Something old – something new

1. Something old – something new Tomas Nordheim Alme Chief Medical Officer

2. A huge investment • DIPS ASA puts about 150 mill Euro in the development of DIPS Arena between 2012 and 2016 • OpenEHR is a central part of the strategy

3. Goal – Develop the world’s best EHR • High functionality • Open • Flexible

4. How do youmove • 15 Hospital Trusts • + 75 000 users to a new, standardized, service oriented, OpenEHR-based platform?

5. …or put differently…

6. A gigantic change of mindset • Customers love the idea of two level modelling • Harder to sell in-house • OpenEHR is complex • Huge first step • Capacity building takes time and constant effort

7. The Norwegian advantage • 3 of 4 Regional Health Trusts use DIPS Classic EHR • Planning migration to DIPS Arena • Structured patient records and CDS is the goal • Where to start?

8. «The interregional structured patient record project» • From April to June 2014 • Clinicians and health informatics staff from the three regions • DIPS is host, but vendor neutral delivery • Project deliverables to be sent to National ICT (national CKM) • An interregional admission note • Generic and a starting point for specialization

9. The interregional admission note (draft) • Step 1: Separate persistent information from event information • 1 document => 5-7 documents • Previous diseases (problem list) • Heredity • Social status • Use of substances (alchohol/tobacco/other) • Medication (separate module) • Critical information (separate module) • The admission note • Step 2: Structure of the different documents

10. How didwework? • The starting point is the generic template for admission notes used by all hospitals today • 2 page document • Background incl social • Presenting problem • Natural functions • Substance use • Clinical examination • Assessment • Plans

11. How didwework? • Three workshops • Material sent out in advance • About 25 delegates, about 10 active clinicians • Group and plenary discussions

13. National vsinternational • Preliminary assessment: • About 40 archetypes involved • Probably need for 5-10 new archetypes • Change request 10-15 • A national admission note template based on common international archetypes is within reach

14. Whatelse?

15. Three ongoingprojects • Involuntary psyciatric commitment • Surgery planning • ER-tool

16. Psyciatriccommitment • New national standard a few years back • Will be made statutory • Current module in DIPS Classic does not fulfill the requirements • Focus on process and correct paperwork/workflow • A pilot for what we can achieve with archetypes • Plan to pilot with University of Northern Norway in 2014

17. Surgery planning • DIPS Classic contains an advanced surgery planning module • Need more process support in early planning state • A pilot for what we can achieve with archetypes • Plan to pilot at University of Northern Norway in 2015

18. Emergencyroom • Based on existing, non-archetype module • Patient list/ER-wall application • Built in archetype support • Any archetype (last registered) can be configured as a column in the list • Enters production on October 20th at Oslo University Hospital

21. What have welearned so far? • OpenEHR is powerful and complex • Issues not related to new platform (backward compatiblity) • Form quality is an issue – need to improve form design • Underestimated the need for business logic around the structured documents • Business rules/error prevention • Applies to process oriented functionality (instr/actions)

22. What’sahead? • Strong customer support for an open, structured, process supporting EHR • The job at hand is huge! • Need a stronger and more focused collaboration within the OpenEHR community • Industry cooperation • Academic activity • Archetypes, tooling, promotion • GDL

23. Thankyou for yourattention!