In sessions addressing the general theme of ‘health records’, several speakers gave varying perspectives based in their personal experiences of using and/or developing open source health record systems.  Firstly, Rolf Englebrecht covered his experience of free and open source electronic health records. He looked first at Mycare2x (http://www.hccgmbh.com/), based on Care2x, which was developed as a supposed open source solution. Designed for hospitals with specialised units, it is adaptable to ambulatory care – the requirements are defined by user cases (scenarios). But he and colleagues encountered problems in relation to its use, and did not believe it was fully open source.

He then looked to FreeMed (http://www.freemed.org/) - developed for multiple languages, and was generally satisfied with it. He discussed looking to move from Freemed to OSeHealth, ie an open source solution for eHealth, and also to trying to develop a European Freemed network.

Tom Beale, from Ocean Informatics and OpenEHR, talked about OpenEHR, a health computing platform for Europe. He talked about healthcare being an information-intensive business, with healthcare information captured in datasets during clinical work events. Clinical care is shared among multiple providers, leading to a need to share information. Information also needs to be aggregated to allow personalised healthcare and decision support. Healthcare information is complex and changing. The challenge is therefore semantic interoperability of systems.

15 years of eHealth standards, Tom suggested, have brought us no closer to ubiquitous sharing of even the most basic healthcare data. Has open source solved this? - no, he says, as many OS applications that have been developed are not interoperable; VistA allows VA hospitals to interoperate, but only because they all use the system. Vendors have also not solved the problems.

The start of the afternoon session saw Simon de Lusignan lead a workshop-based session  on health records, titled ‘How are electronic health records used to support the clinical consultation?’ The focus is on a newly-developed open source tool for observing  the effect of IT on the clinical consultation. Full information and downloadable materials are on the project website at http://www.biomedicalinformatics.info/alfa

The computer is increasingly becoming ‘a third actor’ in the clinical consultation between GP and patient, Simon states. The toolkit has been developed due to considerable variation between GP EPR systems and different systems giving different results from the same queries. Simon described the development over a period of years of using video capture of consultations, using different types of video capture systems to capture different aspects of the consultations (patient and GP activities), and different types of data, and different ways in which the data has been analysed. Open source tools have been developed for analysis.

The ubiquitous computing session had three speakers. Firstly, Johan Gustav Bellika from University of Tromso and Norwegian Centre for Telemedicine talked about the ‘Snow system’, a ubiquitous health surveillance system. Infectious diseases are the second most common cause of death worldwide. The system is named after Dr John Snow, investigator of the 1854 Broad Street cholera outbreak. It is ideal for health surveillance systems and the aim would be to identify infections much earlier in the infection processes than is currently the case. The system would be a peer-to-peer network to exchange data among primary care physicians, and so to try and develop system whereby surveillance data might be used for clinical decision support. His centre is also looking to develop sensor-based surveillance, which measures early indicators of infection.

Prof. Guang-Zhong Yang, from Imperial College, London, talked about ‘Body sensor networks – opportunities for medical informatics’. He also asked about the possibility of detecting disease, and intervening, much earlier than is possible today. Body sensor networks (BSN) are needed, he says, for patient centric healthcare. We have ageing population and increasing age-related chronic diseases, which result in rising healthcare costs. Current monitoring systems/tools give only a  snapshot of a patient’s health – but ubiquitous monitoring can capture infrequent symptoms that may be missed by snapshots. With dynamic, 24-hour, home-based monitoring that is unobtrusive and minimally invasive, there might be possibility to intervene earlier. Bell’s law on evolution of computer technologies - http://en.wikipedia.org/wiki/Bell%27s_law

BSN is about more than hardware and data collection – looking at design of new biosensors to collect new types of data, and need to look at biocompatability of materials; power use (75% of power used for the wireless transmission) – body motion to generate power?  www.bsn-web.org

Nick Hunn, Director of Advanced Technology with Laird Technologies talked about Bluetooth Medical Technology and ‘Wireless specifications for medical, health and fitness devices’. The economics of increasing amounts of GDP spent on healthcare no longer add up, hence the moves to cheaper alternatives, including care at home. Challenges are or enabling people to lead healthier lives and control of chronic conditions.

Bluetooth sees a need to develop new standards to support some of the moves needed to support home care etc. Bluetooth is currently used to replace cables, but there is no interoperability due to different products having different communications protocols. Power consumption is not optimised for many devices, due to wireless drawing on power consumption. Also looking at web connectivity for data sharing etc. Two new standards being developed – Bluetooth Health Device Profile and Bluetooth Low Energy Standard.

My apologies to anyone I have misrepresented in the above - some fascinating talks, some of which went over my head, but some of which I got absorbed in and neglected to take enough notes.

Technorati Tags: EFMI, open source, health records, EHR, EPR, ubiquitous computing, Bluetooth, body sensor networks

Listen to this podcast