Transcript to be used as planning assumption

Transforming Government using
Open Standards
Jagdip Grewal
Chief Technical Architect
29th October 2007
Agenda
• Business Context
• Enterprise Architecture Context
• Services in an Enterprise Architecture
• Using standards to enable integrated
healthcare
• Integration challenges
• UK Government Enterprise Architecture
Our Objectives
To deliver a 21st century health service through
efficient use of technology to:
• Enable and improve Access and Choice
• Enable care pathways and patient focus
• Improve accuracy in treatment
• Create opportunities for improved efficiency
• Create opportunities for real NHS reform
Demographic Challenge
Ageing Population
2001 – over 60s > than under 18s
2050 – 4 times as many needing
care
At 4 times the current cost
…while the number available as
carers declines
The need for change
A Changing Health Environment
Life expectancy increased to 75 years
9 million people over 65 and increasing
Population more mobile
Greater long term chronic illness
Patients more educated on health and want greater
involvement
Has overburdened the system
1,200 Patients dying each year from
medication errors
5,000 procedures cancelled each year
5% of patient safety incidents due to
documentation errors
The NHS in 2002
• Patient records held on paper
• Highly variable usage of IT
• Lots of home-grown specialist systems
• Continuing reliance on 1970s mainframes
1
Challenges
• Local procurement of IS/IT Systems by GPs, Trusts etc
• Disparate Technologies, 1000s of suppliers
• Limited data sharing
• Lack of standardisation
• Lots of paper
• Little leverage of NHS buying power
The answer…
National Programme for IT
• Launched Spring 2002 by “21st Century IT”
policy document
• Mobilisation from Q1 2003
• Procurement completed Q1 2004
•
‘Services’ based contracts
•
Local and National Suppliers
•
£6bn of IT services contracted over ten years
Scope
chooseandbook
Secondary Uses
Service
Analysing National Health Trends
Patient Choice
•
•
•
•
•
•
•
•
Picture Archiving &
Communications
Service
Largest civil IT project
in the world
40,000 GPs
80,000 other doctors
350,000 nurses
300+ hospitals
10 year programme
50m+ patients
1.344m healthcare
workers
Healthspace
National & Local Care Record Services
Web Access for Patients
Electronic
Prescriptions
Service
N3
New National Network
NHSmail
Secure E-mail for all NHS workers
…and what does it look like
Multiple
and
Disparate
Channels
Health System Users
Patient
Pharmacists
NHS Direct
GP
Clinician
Child Protection
3 Suppliers with
differing Architectures
Integration
required with
set of common
Enterprise
Services (NxSPs)
services
Local Services
LSPs
Health Care
Workers
Other Accredited
Systems
National & Trust
Managers
120 Different
Supplier
Accredited
Systems to
integrate
N3 Network Services
Spine Directory
Service
Electronic Booking
Service
Transaction & Messaging Spine
Access Control
Framework
Personal
Demographics
Service
Personal Spine
Information System
Secondary Uses
Service
National and
Legacy systems
Electronic
Transmission of
Prescriptions
Diagram file: VisioDocument
Programme Challenges
• Hundreds of different applications and suppliers
• Large scale systems e.g. Prescriptions at 500tps
• End Users with differing requirements and geographically
distributed
• Diverse (often ‘legacy’) Supplier Technologies
• Lack of Standards
• Desire to Use COTS packages – avoid bespoke
• Evolution in requirements and functionality
• Data availability, quality and integrity is critical
• Enterprise Architecture required to define overall End to End
approach
Agenda
• Business Context
• Enterprise Architecture Context
• Services in an Enterprise Architecture
• Using standards to enable integrated
healthcare
• Integration challenges
• UK Government Enterprise Architecture
EA - Context
Medical
Advances
Business Services
NHS CFH
Policy
IS Services
LSP/ESP
Clinical
Processes
Outcomes
Better Patient Care
Reduced Cost
Lower waiting Times
NASP
Technology Services
Patient
Demand
Enterprise Architecture
We may all have different perspectives but we can make our
lives much easier by ‘talking’ the same language.
