The first morning of the hackathon kicked off with introductory presentations from INTEROPen, OneLondon, Wessex LHCR and NHSX. David Hancock, INTEROPen industry co-chair opened with a reflection on INTEROPen’s journey since 2016, and its continued importance as an organisation in balancing the demand push and the supply pull for interoperability in healthcare. He reflected that INTEROPen is still going strong four years on due to the complexity of the challenge, quoting Bob Wachter, “implementing health IT today is one of the most complex adaptive changes in the history of healthcare, and perhaps of any industry. Adaptive change involves substantial and long-lasting engagement between the leaders implementing the changes and the individuals on the front lines who are tasked with making them work.*” With INTEROPen’s mix of both vendor and NHS leadership and membership, the organisation is uniquely placed to encourage testing and adoption of emerging standards across the board.
Next, Andy Hadley, solution architect for shared records across both Wessex and Dorset set the scene around the challenges currently faced around medications data in the Wessex region. He described how upon hospital admission, clinicians often have the challenge of determining and transcribing the current medications for a patient, based on what they might find in the Summary Care Record and physical medications that the patient may have brought with them. An often time-consuming and inaccurate process. Beyond the hospital setting, he also emphasised the need for providers such as community hospitals and sexual health services to be able to view and contribute to a patient’s medication record.
In Dorset through the Dorset Care Record (DCR), progress is being made in rolling out the Orion Health Medicines Platform, to create a complete, patient-centric view of medications. Discharge medications from the WellSky HEPMA solution at Dorset County Hospital recently went live into the record as the first step. In June, the rollout for 150 community pharmacies launched, to give them access to the DCR and therefore this information, supporting their integration in the local health and social care system. Andy finished by outlining the ambitions for the One Medication Record programme being developed by Wessex Care Records, which will create a single holistic medication record for the LHCRE region encompassing Dorset, Hampshire and the Isle of Wight.
Dave Turner, chief technology officer at NHSX was the keynote speaker, throwing his support behind the hackathon format and its ability to ensure that the tools, standards and APIs being built are fit for purpose, and easy to adopt. He emphasised that the ‘X’ in ‘NHSX’ stands for user experience, recognising how important it is for the organisation to work with users and to understand their needs. Dave noted that we need wide adoption of data standards and simple ways to consume & adopt them to enable us to join up systems & organisations. All in the interest of creating more seamless experiences for patients and laying the foundations to explore new & exciting digital pathways. He concluded that one candidate for this joining up of information was medications, stating that we need to deliver a consolidated view of medications across all care settings. And with that the hack was underway!
The Orion Health team set to work reconciling and consolidating medication information from multiple sources through the Orion Health Medicines Platform. This platform includes solutions for the recording, reconciling and management of medications at transitions of care with Medication Management, a Medicines Decision Support capability, Medicines Viewer to ingest and consolidate medication records and FHIR APIs for bi-directional interoperability. In this hackathon, the team focused on the Medicines Viewer and a new consolidated patient medication list API to expose a patient’s current medications for 3rd party applications to consume.
Over the two days, using the consolidated patient medication list FHIR API within Medicines Platform, to our knowledge unique in the market, medications from a variety of source systems were aggregated, normalised, enriched and surfaced as current medication list using the FHIR List resource. Clinicians and caregivers able to access the current medication list within Medicines Viewer and 3rd party applications we able to access the same structured data to support their own internal reconciliation workflow and medication management functionality.
Medication sources consolidated during the hackathon included EMIS Health, Better, Healthcare Gateway (MIG) and HL7 message sources that were transformed into the appropriate FHIR resource format. The Orion Health team was able to expose the patient medication list FHIR API endpoint to Better, who consumed the data “on admission to hospital”, then passed back the updated medication information “on discharge,” completing the transfer-of-care process. This reflected a great achievement for interoperability in medications, moving beyond the more traditional system-to-system information sharing and demonstrating both the sharing and consuming of data by the Orion Health platform.
The consolidated patient medication list FHIR API is also able to be consumed by other systems and third parties, supporting additional use cases such as presenting current medications to patients through a patient engagement applications. The team was able to showcase integration with a third party personal health record application from Tiny Medical Apps who consumed the FHIR list API to support patient-led medication reconciliation. A writable FHIR API for patient contributed medications was also provided during the Hack but two days just wasn’t long enough to showcase this capability, maybe for the next one….
The online event provided a valuable opportunity to work on refining Medicines Viewer and the patient medication list FHIR API with industry peers. Going forward, we will use the event outputs to develop these further and seek early adopter partners for bi-directional data exchange.
The Wessex team was on hand to support this inaugural virtual hack, using some advanced features of Zoom that were found over the two days. Emma Davis, a GP and the lead clinician for the Hampshire CHIE programme summarised, “I wasn’t sure what to expect, but worked collaboratively with experts from around the country on imagining how patient initiated medication records would enrich a consolidated medication record. It felt we were all learning and contributing.”
The event closed with each team presenting a summary of how they progressed, what they had learned, and the challenges along the way. Every team effort was a partnership, demonstrating the ethos and benefits of working collaboratively on creating “one medication record” probably the most complex digital problem in the already challenging health and social care landscape.
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