Indivo – part of the InnoRx disruption

The Indivo system is cited in The Innovator’s Prescription and showing up in other material I have been reading. It is part of the Children’s Hospital Informatics Program of Children’s Hospital Boston

I started this post to facilitate reference to Indivo. Found much more than I expected. See the link below that includes: Ten Principles for Fostering Development of an “iPhone­-like” Platform for Healthcare Information Technology.”

The Indivo system is essentially an inversion of the current approach to medical records, in that the record resides with the patients and the patients grant permissions to institutions, clinicians, researchers, and other users of medical information. Indivo is a distributed, web-based, personally controlled electronic medical record system that is ubiquitously accessible to the nomadic user, built to public standards, and available under an open-source license. …

Indivo is built to be extended and customized: users can connect their record to third-party applications that enhance the management and analysis of their health information. Indivo accelerates the development of these third-party applications by providing a core set of common features:

  • secure storage, categorization and aggregation of health data.
  • single sign-on and standards-based data-access delegation.
  • a simple, open, web-based Application Programming Interface (API).
  • unified user notification. …

Google, Microsoft and Dossia emerged as giant PCHR platform providers all sharing the basic PCHR platform approach. Microsoft Healthvault launched with Indivo open source code in the founding companies. Google later announced the Google Health model, building a platform around the Anvita (formerly Safemed) knowledge base and analytics. [links added]

Am article titled: An “iPhone-like” Platform for Healthcare Information Teechnology
June 18, 2009 argues “for the development of a platform model – similar in nature to the approach of the Apple iPhone – that would support an ecosystem of “substitutable” health care applications.”

The post includes: Ten Principles for Fostering Development of an “iPhone­-like” Platform for Healthcare Information Technology — truly disruptive.

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2 responses to “Indivo – part of the InnoRx disruption

  1. Do you know…is Dossia also based on Indivo?
    Yes: Indivo is … actively deployed in diverse settings, in particular our own Children’s Hospital Boston and the Dossia Consortium http://indivohealth.org/

  2. The importance of of an EHR platform that allows for health applications to ‘plug and play’ into a health data respository that is non-proprietary and an open standard is largely underestimated. The CHIP concept of an “iPhone-like” platform is disruptive and so neccessary. It breaks our traditional notion of the EHR as a software application and focuses us on the data. After all, it is the health information that is the actual health record that we need to persist for the patient’s lifetime, not simply the GUI and the proprietary data format that lock us into vendor upgrades every 7-10 years. This is an extraordinary fallacy we all seem to accept without questioning. If we break the data out of the silos imposed by vendors into a standardised format, we can start to use the data more meaningfully – imagine two clinicians within the same clinic using different EHR frontends that suit their style and workflow yet reading and writing to the same standardised data repository of their patient’s health information; share EHR extracts between providers because they are based on common and agreed data definitions; use the EHR clinical data to support reporting, public health notifications, research etc etc.

    Is this fanciful? My disclosure here – this is what I do in my daily work. But it’s success to date has largely been in the non-US world!

    There is an open source EHR specification that provides exactly the kind of EHR platform that Boston CHIP speak of – it is known as openEHR – managed by the openEHR Foundation in London, found online at http://www.openEHR.org.

    The specifications are the result of more than 15 years international R&D – predominantly in Europe and Australia, and are the basis for the ISO and European standard for EHR – ISO/CEN 13606. They outline a 2 level paradigm where the techies look after the technical stuff and uniquely, the clinicians look after the clinical content.

    The clinical content is expressed in openEHR archetypes – computable specifications that are being read, understood and agreed by clinicians. Archetypes are maximal datasets about a single discrete clinical concept eg BP, pulse, diagnosis, symptom, etc. Archetypes are then aggregated for specific clinical scenarios. For example a Discharge Summary or Antenatal Consultation might be made up of up to 80 archetypes.

    The basic premise is that if we can agree these archetypes, we can start to share data that has been captured according to these agreed definitions. It’s not rocket science. But the common situation with EHRs is that every vendor makes up their own content specifications and none can talk to anyone else – their solution to interoperability is ‘buy more of mine’. openEHR’s solution to interoperability is based on creating an agreed, open source lingua franca for clinical content ie archetypes.

    openEHR is currently being used within the NHS Connecting for Health program, Swedish national EHR program, NEHTA in Australia and Singapore Ministry of Health. Brazil is about to engage with openEHR more formally. Many countries at national program level are investigating it. Microsoft includes openEHR in its just released Connected Health Framework. The European Union’s Roadmap to Semantic Interoperability includes openEHR as one of the key components.

    But the thing that is gaining most momentum in recent months is the the openEHR Clinical Knowledge Manager (CKM), an international library of archetypes launched only 3 months ago – http://www.openEHR.org/knowledge – currently with 250 registered users from 42 countries are collaborating on agreeing clinical archetypes! Sweden and Singapore will soon have their own national versions of the repository federated with international CKM.

    A recent poll by the openEHR community voted on the next priorities for CKM archetype review, related to requirements for use in an Emergency – http://www.openehr.org/wiki/display/healthmod/Poll+Results+-+Top+10+archetypes+for+use+in+an+Emergency.

    The international EHR environment is starting to change… and the non-proprietary EHR platform has enormous potential as an enabler.

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