Thread by @mwardle

I gave a talk on “Unbundling the electronic health record” at #reclojure22 - . I think we need to turn what we think of as the “electronic health record” inside out.

The conventional approach means thinking in terms of applications, and not data, and is centred on organisations / providers, not the patient, or the wider ‘service’. Architecturally, it is a monolith, at least to outsides, and proprietary and organisationally-centric.

Standards and interoperability in the conventional model are outward-facing - requiring external interfacing and a combinatorial explosion. We end up with multiple concretions, fossilised architectures that are poorly adaptive to change, with data only in context of applications.

We end up with false dichotomies between the systems, applications, services, approaches, tooling, teams, departments, organisations and even the programming languages we use depending on whether we’re using those data for direct care, analytics or research. This is madness.

Instead, we should build our systems ‘like we program the outsides’ of our systems - breaking apart our complex domain of health & care into smaller more tractable components only to recompose together to solve user problems, prioritising meaningful data.

Those data should be patient-centred, standards-based and include models of first-class domain events, and we should think of those data as both at rest in buckets, and moving around in pipes / conveyor belts in order to orchestrate and coordinate care across boundaries.

You can try alternative approaches, such as interoperability through convergence [all use the same software], or interoperability through standards / exchange [you create shared records] but far better to unbundle the EPR by making first-class composable data/software components.

Video available here:

Open-source tools referenced in the video:

hermes - SNOMED CT library and server github.com/wardle/hermes

codelists - generate code lists from ICD-10 and ATC codes. github.com/wardle/codelis…