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

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 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

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.

EtherCIS Clinical Data Repository. More info available at  ethercis/

openEHR: openEHR Foundation. More info available at http://www.openehr.org/

AQL: Archetype Query Language. More info available at
http://www.openehr.org/releases/QUERY/latest/docs/AQL/AQL.html

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

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

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….   

Ewan Davis – Woodcote Consulting

Dr Ian McNicoll – openEHR Foundation

Dr Roland Appel – Maycroft Consulting

Silas Davis – Monax

Dr Rebecca Wassall – Apperta Foundation

Peter Coates – NHS Digital Code4Health

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:

Web Integration Framework – ready, willing and able

Quick and Easy Development –  gets you up and running quickly

Quality for Enterprise – built to be superfast, solid, secure and scalable

Javascript and JSON Based – QEWD.js leverages NodeJS and JSON

Open Source – openly shared to be publicly and freely accessible

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 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.

Ripple Foundation is supporting and promoting the #1percent open digital platform challenge fund that is hoped will stimulate and support both the creation and adoption of an open digital ecosystem for the nation.

EtherCIS Clinical Data Respository. More info available at  ethercis/

openEHR: openEHR Foundation. More info available at http://www.openehr.org/

AQL: Archetype Query Language. More info available at
http://www.openehr.org/releases/QUERY/latest/docs/AQL/AQL.html

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

For technical enquiries about EtherCIS, please contact ethercis@ripple.foundation.

 

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.

Get involved in the latest web enabled real time communication (webRTC) which is being developed within the Ripple showcase stack.  

This open source video consultation software has endless opportunities for use across the health system from GPs communicating directly with patients at home, to multi-disciplinary teams from around a city meeting to discuss patient’s needs.  Currently the clinically led open source webRTC offers voice, video and text functionality.

Ripple want to work with the community to ensure it meets the needs so please get involved.  Ripple is building an open integrated care platform that meets the needs of 21st Century care and telehealth is a big step on this journey.

Attached are some screenshots of the work progressed to date.  If you want to know more please do contact info@ripple.foundation  

Clinician view

Patient view

Appointments and chat history

 

 

 

Building Back Better Update: 2020

We have been contacted from far and wide in 2020 asking for open solutions that may help remote/tele care possible.

We have a been a very small team, but we believe in open source for the greater good, so check out the results of our efforts, openly and freely available to all.

 

 

We hope this work may be useful to you, wherever you are – as part of a global team working to Build Back Better..!

See related article here

Building Back Better: Open Source TeleHealth

 

The article below was published on the Local Digital website on 23 September 2015

We want to encourage debate and discussion about Open Source and will repost and attribute articles whenever we can.  We would also like to encourage guest bloggers and commentators.   The article below has been co written by Source Code Control Limited and Protecode.

Our thanks go to Martin Callinan for bringing it to our attention.

 

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From relieving people of repetitive tasks, to building everything around us that shapes our lifestyle, and on to transformation of volumes of data into new insights and perspectives, software has become the new feedstock for the human evolution. All facets of life are touched by software, and healthcarei s no exemption.

The Complex Web of Health Industry

The health and social care industry is a highly fragmented and complex industry with medical practitioners, nurses, health professionals, hospitals, clinics, government and non-government agencies all providing health services. The spectrum of health care providers range from individual clinicians such as General Practitioners (also known as GP or doctor) to large monolithic entities such as the National Health Service in the UK which is the third largest employer in the world today.

Health and social care providers offer a complex and diverse range of facilities and services. By the nature of these services the healthcare industry is driven by large and varied amounts of data which in turn require varied and complex IT systems to manage this data. Generally, these systems come under the umbrella term of eHealth. While there is no consensus on the exact definition of eHealth two example definitions are:

“…the cost-effective and secure use of information and communication technologies in support of the health and health-related fields including healthcare, health surveillance and health education, knowledge and research.” The World Health Organization (WHO)

“…the use of modern information and communication technologies to meet needs of citizens, patients, healthcare professionals, healthcare providers, as well as policy makers.” The European Commission

Whatever way people choose to define eHealth it generally encompasses:

 

• Electronic Health Records (EHR)
• Electronic Medical Records (EMR)
• Telehealth and telemedicine
• Health IT systems
• Consumer health IT data
• Virtual healthcare
• Mobile Health (mHealth)
• Big data systems used in digital health

eHealth Software Complexity

Software complexity is increasing with no end in sight as today’s code becomes the foundation for tomorrow’s more complex functionality. Historically, healthcare organisations have created platforms to manage these solutions fairly autonomously, both within individual organisations and industry wide. Quite often these systems were procured at significant expense from software vendors who lock them into solutions that restrict innovation, stifle diversity and have little ability to be re-used.

In the past, developing all software internally was a point of pride for many organizations. Today, the complexity of modern software, coupled with the pressures to release applications and products on tight deadlines, has made delivering projects that rely exclusively on internal code development almost impossible. Increasingly, organizations are turning to commercial third party code, code brought in from outsourcers and contractors, and open source software (OSS) to accelerate development and reduce costs.

If this approach is compared to other industries such as the automotive industry where in the early days of car manufacturing car models were largely custom made. In more recent times, automotive manufacturers have developed “platforms”, commonly re-used across companies and continents. This gives them the ability to re-use existing components and enables greater flexibility – a new model is no longer a completely new design and as a result costs are significantly reduced.

The same approach is now being applied to eHealth systems and with the emergence of Open Source Software there is a shift to adopt Open Systems, Open Platforms and Open Data. These solutions are developed efficiently without licence restriction where the code can be shared and re-used across the public and private healthcare industry.