The bigger picture - In support of
traceability (simplified view)
Policy &
Strategy,
medical
advances,
other factors
Acceptance
Status
Contract
Benefits
contains
Have an
“Strategic Tracking”
on TA slides
Has an
Schedule
Release
contains
Requirements
Creates additional
Functional
requirement
Are implemented in a
Are Structured in a
Non-functional
requirement
This seems to be
equivalent to the
“project” concept
from TA
Bundle
Physical
Application
Implements
From TA
May be elaborated in a
In a
Care Setting
Which collectivly create
Are delivered by
Artefacts
Use Case
Implements
Conceptual
Services
Logical
Applications
Service
Provider
Which is supported by
Are represented as
Test Cases
And is implemented by a
Which may be used to validate
NHS – relationship map
MOD
Tribunals
Service
DCAf
Forces
Healthcare
Audit
Commission
Prison
Healthcare
Estates
Management
Prison
Service
Home
Office
Other
Government
Depts
Logistics
External
Support
Services
Courts
Police
DFES
Home Office
Service
Contacts
Independent
Service
Providers
DeFRA
DWP
Management
Services
Young
Offenders
Teams
Non-Statutory
Organisations
DoH
Connecting
for Health
Private
Hospitals
Direct Service
Delivery Links
Public
Health
v
NHS
Charities
NPSA
Research
Patients
NICE
Housing
Other NHS
Organistiaons
Schools
Information
Centre
Relatives
& Carers
Healthcare
Commission
Higher /
Further
Education
Local
Authority
Services
NHS - includes:
Primary Care
Acute Care
Mental Health
& Ambulance
Services
PPA
Drug
Companies
Education
Departments
Special
Education
Needs
Mental
Health
& LD
Pharmacies
Other Health
Services
Prosthetics /
Appliance
Suppliers
Older
People
Services
Social
Services
Dentists
Chiropodists
Opticians
Physiotherapists
Children’s
Services
Domicillary
Care
Adult
Services
Education
Psychology
NHS Service
Contacts
High-level Map
Agenda
• Business Context
• Enterprise Architecture Context
• Services in an Enterprise Architecture
• Using standards to enable integrated
healthcare
• Integration challenges
• UK Government Enterprise Architecture
Enterprise Architecture –
Domain View
Views
Local Services
Enterprise Services
Infrastructure
Integration
Security
Channels and Presentation
Conceptual Services:
what we do
Channels and Presentation
Security
Integrity &
Non Rep Services
Encryption
Integration
Access Management
Manage
Digital Signatures
Authorisation
Non-repudiation
LRS
Integrity
RBAC
Home
monitoring
Profiling &
personalisation
Device and media
repurposing
Authentication
Session &
Context
Management
Scanning
User Interface
Services
Video
Conferencing
Virtual Visiting
Integration Construction
Services
Interaction Patterns
Message Contract
Properties
Message Channels
Local Services
Adapters
Sealing
Care Management Services
Single Sign- on
Manage Waiting
Lists
Manage Patient Stays
Setting Specific
Services
Manage Resources
Emergency Services
Privacy
Manage Risks
& Warnings
Assessment services
Manage Health
Issues & types
NSF Support
Cancer NSF
Chronic Obstructive
Pilmonary Disease NSF
Ambulance
Confidentiality
Audit and History
View Management
Manage Consent to
Share General &
Specific Record
Information
Record Audit Event
Manage Wards,
Rooms and Beds
Manage Whiteboards
and
Patient Tracking
Manage Screening
and Prevention
Programmes
Manage
Administration
of Acts giving
Compulsory Powers
Event Security
Assessment
Children's NSF
Mental health
Manage Patient
Encounters
Manage Patient
Episodes
Mental Health NSF
Manage Patient
Record Presentation
Manage Patient
Registers
Manage Blood
Older People's NSF
Theatre management
Paediatric Intensive
Care NSF
System Identification
Manage Interventions
Manage Local
(pseudo)
anonymised data
Manage Local External
Reporting Tools
Long Term Care NSF
Manage Legal
Requirements
Manage Referral
Manage External
Documents
Digital Imaging
Financial Services
Manage
Commissioning
Image Acquisition
Manage Objects in
Clinical Documents
Manage Local
Reports Types
Dental
Manage Care Spells
Clinical Narrative
Services
Image Archive
Manage Patient
