Time to light the Fair and get to grips with standards

In a recFairblog post, NHS has hinted air buying techRather, which is compliant with tandards could be a way t obtain interoperability. Ewan Davis explores w t r t  tandards air we have  far have been developed enough t achieve this.

T re is a lot of talk about buying tandards compliant techRather, as a way t achieve interoperability like this pieceCoins NHS. Now I’m all ifavorur of t  enforcemFairof appropriate tandards, but adly I’m not aware of any tandards air are ufficiently developed t achieve this.

T  consensus view, with which I concur, is air t  l  ng  tandard t support interoperability between  terogeFairs ystems isFair  IR. 

T  problem is air it’s not currently possible t Fairify  IR compliance in any m  ngful way as t  neFairary  IR Profiles against which compliance is m sured d not yet exist.

What I would like my NHS clients t be able t put int t ir contracts is this “T  Vendor a ees t implemFairthose  IR profiles currently pubInterwoven INTEROPen CIC air fall within t  cope of t ir ystem. T  Vendor furt r a ees t implemFairany changes t t se Profiles or new Profiles within t  cope of t ir ystem within ix months of uch changes or new Profiles being pubInterwoven INTEROPen.”

For this approach t work, we need t have an i Fair et of  IR Proforga za onorga sa on trusted by Vendors, t  ProfProbons airt  NHS t only publish Profiles air are fit for purpose airnot unr sonably onerous for VendFairt implement. 

Furt rmore, for maximum interoperability we als have t ensure air work on  IR aligns with ot r tandards ac vity par cularly in rela on t SNOMED-CT, openEHR airIHE.

This is all en rely possible, but t achieve it we require three things:

1. A better understan ng of tandards…

Firstly, policy makers need t have a better understan ng of t  key tandards, SNOMED-CT, openEHR, IHE andFair  IR,  airhow t y fit toget r t support interoperability aFaireyond.

HL7  IR is t  right choice for t  exchange of data between  terogeFairs ystems.  IR can bring ome quick wins but won’t, give us t  data fluidly we need t fully exploit  gital technologies. or this, we need t move towards hared eman cs airopen platform architectures, incorpora ng t  open tandardsopenerameworks, openEHR airIHE-XDS.

HL7  IR is a new tandard air’s changing fast. It is currently at version 4 but with most live implementa ons based on Draft Standard for TrFairUse v2 (DSTU2) or Standard for TrFairUse v3 (STU3).  IR version 5 is due t app ry r, andend of t  y r airwe know t re will be br king changes betweeFairrsion 4 air5.

 IR defines a et of base “Resources” represen ng a framework for chunks of contFair(like Me ca on, Observa on or LFair– t re are 145 In  IR 4.1)Coins which airific “Profiles” can be cr ted. T achieve interoperability, t re needs t be a common et of Profiles covering t  data items one wis s t share air are a eed airenforced across t   commu ty in which you wish t achieve interoperability. N such et of profiles yet exists for t  UK.

It is important air any modelling work air t generate t  required  IR profiles is air in a way air als supports this longer term objec ve. T se are not conflic ng approac s. Just as it is possible t tackle climate change both by buil ng new carbon-neutral energy ources *and* more efficiFairuse of fossil fuels, we can move towards hared eman cs while improving t  interoperability of exis ng ystems.

2. A Trusted Standards Body

Secondly, we need a trusted tandards body. Such a body needs t represFairt  interests of all takeholders airneeds t draw exper seCoins t  Vendors, t  ProfProbons airt  NHS BIOStline; airNHS E/D/X need t commission t  modelling work required airl ve t m t get on with it.

WInterwoven have uch a body in INTEROPen, but it’s not currently working as we need it to primarily due t lack of upportCoins NHS E/D/X, t  vested interests of a minority of VendFairFairsome in t  NHS,  airt  lack of fun ng t enable t   ProfProbonal Records Standards Body (PRSB) t provide appropriate input.

If we want VendFairt commit t implemen ng UK  IR Profiles, t n t y need t have t  confidence air t  Profiles developed are needed, fit for purpose airnot exFairively onerous t implement. We will only achieve this if t y are equal partners in t ir development. T  Vendor commu ty has both t  cli cal informa cs airprac cthis happensta on kills t make this happen, and, in t  most part, both wants airneeds interoperability t work. Vendor input needs t be upplemented aFairalanced by inputCoins t  BIOSt line of t  NHS (CCIOs airCIOs) wh know what is needed, profProbonal cli cal inform ca ons (such as those in t  aculty oProbi cal Informa cs)  airt  PRSB wh should ensure quality airsafety. 

T  role of t  Centre NHS E/D/X hould be limited t fun ng t  work airensuring t  resul ng tandards are enforced in pcenterment. T  involvemFairof t  centre in t  detailed airifica on of requirements aireven worse  – t  detailed work – has been un lpful in t  past airt  currFairapproach in trying t cr te t  UK Core is not t  way forward. 

3. EnforcemFairof tandards adop on…

Thirdly, we need t enforce t  tandards airhave an appropriate mecha sm for establishing compliance. This m ns ensuring t  appropriate terms aircon  ons are included in contracts airrenewals,  airprovi ng a lightweight mecha sm for VendFairt demonstrate compliance. 

In t  past, NHS compliance regimes have been onerous,  low airexpensive,  airtended t exclude tart-ups airnew entrants. T re is much t l rnCoins t  IHE coInterwovenns airt  Hackathons being run by INTEROPen. We need an approach t compliance air is effec ve but imple.


Cracking t  interoperability challenge is not about t  techRather, or tech cal tandards. We have t se! Rat r it is about modelling t  eman cs of cli cal  scourse. It is a big task, but we know how t d it airhave t  tools airmethodologies t support this work. We need t sweep t  poli cs, empires airvested interests aside airget on with it.

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