Transcript Document

HL7 A.2 Messaging within Wales
Karen Winder
North Glamorgan NHS Trust
The need for standardisation of message
exchange
 1999 saw the formation of Cervical Screening
Wales - CSW
 A National Service for managing the Cervical Screening
program in Wales requiring data in a standard format from
all Welsh legacy pathology systems
 Information requirement for smear takers and screeners
opinions in conjunction with the patients results
 Simple delimited flat file was suitable for basic data
transfer but complex histology and cytology pathology
results required a more structured message – HL7UK A.2
Repository synchronisation
 Multiple National Services now utilise these
messages for surveillance and screening purposes
 Standardising on the HL7UK A.2 message allows:
 Pathology systems at all Welsh Trusts to transfer data in
the same message structure
 One interface engine to receive the messages and feed
several repositories
 Weekly downloads of authorised histology to:
 Breast Screening Wales
 Cervical Screening Wales
 Welsh Cancer Intelligence Surveillance Unit
Progress to real time messages for
database synchronisation
 Use the functionality within the HL7 message for
real time data base synchronisation from all
pathology disciplines
 This enables additional applications such as:
 Data repositories for access to pathology and radiology
results which supplies clinicians with up to date status
information on requests and results
 Transfer of pathology results to CANISC (the Cancer data
repository for Wales) to provide continuity of care
Breast Screening results to GP
using HL7 A.2 messages
 Breast screening currently generates thousands of paper
reports per GP surgery each cycle
 These reports are then manually typed into the GP system
 This process is currently being replaced in Wales by HL7 A.2
messages generated from the National Breast Screening
System and sent out via Middleware and DTS to the GP
systems
 The scope of the project currently includes normal results,
DNAs and decliners
 It will be extended to include Bowel Screening results later
next year
Results to Requesting
 2006 saw the development of an in-house electronic
ordering solution for pathology
 This extended the functionality of the legacy
pathology systems to include HL7UK A.2 orders as
well as results
 It encompasses both primary and secondary care
ordering
 Disciplines currently in scope are Biochemistry,
Haematology and Microbiology
Welsh Clinical Portal and
Test Requesting and Results Reporting
 Test Requesting and Results Reporting (TRRR) in
the Welsh Clinical Portal is making use of the
developments at Trust level using A.2 as the
standard for orders and results.
 A number of new components are also being
developed, including the portal’s user interfaces and
the National Pathology Handbook.
Institution- based System (Hospital)
PAS
Traditional
PAS
interfaces
PAS
database
adapter
Messaging Fabric
Laboratory System
Inbound message queue
Microbiology Haematology Biochemistry
Pathology Service
Request
Monitor
Order
Monitor
Requests
adapter
Orders
Print engine
Outbound message queue
Results
Clinical Portal
Services
Clinical Portal
National
pathology
handbook
NHS Wales Clinical
Portal
Peter Nicklin
HL7 UK Annual Conference,
November 2007
NHS Wales
Topics:
• NHS Wales National Architecture
• NHS Wales Clinical Portal
• Clinical Communications and CDA.
NHS Wales
Topics:
• NHS Wales National Architecture
• NHS Wales Clinical Portal
• Clinical Communications and CDA.
NHS Wales National Architecture
Objectives:
• Provide a migration path for NHS Wales
health systems from “where we are now”
to a common framework,
• enable communication between clinical
services within an organisation (short
term),
• enable communication between
organisations (longer term),
• adapt to radical changes in organisation
structures (mergers, specialisations etc.),
• protect privacy and confidentiality.
NHS Wales National Architecture
Infrastructure:
• information design for what information will
be exchanged,
• SOA: how information will be exchanged,
• connectivity with existing systems,
• identification of patients, users, and
organisations,
• security and control of the use of
information.
NHS Wales National Architecture - National
Local
national
services
Institution- based System (Hospital)
Adapters to
existing
departmental
Gateway
systems,
systems, Services
PAS
Authentication
4
Services
Pharmacy
Pathology
Radiology
and gateways to
National
external systems
Messaging
Institutional
Messaging Fabric
Demographics
Services
Fabric
5
Patient
Record
Services
Other
systems
2
Clinical Portal
Services
the Welsh
Clinical Portal,
Clinical Portal
linkednational
together
services
by
the
develop the
need a national
messaging
local patient messaging fabric
fabric.
record
NHS Wales
Topics:
• NHS Wales National Architecture
• NHS Wales Clinical Portal
• Clinical Communications and CDA.
NHS Wales Clinical Portal
Objectives:
• clinical communications and
correspondence,
• view an individual's records,
• request, prescribe, report, track,
• document care.
NHS Wales Clinical Portal
Phases:
• foundation phase:
– lists and basic patient information,
– pathology requests and results.
• further phases:
– radiology requests and results,
– referral and discharge comms. (+ clinic letter),
– transcription of medicines,
– etc..
NHS Wales Clinical Portal
Approach:
• Requirements and design:
– User Centred Design sessions,
– heavy emphasis on clinical needs,
– captured in the Generic Information
Framework for the Individual Record
(GenIFIR).
• Iterative. Services & phases based on:
– user requirements as they are gathered,
– feedback from clinical use of the Portal.
NHS Wales
Topics:
• NHS Wales National Architecture
• NHS Wales Clinical Portal
• Clinical Communications and CDA.
NHS Wales Clinical Communications
Institution- based System (Hospital)
Gateway
Services
PAS
Authentication
4
Services
Pharmacy
Demographics
Pathology
Institutional
Messaging Fabric
Radiology
5
National
Messaging
Fabric
Patient
Record
Services
Other
systems
Clinical Portal
Services
Clinical Portal
2
access to
external patient
records
Services
Clinical communications
Demands:
• complex clinical info.: diagnoses, signs & symptoms,
medications, results etc.,
• linked information,
• identity: attribution, provenance, creator, the individual,
• domains: identification, code sets,
• flexibility, the capacity to reorganise information (into a
new document),
• longevity; all information must have a human-readable
form,
• usability,
• stability.
CDA Characteristics
HL7 CDA Release 2.0, 28th July 2003
•
•
•
•
•
•
•
•
Persistence – A clinical document continues to exist in an unaltered state, for a time
period defined by local and regulatory requirements.[1]
Stewardship – A clinical document is maintained by an organization entrusted with its
care.
Potential for authentication - A clinical document is an assemblage of information that
is intended to be legally authenticated.
Context - A clinical document establishes the default context for its contents.
Wholeness - Authentication of a clinical document applies to the whole and does not
apply to portions of the document without the full context of the document.
Human readability – A clinical document is human readable. ..from
elsewhere…(Human readability applies to the authenticated content. There may be
additional information conveyed in the document that is there primarily for machine
processing that is not authenticated and need not be rendered.)
……………….
Pre-formatting documents:
–
–
•
•
section level templates
entry level templates
…...............................
Provenance (paraphrased): authoriser, transcriber, doer, etc..
Major components of a CDA document:
<ClinicalDocument>
... CDA Header ...
<StructuredBody>
<section>
<text>...</text>
<Observation>...</Observation>
<Observation>
<reference>
<ExternalObservation>...</ExternalObservation>
</reference>
</Observation>
</section>
<section>
<section>...</section>
</section>
</StructuredBody>
</ClinicalDocument>
Context