Documentation
Manage Clinical
document tools
Image Retrieval
Identity Services
Manage Death
Manage User Services
Manage Healthcare
Organisation
Manage services
Manage Costing
Care Delivery
Manage Duplicate
Records
Manage Internal
Support Tools
Manage Third Party
Support Tools
Manage Expenses
Manage Patient
Demographic Details
Manage Mobile
Working
Manage User Devices
Manage Private
Finance
Image Viewing
Manage Patient
Identification
Manage Patient
Record Presentation
Manage user interface
Diabetes NSF
Ambulatory Care Mgmt
Domiciliary Care Mgmt
Manage Care period
Manage Incidents
and
Complaint Recording
Request Assessment
Create and Manage
Local Reports
Maternity Services
Manage MultiResource Scheduling
Major Incident
Management
Manage care delivery
breach times
Access Validation
Coronary NSF
Manage Materials
Local Reporting
Management
NSF Information
Services
Manage Professional
Carer Relationships
Evidence Collation
Renal NSF
Scenario Recreation
Manage Clinical
Documentation
Templates
Manage Local
Reports Groups
Image Purge
Manage Local SUS
data review prior to
submission
Image Export
Local Translation
(Language)
Clinical Messaging
Services
Reimbursement
Hardcopy Production
Manage Patient
Property
Manage Patient
Registration
Manage People
Manage User Sessions
Medication
Management
Services
Manage medication
administration
Manage medication
charts
Transport Protocols
Interoperability
Framework
Integration Processing
Services
Execution
Manage medication
record
Validation
Manage nonpharmacy dispensing
Transformation
Manage Pharmacy
Dispensing
List management
Manage prescribing
medications
Technical
Orchestration
Manage prescriptions
Local Structured
Care Mangement
Local Content
Management
Imaging History
Manage care
pathways
Local Authoring
Manage Medical
Device Integration
Requesting Services
Manage care plans
Local Publishing
Result Management
Request
Management
Manage Messages
Manage
e Booking
Diagnostic & Results
Services
Configuration and
Management Services
Configuration
and Design
Decision Support
and Alerts
Manage Decision
Support Rules
(Active Decision
Support)
Local Workflow
Manage Alert & Event
Notifications
Platform Registration
Service Discovery
Record Retrieval
Service Managment
Enterprise Services
SAR Collation
Quality of Service
Metadata and
Repository
Clinical Summary
Access
Clinical Summary
Records
Demographics
Medications
Management (EPS)
Knowledge Management
Services
Terminology
Services
Reporting Services
NHS No. Services
Directory Services
Update Spine data
Store, maintain, retrieve
summary etc data
User Directory
View Spine data
Prescription Transfer
Registration &
Maintenance
Manage Reports
Manage
Knowledge Bases
Manage Patient Record
Coding, Grouping and
Terming
Manage Reports Types
Duplicate Record mgmt
Patient Personal
Health Information
management
Patient trace & info
Service Directory
Prescribing Alerts
Manage Reports
Groups
Create event,
workflow or alert
External Interfaces
Service Registration
Maintenance
Print prescription
eMail
Manage (pseudo)
anonymised data
Update stored data types
Legacy
NHS Direct
Business
Orchestration
Screening
Management
Message Level Security
Manage Scheduled
Bookings
Address lookup
& validation
Message
Authentication
Message Integrity
Manage SUS data
review prior to
submission
Certificate
Management
Message
Authorisation
Message Encryption
Translation (Language)
Strategy
Inf rastructure
Hosting Services
Business Process
Management
Platforms & Devices
Disaster Recovery
Management Services
Service Management
Storage
Data Management
Assistive Technology
Environmental
Services
Network
Services
Scheduling
Services
Deployment
Data Quality
Services
Governance
Asset Mgt
Backup Mgt
Incident & Problem
management
Replacement IS and
IT resources
Storage Mgt
Systems Mgt
Help desk Support
Restore Services
Change & Config
Mgmt
Network Mgt
Data Backup
File Services
Print Services
Service Hosting
Monitoring
Strategy
E.g. Demographics
Within local Services Domain
