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.

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

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

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:

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

Defining an Open Platform – Thought-provoking collaborative document from the Apperta Foundation that we highly recommend reading.  

The paper has pulled together with the experience and knowledge from a wide range of clinical, health informatics and health system economics including our very own Dr Tony Shannon but also….   

We believe that the thinking within the report is relevant not just to the UK and Ireland but across the globe so please share this document with colleagues.

Ripple Foundation is proud to be leveraging the multi-purpose QEWD.js as a world leading integration framework to meet the increasing demands of Healthcare IT.  

QEWD.js is an incredible versatile middleware that Ripple Foundation, a not for profit organisation, is endorsing as part of its showcase stack in the pursuit an open health and care platform to improve clinical systems.  It offers an integration framework that can link the UI components you need with the APIs you want and the database you use.  QEWD.js is a framework that is perfect for web integration challenge because it is fast, capable, flexible and scalable.

Ripple Foundation have five reasons why they believe that QEWD.js is a great choice for the 21st Century demands that clinicians and technicians face:

Rob Tweed, the technical leader behind QEWD.js and co-owner of M/Gateway Developments Ltd said, “I’m acutely aware of the issues that health and care is facing not only in Britain but also around the world.  I am encouraged that Ripple Foundation see the value of our quality web enterprise development platform – QEWD.js – to help tackle some of the issues facing HealthIT.  It’s open source, super-fast, scalable and adaptable – what’s not to like?”

Dr Tony Shannon, Director of Ripple Foundation said, “QEWD.js is a key component of the Ripple Foundation’s showcase stack and should be taken very seriously.  It’s been cleverly crafted by Rob Tweed and it’s an incredibly versatile integration framework that is swift, agile and flexible.  If you combine QEWD.js with the rest of Ripple Foundation’s showcase stack – PulseTile and EtherCIS – they offer the basis of an open platform that can be used across the world – large or small scale.  Being modular, the flexibility is yours – please use it, get involved, build upon it and share the learning”.

To learn more about QEWD.js please visit the newly launched website – http://qewdjs.com/.  To find out more about Ripple Foundation’s work please look around this website www.ripple.foundation

The world of healthcare can now begin to leverage the power and potential of the EtherCIS Clinical Data Repository. EtherCIS development has been supported by the non profit Ripple Foundation and this leading technology now provides the key foundation of its “showcase stack” and work towards an open platform in healthcare.  EtherCIS development is led by Christian Chevalley of ADOC Software Development and the EtherCIS technology is now the leading open source implementation of the openEHR standard in action (including AQL support). The openEHR standard has been adopted and implemented across healthcare systems throughout the world, representing the future of health IT.

Christian Chevalley of ADOC Software Development said, “EtherCIS being open sourced is not accidental, it is organically inherited from its fundamental components and philosophy. It is based on the open standard openEHR that specifies an open, vendor neutral, patient centred clinical data handling and knowledge engineering. Its implementation has been feasible due to the remarkable progress of the open source database PostgreSQL supporting the combination of relational and document typed data efficiently. Most of EtherCIS components have been derived from open source building bricks: service architecture, object oriented database querying, data serialisation, Web communication etc. As such, it is the result of the contributions of hundreds of analysts and developers.

Christian continued to say, “Open Source entitles anybody to have access to the source code, uses and copies the software and contributes to it; it is technically extremely convenient, however to promote successfully EtherCIS into the highly competitive Healthcare IT arena, it had to be free as in Libre. As a free and open software platform, it gives the freedom to anyone to create copy and run a clinical applications that is respectful of the fundamental right to store, query and interchange medical information without being tied to a specific vendor, proprietary encoding or physical location.

“Ripple Foundation has been instrumental to make this achievable; it has not only provided the necessary means to achieve EtherCIS development, but has also stimulated the collaboration, contributions and reviews by clinicians and IT peers, internationally. The result is a solid and relevant IT platform that is now naturally and logically fully integrated into the Ripple Foundation, supporting the adoption of an open health and care platform. The mission and values that Ripple Foundation is abiding by firmly sits with my own views, so I’m thrilled that EtherCIS is now officially part of the Ripple Foundation family.”

