Roadmap 2017/03

Below is the draft roadmap for Q2 and Q3 2017. (Click to see the Q4 2016 / Q1 2017 roadmap.) As usual, final delivery timelines will change in response to the feedback of early adopter customers and as our developers dig deeper into the details of each feature. For questions about any of the features below please contact us. The PKB blog has archives of past roadmap postings. And if you are a developer, we're hiring!

Performance

We are continuing our focus on speed of page loading times. The more quickly PKB can show information to the user, the more often users choose to access the information which makes the patient's care more accurate and safe. You can monitor current page load speed on pkbstatus.com. We want every page to load within a second. We are a long way away from this but we have also come a long way. Over the past year we set up parallel decryption infrastructure so that multiple virtual machines are able to decrypt in parallel the data points for a particular page, e.g. all the measurements or all the discussion messages.

This year we are making a number of optimisations:

• 1. Zero-downtime for upgrades as we roll out our clustering architecture.

  2. Shifting to a Advanced Encryption Standard (AES) algorithm from the current DESede (Triple DES). This is orders of magnitude faster, more secure and allows us to encrypt more data with a single key.

  3. Each page will be optimised to make fewer database queries. We will start with the most commonly used pages i.e. the dashboard, the discussions page, the patient summary page and the lab results page.

Stability

Last year we had focused on major architectural changes that support population-scale deployments with patient-controlled health information exchange. With these architectural changes complete, we are focusing on stability of the platform to allow a lot more automated testing every night for new code, which in turn allows upgrades to be more frequent and smaller.

Integrations

EMIS direct integration

Phase 1: Two GP practices are piloting EMIS integration with PKB: demographics, diagnoses, medications, allergies and appointments are copied daily for all patients' records into PKB. You can read more information in the PKB / EMIS PDES page.

In parallel we are working with HSCIC's GPSoC on the SystmOne client-side API, and after that we will work on INPS and Microtest's APIs.

Phase 2: single-sign on with context switching from GP EHR to PKB. This means a GP using their EHR to look at a patient's record will see a link to PKB. The link will sign the GP into PKB using credentials already stored in the EHR system and display that patient's full record in PKB. So the GP can see the patient's non-GP data i.e. from hospital, social care and the patient.

Phase 3: ultimately we want data to display inside the GP system's EHR. Not every GP system can cope with this at the moment, but our long-term approach to EHRs is to allow the user to stay within their chosen IT systems without having to log into PKB. If you would like to make PKB data available to your customers you can use our open API, a read / write REST API.

HL7 APIs to support SystmOne data

We are completing testing of HL7 APIs to support diagnoses, medications and allergies. This allows local IT departments to reformat CSV extracts e.g. SystmOne GP EHR data, to send the data to PKB as HL7 messages.

Mapping Read codes to privacy labels

As part of the GP integrations, PKB are mapping Read version 2 codes to privacy labels. This means an HIV diagnosis for example will automatically have a sexual health privacy label, so only teams with access to sexual health data can see the diagnosis.

Lorenzo integration

CSC's Lorenzo team has started testing single sign-on integration with PKB. This allows a Lorenzo user to click to see a patient's data in PKB without needing to sign into PKB. Their existing Lorenzo session is enough to decrypt and display data.

SCI Store integration for data from Scotland

We have completed the first phase of SCI Store integration, receiving data for HIV patients. Later this year we will expand testing and automation to handle data for all patients. The optimisation of the speed of the test results page (above) will allow pages to load much faster for patients with thousands of test results, a common occurrence with SCI Store as one of its great features is providing lots of past data.

Two-factor authentication

Professionals will have this first for added security. Eventually we will provide the option for patients who can choose to switch on the added security without affecting usability for most patients. We already have this working for internal staff at PKB as we test for usability.

To switch on the functionality the user needs to download the Google Authenticator smartphone app for their iOS or Android device.

Expanding smartphone app

The version we released in March is a lot faster and starts with discussions support. The next releases will expand the screens to ultimately match the PKB web site. This will mean most of the PKB web functionality will be available to users offline, without an internet connection. This is important when traveling abroad or underground, or even while inside a hospital with poor signal.

Planned features include:

• • Large attachment handling: this allows the patient to upload videos and photos from their smartphone. These files are increasingly large as smartphone camera technology continues to improve.

  • Test results: storing test results automatically transferred from hospitals but also allowing the patient to enter new test results. This includes taking a photo of the print-out the patient may be copying the test results from so the clinical team can see the original paper to verify accuracy.

  • Appointments: the smartphone app will add an iCal feed to the smartphone's calendar so the calendar will show PKB appointments. The information in the appointment will be link to the PKB for decryption so that the calendar does not show clinical information. But the patient can rely on their smartphone calendar's functionality for managing appointments, including reminder and seeing their clinical appointments with the rest of their schedule.

  • Symptoms: this allows fast convenient entry of patient-reported outcome measures

  • Care plans: seeing and editing care plans from all clinical teams helping the patient. The care plan includes the metrics the clinical team is monitoring i.e. the symptoms, measurements and lab results which are relevant to the patient.

  • Diagnoses, medications and allergies. We delayed this as the most scalable data are only now starting to arrive as we in GP and hospital electronic health record integrations.

Designs for 2017

We have several designs based on customer requests. We will prioritise these based on roll-out scale, i.e. customers which will make use of these features with the most patients. If you would like to use one of the designs below please contact us.

Timeline view

The timeline view on the home page of a patient's record will combine data from multiple other pages all plotted against a horizontal x-axis.

At the moment the discussions view shows past interactions with the health care systems, including secure messaging, clinic visits and hospital admissions. The calendar view shows appointments, defaulting to future ones and needing scrolling for past ones. Furthermore professionals and patients alike want to see their encounters and appointments lined up data such as symptoms, measurements, test results and care plans.

The timeline view will do this, giving a fast overview with click throughs to details.

Professional views

Professionals need to look at a lot of information on one screen in a patient's record. They are used to seeing lots of information tightly packed but they also typically have smaller screens than home users do. We are redesigning the professional view within PKB to make it more dense and with less white space.

The patient summary page will list the latest panels as well as the vitals signs from measurements.

Clicking on a panel will show the results.

The discussions page shows information about professional users in as few lines as possible to minimise vertical scrolling. Where a message is formal communication (e.g. a discharge letter or a clinic letter) rather than an online consultation the bottom of the page allows the user to enter their notes rather than send a reply.

The professional's schedule screen is also getting a makeover into a monthly view.

Symptoms

Earlier this year we updated the symptoms view to make it easier to document symptoms and clearer to see their changes over time. However, adding a new symptom to track is still too hard. This is the design we have for adding new symptoms, which is much closer to NHS Choices and other patient-friendly sites:

Measurements

Earlier this year we updated the measurements view to group data into vitals, exercise, diet and sleep. Although adding data from a device is easy, manually entering the data is still cumbersome. This is the deign to make it easier.