We all know that context synchronization is vital for increasing efficiency and improving patient safety. We use it for DTI between RIS and PACS but we recognise that it has much wider applications throughout the organization. It would lead to Integrated Healthcare in a multivendor enviornment.
I think there are 3 types of methodologies 1. Proprietary (like Agfa broker)--In my view this is least preferred. 2. CCOW (again this a a type of broker system) but use the HL7 CCOW standards. 3. Using standard Web technologies.
Now, I do not know much about these. I would be grateful for those of you who are more technically literate (users/suppliers/developers) to post on the forum with ideas and suggestions and pros and cons.
Patient Synchronised Application Profile of IHE is similar to CCOW with context management limited to patient ID level. Above defines the number of suppliers who have made their products compliant to this. I am interested to know why there is a general lack of adoption of this concept of standardising context synchronization. 1. Is it due to commercial reasons where vendors wish to provide a Full EPR rather than a intergrated health record in a multivendor enviornment 2. Or there is some technical problems with this profile/CCOW standard.
As the CTO of Sentillion and the leader in providing context management solutions in healthcare, I have seen the effective use of context management in many different scenarios. The value of context management can significantly streamline the caregivers workflow and produce significant time savings along with improving patient safety as you pointed out.
With regards to different approaches, certainly proprietary is one approach but it requires the healthcare organization to coordinate the effort to have the integration come together in a way that meets your requirements. This can be expensive leaving you with a unique and highly customized solution. Web technologies can be applied to some degree but they do not provide the constant ongoing peer-to-peer synchronization and this does not work with the significant numbers of applications that are not web based. The CCOW standard is a standards-based way for applications to support context management. This of course requires a CCOW compliant context manager component to make this work and assumes the applications are CCOW compliant so you will need to determine this for the applications you would like to integrate, but even if they are not CCOW compliant, there are still other options.
Sentillion provides a CCOW SDK used by almost all CCOW compliant applications and we also provide a CCOW compliant context manager component with hundreds of successful installations. However, because all applications are not CCOW compliant and healthcare organizations do not want to wait for the vendors to implement CCOW in their application, then of course having to upgrade to that new version of the application, Sentillion provides a technology that works external to the application so the application behaves in a context aware fashion without modifications to the application.
Another thing to consider that can get overlooked is not just coordinating applications to the same context, but now that the applications are interoperating at the glass there needs to be something that manages them at the desktop so the different applications can be signed off and shut down in preparation for the next user. While this is not part of the CCOW standard, managing the desktop session makes the solution much more usable once you move down this path.
To address the subsequent posting of commercial or technical reasons why so few healthcare applications are delivered as CCOW compliant in the UK, the answer is quite simple. There has been very little demand from NHS Trusts on their respective suppliers to deliver CCOW compliance in their applications. If you, the customers, are not demanding this "feature" then your suppliers are most definitely not going to provide it for you.
If this was a technical issue, it would be much easier to resolve. Using our SDK, many suppliers have CCOW-enabled their applications in just a few weeks. If your Trust have self-developed applications, you can CCOW-enable these yourself. However the cycle of convincing your suppliers, either through continued support payments or new purchases, to implement this feature still takes time to plan, do, and deliver in a release cycle. This process could take months or years. As mentioned above, this is why suppliers such as Sentillion have developed sophisticated ways of implementing workflow-based integration without requiring the application suppliers' participation.
From a patient safety perspective we do need an INTEGRATED health record. I do believe, that there are 2 fundamental standards to achieve an integrated health record, a. Document indexing and display standard--XDS b. Context Management Standard--CCOW
We had John Gobron from Sentillion talk about CCOW at our Spring meeting. At the Autumn Meeting we have Carefx (from the supplier side) dealing with the same issue. John Skinner from Oxford will deal with user/IT implementation issues of context management.
I will also ask our departmental systems suppliers a. PACS-Fujifilm b. RIS--HSS c. Medisec--Clinical Letters d. Visbion--Medical photographs/ophthalmology images and also e. Forcare--XDS Registry supplier to have a view on context management.
These suppliers are going to discuss the concept of standards based EPR, with also a concept of integration between departmental systems using context management.
Let us analyse, what are the problems of adopting standards like 1. XDS 2. CCOW to achieve this goal of a integrated health record in a multivendor environment.
Book early to participate in this debate between users and suppliers.