RippleStack, building blocks to construct EHR based on openEHR technology, presented by Christian Chevalley.

1. Christian Chevalley
Ripple Foundation
openEHR SEC
ADOC Software Thailand
RippleStack & EtherCIS:
Shinkansen to openEHR

2. 2
UI Middleware Backend
IconsdesignedbyFreepik.com
2
The Ripple Stack
UI/UX Usability: JavaScript UI Toolkit,
REST
UI/UX Usability: JavaScript UI Toolkit, REST openEHR CDR: REST

3. A ToolChain for Building Quickly Open Clinical Information Platforms
3

4. PulseTile
Web UI/UX Toolkit
https://www.pulsetile.com/
4

5. RippleStack: PulseTile
● Plugins
○ Clinical Notes
○ Problems Diagnosis
○ Images
○ Documents
○ MDT
○ Orders
○ Personal Notes
○ Procedures
○ Referrals
○ Test Results
○ Vaccinations
○ Vitals
○ Clinical Statements
○ Events
○ Transfers Of Care
○ Drawings
○ WebRTC
● AngularJS -> In Browser
● Tiles & Plugins
○ Rendering
○ API
○ Networking
○ Markups
● Basic “Tiles”
○ Intelligence - Charts
○ Search
○ Multi Person/Patient View
○ Person/Patient Summary View
○ Allergies
○ Medications
○ Contacts
5

6. PulseTile: Charts
6

7. PulseTile: Images
7

8. PulseTile: Vitals
8

9. PulseTile: WebRTC
9

10. PulseTile: Clinical Statement
10

11. PulseTile: Drawing
11

12. QEWD
Microservices Middleware for Data Integration and
Normalisation
http://qewdjs.com/
12

13. QEWD: Multipurpose REST Server Platform
▪ Web Server → serves PulseTile UI components
▪ Data Transformations (FHIR, openEHR, HL7, XML,
SOAP …)
▪ Microservices Based
▪ Authentication (OpenID connect, JWT)
13

14. RippleStack: QEWD
14

15. QEWD JSON transformer: Jumper
▪ Quick access path to openEHR
▪ Automates openEHR transactions AQL, CRUD
▪ Uses template introspection
▪ Transforms complex representation to/from json
structure: rippleui, FHIR ...
▪ GUI to specify mapping rules
▪ https://www.youtube.com/watch?v=iaGGGgJdWvM
15

16. 16
...
"data": {
"items": [
{
"@class": "ELEMENT",
"name": {
"@class": "DV_TEXT",
"value": "Causative agent"
},
"archetype_node_id": "at0002",
"value": {
"@class": "DV_TEXT",
"value": "Amoxycilin"
}
},
{
"@class": "CLUSTER",
"name": {
"@class": "DV_TEXT",
"value": "Reaction details"
},
"archetype_node_id": "at0009",
"items": [
{
"@class": "ELEMENT",
"name": {
"@class": "DV_TEXT",
"value": "Reaction"
},
"archetype_node_id": "at0011",
"value": {
"@class": "DV_CODED_TEXT",
"value": "Rashes",
"definining_code": {
"@class": "CODE_PHRASE",
"code_string": "846316841",
"terminology_id": {
"@class": "TERMINOLOGY_ID",
"value": "SNOMED-CT"
}
}
}
}
...
{
"cause":"Amoxycilin",
"reaction":"Arshes",
"reactionTerminology":"SNOMED-CT",
"reactionCode":"846316841",
"author":"Dr Ian Shannon",
"dateCreated":1482185462518,
"source":"ethercis",
"patientId":"9999999000",
"sourceId":"f8d4f97b-55ab-4f89-8314-bf3f5c622cd0::local.ethercis.com::6"
}
QEWD jumper
transform
get composition fmt: RAW get composition fmt: rippleui

17. EtherCIS
Database centric openEHR CDR
http://ethercis.org/
17

18. EtherCIS: Enterprise open source openEHR CDR
▪ REST Web Server
▪ Standard openEHR CRUD and AQL
▪ Multi-dimensional projections: JSON, XML etc.
▪ Strong security: JWT, RBAC, MAC
▪ Multi-tenancy
▪ Authentication (OpenID connect, JWT)
▪ Supports data extensions, batch and automated data processing
18

19. Five Key Principles
➢ Stored Data is Usable
➢ Strong Security and Privacy
➢ Multi-dimensional Projections
➢ Reusable Knowledge Models
➢ Open Source, Open Standard
19

20. Shared CDR and Security (EU GDPR)
▪ Extended Responsibility of custodian
▪ Compulsory Informed Consent
▪ Data Handling
▫ Need-to-Know, purpose
▫ Retention
▫ Confidentiality, Privacy and observance of Rights of Individuals
▪ Documented Measures, Procedures and Organization (and updated)
▪ Rights of Individuals
▫ Explanation of data usage
▫ Modification, erasure or opposition
▫ Right to transfer data
▫ Right to be forgotten
20

21. RippleStack: EtherCIS
21

22. EtherCIS Java Application Internal
22

23. EtherCIS: Processing Delegation
23

24. EtherCIS Service Based Deployment
24

25. EtherCIS Database
Modern SQL
https://www.postgresql.org/
25

26. 26

27. EtherCIS Database (PG10)
27

28. Next
28

29. Where is EtherCIS Used Now (AFAIK) ?
29
1. UK: Helm, PHR
2. Germany: HighMed
3. Various European Projects
4. India: HealtheLife
5. Vietnam
6. Russia
7. Japan?
8. USA?

30. EtherCIS Future Moves
▪ Roadmap
▫ Tools for Deployment & Administration
▫ Demographics Integration (Analytics)
▫ Free Text (medical notes)
▫ openEHR Compliance
▫ “Smart” terminology integration in querying
▪ Security & Information Governance (September 18)
30

31. 31
THANKS!
Thank You!
You can find me at:
▪ christian.chevalley@ripple.foundation
▪ christian@adoc.co.th
Useful Pointers
▪ https://ripple.foundation/
▪ https://github.com/ethercis