• Set of services required to be implemented by local systems
Within Enterprise Services Domain
• Set of services required to be implemented by national service
provider for all 60m patients
Set of compliance docs from NHS CFH
• Covering requirements to be met by systems implementing those
services
• MIM for message definitions and example process flows
• Principles - loose coupling, search local first, update local first
• What is to be tested and verified during integration testing
Logical Applications…
Channels and Presentation
Security
Channel
Management
Legacy
Channels
Web
Web Service
Assistive
Technology
Phone
SMS(text)
Paper
DTV
Client Identity
Agent (IA)
Local
Application
Integration
Local Services
Local Services
Image
Management
PACSSecurity
(GE)
Services
PACS (Agfa)
Patient
Patient
Administration
Radiology
Radiology
Image
Management
Administration
Pathology
Pathology
CRIS
Community
Services
Legacy Systems
Knowledge and
Research Services
Pharmacy
Lorenzo R2
Document
Prescribing
Management
Theatres
Theatres
TMS
Emergency
ORMIS
Directory
Community
Services
Services
Child Health
(HSW)
Access Control
Framework
Document
Management
Enterprise Services
Demographics
Information,
Demographic
Back Office
Knowledge
and
Research Services
Demographics
Data
Map of Medicine
GP Systems
GP Systems
Ambulance
Lorenzo R4
Maternity
Requesting &
Data Warehouse
Results
Assessments
and Clinical
Documentation
Ambulance
Secondary
Lifenet ECS
Data Uses
Terminology
Electronic
Emergency
Prescriptions
Prescribing
Clinical
Summary Data
Choose and
Lorenzo
R2
Book
HealthSpace
Lorenzo R1
Legacy Services
NHAIS
Evolution
CHRIS
NSTS
QMAS
Local
Infrastructure
Devices
Networks
Hosting
Assessments
and Clinical
Documentation
Data Feeds
SAP
i.CM
Workflow
and Rules
Lorenzo R3
NWCS
Lorenzo R2
Infrastructure
Enterprise
Application
DataIntegration
Warehouse
Blood
[Maternity]
Lifenet ECS
Reporting
i.CM
Maternity
NN4B
Clinical Summary
Clinical
BloodSummary
Application
Reporting
Requesting &
Results
Pharmacy
Scantrack
Gazetteer
Dental
Dental
SystmOne
i.PM
Legacy
Systems
Information,
Integration
System
Management
Lorenzo R1
Agenda
• Business Context
• Enterprise Architecture Context
• Services in an Enterprise Architecture
• Using standards to enable integrated
healthcare
• Integration challenges
• UK Government Enterprise Architecture
The role for standards
• Explicit from the outset.
• The standards base evolves and grows
• Standards chosen to maximise interoperability and to meet different
integration requirements
• Use of ebXML, (https, SOAP, XML) - reliable asynchronous messaging for
patient demographic updates
• Web Services and WS standards e.g. WS-A – lightweight synchronous
messaging for patient demographic queries
• Use of SNOMED CT
• Use of HL7 v3 (ETP, C&B, PDS) and CDA v2 (Clinical Documents)
• Lots more….
• Objective is to federate the design responsibility to the
systems providers, working within a framework of
standards and specifications
Not just technical standards
• Common User Interface (CUI) - Microsoft and NHS CFH
(http://www.mscui.org/)
• Knowledge authorship to allow Knowledge Support (KBS) and Decision
Support into all aspects of the implementation
• The International Health Terminology Standards Development
Organisation
• SNOMED CT
• Charter Members (Australia, Canada, Denmark, Lithuania, New
Zealand, United Kingdom United States)
• A drug database – The Dictionary of Medication and Devices (dm+d)
• Standards by which we accredit systems as safe to implement and
exchange information
Elective / Passive Decision Support – same component in all local
solutions
Standard drug dictionary
A standard drug dictionary for all systems
We (and Australia) have chosen to make and
maintain a new one called dm+d (The dictionary
of medications and devices)
NB. This is NOT decision support but a standard way
of naming and structuring medication and devices
so that decision support and complex rules based
content can be added with predictable results.