Dr Tony Shannon, Director of Ripple Foundation said, “We are honoured to be supporting EtherCIS as a key element of the Ripple Foundation’s open platform showcase stack.  We know to improve health IT we need data, information and knowledge to support the complex and highly pressurised health and care system.  EtherCIS ensures that information and data can be accessed, stored and exchanged securely because it a world leading open source example of the vendor-neutral & technology-neutral openEHR standard in action, developed and tested in the context of a highly usable clinical application. EtherCIS is a Clinical Data Repository fit for 21st Century Health and Care.”  

ENDS

Ripple Foundation is launching a series of three videos that introduces viewers to openEHR. openEHR is an open, clinically lead approach to creating a standards based healthcare platform for the 21st Century. This includes standardised clinical content and information models for the health and care market.  Allowing vendors and developers of front-end and back-end solutions to leverage a common set of standards to help design, store and querying rich clinical information sources.  openEHR is leading the international field in this effort, with benefits for stakeholders and key decision makers which allows them to :

•   let their clinical experts be directly involved in solution development, via archetype authoring
•   built a patient centred record while avoiding technology and/or vendor lock-in
•   retain ownership of the data for primary and secondary use

Put another way… it is an open data standard, both vendor and technology neutral, that’s been designed to support the needs of 21st Century Healthcare. 

Each video is approximately two minutes long and can be shared with anyone who wishes to understand more about openEHR.

Watch. Learn. Share. #openEHR

This short video is part 2 of a 3 part series to help explain openEHR, the future of healthcare IT.

Watch. Learn. Share. #openEHR

This short video is the last of a 3 part series to help explain openEHR, the future of healthcare IT.

Watch. Learn. Share. #openEHR

Ripple Foundation’s showcase stack encompassing three open source elements – front end UX/UI framework, middleware and backend/data repository.  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 to our care professionals and patients.

Ripple Foundation was established in 2016 to support the adoption of an open health and care platform internationally.  As part of its mission, the team has supported the development of a leading edge UX/UI framework which they’ve recently launched called PulseTile. The clinically led team has also been reviewing complementary products and components that meet the increasing demands of the modern day health and care system.  They are proud to support and promote the incredible versatility of both the middleware – JSON API oriented QewdJS framework led by Rob Tweed of MGateway Ltd, plus the openEHR compliant backend of EtherCIS led by Christian Chevalley of ADOC Software Development.   

Dr Tony Shannon, Director of Ripple Foundation said, “We are promoting Ripple Foundation’s showcase stack to demonstrate how health IT can be done in the complex and highly pressurised health and care system.  For years care professionals have had to put up with inadequate, antiquated clinical systems and we believe this showcase stack shows what can be applied to any health and care setting to help provide a better solution for both the clinical requirements but also the business needs of health and care technology.  Information and data that you can access, store and exchange securely is an option if you adopt an open source, open standards underpinned by open architecture approach.

“I’m calling out to the health and care community to take a look at our showcase stack and have a play with what’s now openly available to reuse.  At Ripple Foundation we are here to support you and can answer any questions you may have and help to move health IT into the 21st Century.  

Tony continued, “We are also appealing for an open digital platform challenge fund that we have called #1percentfund.  Diverting 1% of available healthcare IT funds to an open digital challenge fund we believe could improve the care of 99% of the population by stimulating and supporting both the creation and adoption of an open digital ecosystem internationally.  We hope this Open Platform Challenge Fund could help any interested clinical and technical leaders out there to implement a different approach to issues we are facing.”

It is clear that Health IT is not good enough to support 21st Century care, Ripple Foundation believe their showcase stack components, used separately or in combination will help to meet the needs of clinical systems that are easy to use but also communicate and interoperate using open source and open standards.

The showcase stack can be explored from the Ripple Foundation website, including full “showcase stack” documentation.