In an exclusive interview with Talkstandards, Professor David Ingram of openEHR, one of the most innovative players in the eHealth field, outlines some of his expectations for the future of ICT in the health care sector. This transcript has been prepared from notes taken during a telephone interview on February 22nd.
Part I: The Future of eHealth
(This is the first of three parts of the interview. Read Part II on eHealth in an international perspective here, and Part III on Openness, implementation and governance here.)
TalkStandards (TS): There is currently a great deal of political hopes that eHealth can improve health care. Are these hopes realistic?
David Ingram (DI): The greatest challenge for eHealth today is trying to collect the disparity of ideas and efforts under one single umbrella to gain sufficient momentum and progress. Depending on the specific issue, hopes may or may not correspond with prospects. Generally, I am afraid that governments tend to be excessively enthusiastic about getting eHealth services up and running. Sometimes they do not fully realize the complexity of standardization processes of IT solutions.
Today, information technology is embedded in everything that we do. It has been a long learning process. Unfortunately ICT is sometimes taken for granted, and solutions are expected to come automatically. Therefore, governments run into trouble when trying to build a complex system. Technology is constantly evolving and we must learn how to best exploit these new technologies to manage information in order to reap the full benefits of eHealth.
TS: A distinguished feature of the openEHR is the way in which the patient is put at the center of development. What are the outlooks of creating a system where the patient fully controls his or her information?
DI: This is an interesting issue as we already see this sort of systems developing today. There are many long term treatments that need regular and careful monitoring. An example is system of 5000 patients with a coagulation deficiency who can regularly sample blood autonomously and upload the result to their medical institution for analysis.
However, it is important not to generalize when discussing this issue. There are territories where patients are reluctant to accept autonomous care, where they need the assurance of being under professional care and responsibility. In these cases they rather visit hospitals or a general practitioner in person. However, there can be different areas where patients could request autonomy and there is no certain rule that applies since patient preferences differ.
TS: What important trends do you see in the near future and what role is openEHR playing in this development?
DI: First and foremost, I welcome that the challenge of accomplishing practical progress toward interoperability is being addressed. Many different stakeholders – public as well as private – are involved in eHealth development and need to collaborate. We need to capture information as close to the physical encounter as possible and simplify it in order to facilitate sharing. This requires clear specifications which can serve to give us an overview of each patient’s information.
Another important trend is trying to understand and learn how genomics interact with treatment, especially for cancer patients. 30-40 years ago treatment policies mainly included “weed-killers”, which while targeting the malignant cancer cells, also caused much damage to healthy tissue. Today, with the use of IT systems, we can gather data which allows us to analyze which patient responds to what treatment. As a result disease profiling allows customized treatment, for instance oncology has moved towards a more efficient management of cancer. With the combination of making healthcare delivery better and managing individual data better in the long term, personalized treatment is now a reality.
In reality, openEHR is still a relatively small player. Our goal is to provide base standardization that can be adapted to a shared infrastructure as well as being adapted to local requirements, which often vary. Our approach is empirical and pragmatic, which in our opinion is the best way to contribute to the systemic landscape.
Biography David Ingram, Professor of Health Informatics, University College London
David Ingram is Director of the Centre for Health Informatics and Multiprofessional Education (CHIME) at University College London. After undergraduate Physics at Magdalen College Oxford, his career posts have been in industry, the National Health Service and University Medical Schools. CHIME is active in a wide range of international research programmes, and offers an extensive, multi-disciplinary educational programme, in quality, information and governance for health. The work of CHIME is founded on close working partnerships, with health service professionals, industry and community groups, and contributes to every-day services within the NHS and further afield.
David Ingram’s work in health informatics has covered contributions in the areas of mathematical modelling of biological and clinical systems, informatics in medical education, and formal methods for modelling health information requirements and architectures. Since 1990, he has been co-ordinating partner and partner in six major EU Health Informatics Framework Programme projects, focusing on health record architecture, implementation and standards, internationally. He is currently a principal investigator in the Medical Research Council e-Science Programme (Clinical e-Science Framework project, CLEF). He is active in research on representation of knowledge about inherited diseases. In 2003, CHIME was officially designated as a World Health Organisation Collaborating Centre, working on genetics knowledge management for patient advisory systems.
David Ingram’s professional activities include membership of the MRC Health and Bioinformatics Advisory Board, the national e-Science Advisory Board, the eScience Advisory Board of the Central Computing Laboratory for the Research Councils and the UK Council for Health Informatics Professions. He is the founder and chairman of the board of the openEHR Foundation, which is dedicated to sharing of standardised and open source software to support interoperable electronic health records. He is a Trustee of Starthere, an innovative charity which is establishing a national, highly accessible network of electronic signposts to local healthcare support services. He is international advisor to the EU project promoting health informatics in the accession states of the EU. He was elected Honorary Member of the Royal College of Physicians of London, in 1999, in recognition of his contributions to medical science.