Dm+d and SNOMED CT
(300,000 terms)
Snomed CT drug core
•Both dm+d and
SNOMED have a
central core with local
additions
etc etc
IS_A
Beta-blocker drug
IS_A
Cardioselective beta-blocker
IS_A
Atenolol
(drug product)
(VTM)
NHS dm+d
Atenolol 50mg
Tablet
(VMP)
Atenolol
50mg
Tablet x28
(VMPP)
Atenolol 50mg
Tablet
(Cox)
X28
(AMPP)
Atenolol 50mg
Tablet
(COX)
(AMP)
Standards enable
supplier expansion
• The use of Open Standards for integration (ebXML, HL7)
has enabled an expansion in number of suppliers to the
programme
• Leverages existing knowledge capital and established
standards
• Allows suppliers to build COTS packages based upon
industry standards. Move away of bespoke development
• Allows plug and play of new services
• Standardisation reduces overall testing complexity
• To meet business objectives we have integrated
• 100s of supplier applications
• Access from private corporate WAN (N3) as well as internet
aggregators for high street access
What have we achieved so far? …
- some “numbers”
(at 08/10/07)
• 17,454 instances of systems connected into the national
services which allows in a typical day
• 190,000 prescription messages issued electronically
(18% of all prescriptions)
• 19,000 Choose and Book electronic bookings
• 1,400,000 queries to be recorded on the patient
demographic system enabling letters to be posted to the
correct address and patient information to be handled
more efficiently
• These are deployed via the 20,662 connections to N3 (the
national NHS WAN)
• 380,350,622 images have been stored using PACS from
NHS CFH
• There are 394,367 Smartcard holders who are registered
and approved for access to systems
What’s next - more clinical Information
flows between systems
Emergency
Dept
Discharge
Patient info
Patient visits GP
GP System
Acute
System
Back Pain
Patient visits Emergency Dept
Broken Leg
Update GP
Summary
Emergency
Dept
Discharge
Summary
Care
Record
Patient info
Acute
System
Patient visits hospital
Chest infection
Discharge
Discharge
Enabled by standards (HL7v3 and HL7
CDA v2 over ebXML (https/SOAP/XML)
and central messaging services (TMS)
Agenda
• Business Context
• Enterprise Architecture Context
• Services in an Enterprise Architecture
• Using standards to enable integrated
healthcare
• Integration challenges
• UK Government Enterprise Architecture
Integration –
The Challenges
• Large number of suppliers – and growing
• Each supplier footprint is different & can consume
different services
• Suppliers in different phases of development
• Business critical services – cannot be stopped for more
than a few hours
• We cannot ‘lose’ data
• Data must only flow from accredited applications running
from authorised endpoints originating from users with the
relevant roles
• Large numbers of endpoints, systems and users
• Strict Information Governance Rules
Challenges –
Service Definition
• Right Granularity ? To high and they are subject to constant
change. To Low and it can result in significant increases in
message flow.
• Generic or Specific business process ? The level of business
logic can impact the re-usability of the service.
• What SLAs ? Services that are used for many business
functions may have varying SLA needs – these must be
balanced against cost
• Trade off between performance and extensibility
• What security model ? Whilst some aspects of information
security can be centralised – others must be federated
Challenges –
Compatibility
• FORWARD and BACKWARD
• A change to a service can impact many
applications and suppliers
- Each system needs to be fully tested before it is
accredited for deployment !!!
• The more ‘versions’ we support the less scope
we have to add new capabilities
• Translation services are required to
accommodate supplier applications running at
different versions
Services usage can be
different to expectation
• All local systems will integrate with Summary Care
Record
• SCR provides a set of services to enable this in
different ways
Summary Care Record
Response
ESP
On-demand
Request
Response
LSP
Pre-fetch
Request
Response
Request
CSA
…
Agenda
• Business Context
• Enterprise Architecture Context
• Services in an Enterprise Architecture
• Using standards to enable integrated
healthcare
• Integration challenges
• UK Government Enterprise Architecture
Cross Government
Enterprise Architecture
• CTO Council formed in Sept 2005. The aim is to support
the CIO Council through the optimisation of the use of IT
resources across the public sector.
