foundation is a community interest company that is supporting the adoption of an open health and care platform.  It is a clinically led team that working with communities to support using an integrated digital care platform for today and the future. Open source, open standards and underpinned by an open architecture that can be used worldwide.
  2. For media enquiries about Ripple Foundation, please contact info@ripple.foundation or visit the website for more information www.ripple.foundation

EtherCIS Clinical Data Repository is developing at pace with radical new improvements in its latest V1.2 release including enhanced security, more complex querying, federation,  improved configuration capabilities and much more. EtherCIS is the leading open source implementation of the openEHR standard in action (including AQL support) and these new developments make the use of EtherCIS even more compelling in the marketplace.  

EtherCIS development is supported by the non profit Ripple Foundation and is a key component of their “showcase stack” and work towards an open platform in healthcare.  It is led by Christian Chevalley of ADOC Software Development who said, “We’re thrilled with the latest release of EtherCIS and proud that our work combines contributions by the community across the globe.  It is helping Health IT to become sustainable, open, vendor neutral and delivers patient centered clinical data handling with knowledge engineering.  Helping to deliver this message to key decision makers and leaders has been part of Ripple Foundation’s mission and we are excited to be part of the action.”

Dr Tony Shannon, Director of Ripple Foundation said, “We welcome the work that Christian and his company is continuing to deliver for EtherCIS, it’s a great achievement and really helps to ensure that open platforms are the future of Health IT.   We are also thankfully that cities like Leeds in Britain are implementing EtherCIS in their area for Helm, the adoption of an open platform Person Held Record.  EtherCIS is helping to contribute to the global endeavour of improving data quality, access, storage and research which is fit for 21st Century care.”

Below is some further information on the enhancements made or if you require an indepth understanding please visit Github at https://github.com/ethercis/ethercis .  

Enhanced Security

EtherCIS upgrade ensures sensitive data is further protected against eavesdropping and it controls access to the database, so users can only access the data they have been authorised to see.  

Enhanced openEHR querying (AQL)

Users can now perform more complex querying due to new enhancements using openEHR templates for meta data. The openEHR standard has been adopted and implemented across healthcare systems throughout the world, representing the future of health IT.

Federation

Improved federation which allows information retrieval technology to simultaneously search in multiple resources. This means that a user can make a single query request which is then distributed to the search engines, databases or other query engines participating in the federation.

More configuration capabilities

EtherCIS REST server now supports a full set of parameters for basic HTTP, SSL, low resource monitoring and request logging.

Under the hood improvements

There has been an upgrade to a number of critical components including REST server, DB programmatic interface and XML handling. EtherCIS libraries have been cleaned up and simplified to reduce dependency conflicts and many unit tests have been finalised

To find out more about Ripple Foundation please visit www.ripple.foundation

 

ENDS

  1. Ripple Foundation is a community interest company that is supporting the adoption of an open health and care platform.  It is a clinically led team that working with communities to support using an integrated digital care platform for today and the future. Open source, open standards and underpinned by an open architecture that can be used worldwide.
  2. EtherCIS Clinical Data Repository. More info available at  http://ripple.foundation/ethercis/
  3. openEHR: openEHR Foundation. More info available at http://www.openehr.org/
  4. AQL: Archetype Query Language. More info available at
    http://www.openehr.org/releases/QUERY/latest/docs/AQL/AQL.html
  5. For media enquiries about Ripple, please contact info@ripple.foundation or visit the website for more information www.ripple.foundation
  6. For technical enquiries about EtherCIS, please contact ethercis@ripple.foundation.

 

Developments in recent months have brought the leading work of QEWD.js to even greater heights. Three key areas bring the technology led by Rob Tweed of M/Gateway Ltd bang up to date in the refactoring of the Ripple-QEWD solution:

  • Shift towards a microservices based architecture
  • Leveraging the power of JSON Web Tokens (JWT) to secure the technology
  • The Dockerisation of the solution to enable ease of install for this powerful technology

QEWD.js is a lightweight yet very powerful open source technology. The recent improvements make it even more appealing and central to Ripple Foundation’s open platform adoption mission.

For more information about QEWD.js and the QEWD-Ripple microservices infrastructure please check out these links:

http://qewdjs.com/

https://github.com/RippleOSI/Ripple-QEWD-Microservices