Code4Health

A great example of this repurposing is an initiative launched recently by NHS England called Code4Health.

Code4Health is a resource used by healthcare professionals and providers of services to deliver better patient outcomes. It provides a platform for clinicians to come together with IT suppliers to identify and experiment with the systems in their Trusts and develop new functionality and products or solutions that they can potentially deploy.

“Our ambition for Code4Health is to educate clinical and administrative staff to develop their interest in digital technology and stimulate a desire to engage more closely in the design, development and delivery of systems and apps”.

Code4Health are currently piloting ‘App In a Day’ where individual clinicians are being trained and encouraged to play an active role in the development of apps or even develop their own apps using LiveCode.

Over time, the goal of the NHS is to:

• Create a market of viable Open Source solutions
• Provide evidence of the value of Open Source software to the wider Health and Social Care Community
• Ensure by default all code created in the NHS is shared as part of a library of assets for re-use
• Ensure a level playing field for Open Source commodity and infrastructure services
• Achieve a self-sustaining eco-system of communities

Managing Open Source and Other Third Party Content

Clearly there are huge benefits to be gained from this approach but it is not without its risks. Along with the advantages realized by using third party code, there are a few challenges that can arise. Governing the quality, security, licensing and intellectual property (IP) ownership attributes are imperative in avoiding risks and potential downstream costs of using third party software. Last year Community Health Systems Inc. lost data related to 5.4 million patients which could end up costing the health system between $75 and $150 million. This data breach leveraged the bug Heartbleed to access VPH log-in credentials.

The process of managing third party content in a code base can be time-consuming and resource intensive, and an understanding of the effort associated with this exercise is the first step in optimizing the process and mitigating the costs. This highlights a need for a governance program to underpin Open Source initiatives. Indeed the NHS have created a custodian model for Code4Health and will have “code custodians” to manage the risks of OSS and make the adoption of OSS based solutions easier for less technically proficient trusts.

A study of common practices deployed at software organizations, concerning adoption of open source and other third party software components, has revealed a pattern consisting of a number of necessary as well as some discretionary steps. Originally coined as Open Source Software Adoption Process (OSSAP), this process is equally applicable to any third party software that is deployed and used in a project within any organization. Eight steps are identified in a structured open source adoption process.

1. Establishing a software policy, identifying acceptable attributes of a third party software, and highlighting remedial actions that should be taken in case of a violation of the policy. Typically, an “open source committee” consisting of legal, technology, security and business stakeholders are responsible for establishing and communicating the policy.
2. An optional software package pre-approval workflow process that allows technology teams to request open source and other external packages to be approved for use on a certain project under certain use-case scenarios. The package-preapproval process would allow the “software clearing house” in an organization to open and assess the requests and grant or deny permission depending on how well the requested package aligns with the policies established in step 1.
3. Establishing a baseline, or taking stock of the existing code in the organization. This is a necessary step in all but the simplest cases and is performed using automated tools creating a detailed view of the code that is already present in the software organization. This will produce a resulting map of proprietary, commercial or open source components and their licensing, security, quality and supplier attributes. Furthermore, the results obtained at the conclusion of this step are compared against the established policies and components and can be blacklisted/whitelisted as a result for future projects.
4. Assessment of all code delivered to the project by contractors and outsourcing suppliers against the policies using automated tools, and extending the software inventory map that was established during the baselining process of step 3.
5. Regular scanning and examination of the project code library. This can be done by scripting an automated policy-based scanner to review the complete library for any changes at regular intervals, for example, every weekend, and highlighting content that violates a policy component.
6. Optional real-time assessment of code as it is checked into the organization’s Source Control Management (SCM) system against the policies, and taking appropriate action if a violation is detected. This step ensures that the project repository contains only acceptable code.
7. An optional real-time automated scanner residing on the developer’s workstation. Similar to a virus checker, the content that is downloaded from the web, brought in through, for example from a USB memory card or simply assembled on the developer’s workstation is continually scanned against the project policies. Any violations against the policy can be highlighted to the developer (and the developer only), allowing for either quick remedy at the source or a comment to be inserted against the offending code (e.g. “will be used for testing only”).
8. Final build assessment, usually through an automated process tied into the build (for example Jenkins) process.

The purpose of steps 2-7 is that all the code that could potentially end up in a project is logged and approved in that it satisfies the project IP, security and exportability policies. By the time the final application is built at step 8, there will be no surprises if steps 2-7 are diligently followed.

Conclusion

There is a significant opportunity to advance the caliber of healthcare by applying intelligent software solutions to electronic health records, delivery of consumer health information, and the provision of mobile and virtual health services. Leveraging open source software and drawing on the associated groups accelerates the identification and development of healthcare applications, creates a level playing field for all ecosystem communities, and allows the sharing and re-use of efforts across a wide range of healthcare domains and geographies. The distributed and crowd-based nature of the open source development can be managed by applying a structured open source software adoption process that will ensure quality, security and legal compliance to the re-use obligations inherent in any open source code.

Download this article as a PDF

 

List Of Additional Resources

Open Source Software Adoption Process (OSSAP) | Best practices that enable organizations to effectively leverage open source software in their projects. Infographic, Measuring Open Source Management ROI | As open source adoption becomes mainstream, open source compliance management is maturing. Organizations are moving away from manual code audits to real time, automated open source scanning tools. Ensuring Responsible Open Source Use with Software Audits | This paper explains how organizations can responsibly adopt and manage open source software in order to remain innovative and competitive.