• Strategic value of xGEA is to identify opportunities for
collaboration and reuse across government.
• Without a business and IT Blueprint for Government – an
Enterprise Architecture – avoidable cost would be incurred
as IT is developed in ‘islands.’
So where do the CTO
Council sit?
Ministerial Group
Ministerial Leadership
DA (PED)
Leadership Groups
Business Leadership
Delivery
Council
CIO Council
PGSSB
CTO Council
Technical Leadership
Deep Business and
technical knowledge
Technical Steering Group
Working Groups
Working Groups
Working Groups
xGOV EA Domains and Leads
PROCESS DOMAIN
John Wailing (Home Office)
INFORMATION DOMAIN
Pete Desmond (DWP)
APPLICATION DOMAIN
TBD
INFRASTRUCTURE DOMAIN
Andrew Bull (HMRC)
INFORMATION ASSURANCE
DOMAIN
Marc Hocking (Cabinet Office)
CHANNEL DOMAIN
Terry Hawes (HMRC)
INTEGRATION DOMAIN
Inderjit Singh (NHS CfH)
SERVICES MANAGEMENT DOMAIN
Paul McAvoy (DWP)
STRATEGY
Andrew Stott (Cabinet Office)
xGov EA Context
• The majority of the work of the CTO council is structured
around the xGov EA through the Domain Teams.
• The Domain Team leads collectively form the Architecture
Review Board (ARB) whose purpose is to:
• Oversee the development of cross-Government
Enterprise Architecture – xGEA
• Oversee the development and operation of the clearing
house process for exemplars
• Assesses the fitness for purpose of proposed exemplars
(managed services and solutions) for reuse across the
public sector
• Resolves overlaps between domains
• Provides a forum for peer reviews
Capturing EXEMPLARS
at various levels
Managed Service
Potential Value
• A hosted service that is offered to others
Solution
• A packaged service including: code, design
that can be rebuilt
Pattern
• The approach to providing the service
Lessons Learned
Number of assets found
• Experiences gained implementing the
service
Clearing House Process and Domain
ToR Detailed Process
Flow
Business Idea
X
Architecture Priority : 1
CIO Gate
Status : ViabilityArchitecture Team
Organisations’
PrimaryInterface
Domain : Infrastructure
Process
Secondary Domain : Channels
Delivery and Transformation Group
Organisation
Business Idea X
CTO Council
Organisation
Organisation
Generate Idea
ARB
Define Idea
Organisations’
Organisation
(Technical)
Architecture
Organisation
Team
Entry
Test Feasibility
Viability
Domain Teams
Business
Idea
X
Check
keywords
Define
Proposition
STRATEGY
INFORMATION
DOMAIN
DOMAIN
SECURITY DOMAIN
PROCESS
INTEGRATION DOMAIN
SERVICES MANAGEMENT
DOMAIN
CHANNEL DOMAIN
Priority ‘Metadata’
:1
against
Match Reqs Architecture
CIO GateDefinition
Status: Viability
Primary Domain : Infrastructure
Design Service
Secondary Domain : Channels
Design
COMMON APPLICATION DOMAIN
Exemplar
Re-used
Complete business
case
Exist
Business
Business
‘artefact’
Justification
INFRASTRUCTURE DOMAIN
Reuse & Identify
New
Record
as WIP
Clearing House
Future / WIP
Organisation
Existing
Build Service
Build
Re-use
as-is
Test Service
Go Live
Live Running
eRoom
Harvest to
Exemplar
Organisations’
(Technical)
Organisations’
Architecture
(Technical)
Organisations’
Team
Architecture
(Technical)
Team
Organisations’
Architecture
(Technical)
Team
Organisations’
Architecture
(Technical)
Team
Architecture
Organisation
Team
Benefits
Live Running
Enhance
and re-use
Organisations’
(Technical)
Architecture
Team
Summary
• Use a service based Enterprise Architecture to
enable a common language
• Set standards and frameworks that permit
increasing levels of interoperability and interaction
across multiple suppliers
• Be aware of the challenges of integrating multiple
suppliers