Transcript Applications of XML in the NHS - Information Services Division

Applications of XML in the
NHS
Paul Woolman
Standards Program Manager
ISD
Contents
XML for:
 Patient Records
 Publishing
 Communications
Patient records

Store clinical information as XML

Structured documents
Case notes
 Discharges
 Referrals
 Summary documents


Structured data

XML data model
Information storage

XML as the format for authoring and
storage of documents
Rather than Word .Doc, Rich Text Format,
Text
 Clinical documents
 Metadata (description of documents)
 Latest Office applications (MS, SUN, Open)

Examples
Graphnet
 CSW
 Office
 Anaesthetic records…
 Next 4 slides…

Office applications
MS office, Sun, OpenOffice
store & use XML documents
 Infopath forms client

Supports web services & XML
 Build forms from xml schema

Replacing Paper Forms
pre-op
instructions
pre-op
assessment
lab
test
results
Patient info
Case type
post-op
instructions
Pasting a Theatre List
Client Behaviour
XML
SAX
Writer
XSLT
Transform
(Optional)
XML
Signature
&
Encryption
SOAP
Message
server
XML
SAX
Handler
XSLT
Transform
(Optional)
XML
Signature
&
Encryption
SOAP
Message
SCI Store
Web Server(IIS)
Browser
(IE5.5)
Party
Application
ASP
Pages
3rd
Web
Service
.Net
Frame
work
Objects
Database
Request
Request
Handlers
Request
Handlers
Handlers
Log
Handler
Log
Contents
XML for:
 Patient Records
 Publishing
 Communications
Publishing
Document Metadata
Data about data…descriptions eg
keywords
 Descriptive headings about documents
 Useful for filing, searching and
cataloguing
 E-Government metadata standard
 HL7 Clinical Document Architecture
 need NHS Scotland standards

SHOW & NELH
Main NHS portals
 HTML pages need manual updating
 XML data storage
 XML -> HTML in active server pages
 Advantages:

Many views of single data
 Support clinical networks
 Support automated query tools

NHS Data Dictionary
Data definitions on web
 XML export selected definitions
 UML models designing XML schema &
refer to data definitions.


New dictionary to tie all three together
Contents
XML for:
 Patient Records
 Publishing
 Communications
Communications
Electronic Data Interchange
Moving data from one computer to
another
 Eg Patient referral from GP to hospital
 Replace older formats eg EDIFACT
 New forms of EDI with user interaction
 XML allows Graceful Degradation


View messages if required
GP records exchange
Patient moves house or changes GP
 Records follow 4+ weeks later
 Electronic exchange is quicker
 GPASS early implementations ongoing

NHSScotland GPEX
GPASS specific message
 GP exports XML document to PSD
 PSD send off to new GP & update CHI
 New GP selectively imports record into
new GPASS
 Currently in early implementation sites

Scottish Birth Record
Replaced SMR for births
 Added clinical information
 Make useful to clinical care
 Rolled out to all maternity units

Concept
Single web site in NHSnet
 Browser input from maternity units
 Link to PAS’s
 Link to new maternity systems



Reduce data duplication
Link to CHI

Give baby new CHI number at birth
Scottish Child Health Information Development (SCHID) Project
Patient ID and demographics
PAS
EXTERNAL
INTERNAL
SBR
CHI/UPI
Clinical data
Example of Hospital
Data-flows
INTERNAL AND EXTERNAL
Clinical System
Other Child Systems
Paper
Want more information? www.show.scot.nhs.uk/sbr alternatively tel: 0131 551 8046
Use of XML
CHI link
 Maternity system
 Ongoing development

Community Health Index (CHI)
Mainframe application
 Green screen terminal input
 Need machine EDI input & query

Concept
Casablanca XML to VMS transform
application
 NHS Standard XML Schema
 Web server
 HTTPS and XML input to active server
pages

XML messages
Register new patient
 Find patient
 Responses

SCI integration
SCI Store – every health board
 Labs systems – feed into Store
 E-Biz 2000 middleware & XML

Test requests and results reporting
To achieve this SCI first has to integrate
existing hospital systems and reassemble the patient’s information in a
new system called SCI Store
SCI Store
Id XRay Lab1..
xx OK
OK
3.2
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SCI
Integration 
PAS
Labs XRay other
community/
MH system
community
pharmacy
GPASS
practice
non-GPASS
practice
SCI web services
Electronic Transmission of Prescriptions
 Referrals to outpatients
 SCI Gateway


David Brazier this afternoon
E-Care
Shared care records between health,
social services, education and others
 Eg Shared Assessments

Elderly
 Mental health
 children

Single Shared Assessments
Lots of work on data and definitions
 Based on paper versions
 Initiated by any party
 Involves patient/client and
relatives/carers
 Involves independent sector


Eg churches, voluntary orgs.
Concept
Server in demilitarized zone
 XML integration to health system
 XML integration to social work system
 Browser input

E-care store
Central data store
 Multiple identifiers – CHI, Hospital nos.,
social work numbers
 XML Web Services for data exchange

Virtual EHR portal
Pull data from distributed systems
 Rearrange
 Present to viewer

LA net
Internet
Social Care
Education??
parent/child
+ smartcard
Integrated Children’s Services Record
Health
Care
Name:
Personal Record
Alerts:
Demographics:
Carer:
Health
Care
Personal Record
Health
Care
Interventions:
Name:
Health:
Who lives with me:
Personal Record
Interests:
Allergies:
GP:
Teacher:
Health Problems:
Social Worker:
Social Work:
Treatments used outwith health service:
Child Protection Status:
Medications:
NHSnet
Section of register:
Special Information you may want to know about me:
Special Needs Status:
Immunisations outstanding:
School:
CH System
GP SBR SIRS School SNS
NHS systems
Health
Care
Name:
Personal Record
Alerts:
Demographics:
Carer:
Allergies:
GP:
Teacher:
Health Problems:
Social Worker:
Child Protection Status:
Medications:
Section of register:
Special Needs Status:
Immunisations outstanding:
Health
Interventions:
Health:
Social Work:
School:
Care
Personal Record
Health
Care
Personal Record
Name:
Who lives with me:
Interests:
Treatments used outwith health service:
Special Information you may want to know about me:
‘Virtual’ EHR Model
A&E
OoH
GP
NHS24
Portal
Patients
XML web views of systems
EPR
EPR
EPR
‘EPR’
Acute
Commun
MH
GP
NHSnet - a fully distributed
Data Web
Data
Publishers/owners
End-user
client
The Semantic NHS Web
Local systems
SCI
Gateway
Discharge
e-Care Stores
EHR Gateway
SCI Stores via web
services
SHOW2
Web service
Web
Browser
EHR Store
Mk 1.x
Demographic
s
Access rights
Pointers
SCI-DC
CHI and child
health systems r
Terminology; Definitions; Schema; Services
- NHS Dictionary and Grammar