Better is well known for its innovative use of openEHR in its Better digital health platform. Our belief is that openEHR is the most appropriate standard for a patient’s lifelong clinical information. Perhaps less well-known is the fact that alongside each openEHR clinical repository, Better makes use of the FHIR open standard for the persistence of operational data.
The combined used of FHIR and openEHR in healthcare platforms is increasingly prominent in the open standards world. Both Grahame Grieve (HL7 FHIR Product Director) and Rachel Dunscombe (openEHR International CEO) are publicly talking about the need for these standards to work constructively together. The shared belief is that to achieve the healthcare systems of the future, both standards should play a part. Better already has extensive experience in this area and is actively engaged in the respective communities to accelerate the collaboration.
We currently use the R4 version of FHIR, as this one is the most widely adopted, but we are already prepared for the later versions, and can provide an R5 version if and when our customers need it.
The patient record as a whole
The most significant items of operational data we keep is demographic information pertaining to the patient (e.g. healthcare number, name, date of birth, gender, address, …). The openEHR data is ‘anonymous’ by design, meaning we do not keep non-clinical information within it. As such, we link the openEHR data to the FHIR patient data to enable the patient record as a whole to be maintained. Once the FHIR patient is defined, additional related people can be defined within FHIR. These could include their next of kin, spouse, or other family members.
In addition to the patient information, the Operational data repository (ODR) is used as the store for the Encounters between the patient and healthcare professionals. The date, time, location, and healthcare professionals involved can all be stored within the FHIR Encounter. Where patients stay as inpatients, then their location within a hospital can also be recorded. Most Encounters will result in clinical information being recorded, to support this FHIR Encounters and the associated openEHR data is linked together, making best use of both standards.
As much of the encounter information is shared using HL7 ADT messaging, we also have a transformation capability to convert HL7 ADT messages to FHIR. Our integration capabilities support the movement of data between FHIR, openEHR, and other non-standard forms as seen in many of our existing solutions.
The ODR as the master data store for organisational data
The ODR has utility above and beyond the Patient and Encounter information and can be used to cater for many other operational needs. Whether that is managing patient Appointments, Healthcare service registries, or the central store for healthcare professionals, then, the ODR can support them. The ODR is increasingly being used as the master data store for organisational data, healthcare professionals, and other registries required within a healthcare solution.
The Better ODR is engineered to the same standards as our openEHR Clinical data repository (CDR) equivalent. It is highly secure and scales to national scale volumes without sacrificing performance or agility of use. As per the FHIR standard, the ODR can be extended to support additional search capabilities and operations.
With the FHIR standard, the use of profiles is frequently used as a mean to constrain the FHIR data models (resources) or extend them where required. The Better ODR fully supports the use of FHIR resource profiling, allowing for constraints and FHIR extensions as required. This allows for locally identified and national level FHIR profiling initiatives alike.
As with the CDR, the platform supports the use of high-quality data. The ODR uses the FHIR validation processes to validate the completeness and conformance of FHIR data as defined within FHIR profiles.
Management of terminology codes as an inherent part of the process
A further use for the ODR server is the functionality it offers around providing Terminology Services. The ODR supports the use of the resources used for terminology management and the FHIR operations that go along with them. The robust management of terminology codes is an inherent part of the process for creating high quality structured health data for data with both the ODR and CDR. Additionally the terminology services of the ODR provide an excellent opportunity for a terminology management capability across the enterprise.
Technically, the ODR is more than just a generic FHIR server. The ODR exists as an intrinsic part of the overall Better Platform offering. As such it shares many of the same platform capabilities as seen on the CDR. These include the same security and access control features, interface to the common platform audit services and event streaming for enhanced data integration.
For organisations looking at Better for their future modern healthcare platform, the combination of openEHR and FHIR should represent an appealing choice. For existing customers already on the platform, the ODR provides opportunities for exploiting the Better Platform in many diverse ways.
