Transcript HL7 UK 2006: How standards for integration will enable key

How standards for
integration will enable
key business objectives.
Jagdip Grewal
Chief Technical Architect
Agenda
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•
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CFH Update and Why are we here?
Enterprise Architecture – Integration Domain
CFH and HL7 CDA
The Future
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
…and the NHS in England
is BIG

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In a typical week:
6 million people will visit their GPs
More than 800,000 outpatients will be treated
Over 10,000 babies will be delivered by the NHS
NHS ambulances will make over 50,000 emergency
journeys
• Pharmacists will dispense approximately 8.5 million items
• NHS surgeons will perform around 1,200 hip operations,
3,000 heart operations and 1,050 kidney operations
• Labs and associated services will provide
results on millions of tests
 Or another way, 3 million critical transactions a day
There is no way to do this on a small scale
Motivation: Why ?
Information Strategy & Systems
Patient Choice
Patient Info
Long Term Conditions
Commissioning
PCT Development
Demand Management
Demand -side
Reforms
Payment by Results
Transactional
Payment & Settlement
Reforms
Better care
Better patient
experience
Better value for
money
Supply -side
Reforms
Out of Hospital
18 Weeks
Values, Brands & Codes
Wider Review of Regulation
Standards, Accreditation & Inspection
Financial Strategy
System Management
Planning, Performance & Assessment
Plurality in Primary Care
System
Management
Reforms
Plurality / Contestability
Independent Sector
NHS Treatment Centres
Foundation Trusts
Workforce
Progress to date
• NHS Connecting for Health deployment statistics (to
3 October 2006)
 276,899 users registered for access to the Spine
 5,654,360 prescription messages transmitted using
the Electronic Prescription Service (EPS)
 1,348,277 Choose and Book bookings
 70,907,782 images stored using Picture Archiving and
Communications Systems (PACS)
 15,686 National Network (N3) connections
• Thousands of systems exchanging information
 Over 9000 Accredited Systems connected
Why are we here?
• Enable the best integrated healthcare by the
time these children grow up!
Agenda
•
•
•
•
CFH Update and Why are we here?
Enterprise Architecture – Integration Domain
CFH and HL7 CDA
The Future
Enterprise Architecture –
Integration is a key domain
Views
Local Services
Enterprise Services
Infrastructure
Integration
Security
Channels
Channels and Presentation
Security
SSO
Authentication
114.10.15
User interface
services
Device and media
repurposing
Integration
Scanning
[116.6]
Profiling &
personalisation
Home monitoring
[107.5.2 & 123.1]
Virtual Visiting
[123.2]
Video Conferencing
[123.3]
Session & context
management
Data Migration
RBAC 730.12
Local Application
Integration
Local Services
Audit: Local Capture
& management
Audit record
Consolidation
(Cluster)
Operational
reports
Central Audit
Ad Hoc Reports
Audit record
Consolidation
(National)
Audit: View,
Analyse, Search
Digital Signature
[730.67]
Encryption
[730.87.2, 975.6.3]
User Registration
Patient Record
Presentation
Decision
Support [112]
Requesting
services [110]
Digital Imaging [115]
Care management
Order Management
[110.11]
Caseload mgmt Encounter mgmt
Configurable
reports [124.3]
Bed mgmt
[107.7]
Financial Services
[117]
Waiting list
mgmt
Analytical tools
[124.4]
Workflow
[101.7]
Prescribing [113.6
– 11]
Referral mgmt
Results Mgmt
[111]
Diagnostic &
Investigative
Services [114]
Clinical Noting
[106.5]
Correspondence
mgmt
[106.6]
Alerting
User Directory
Dispensing
[113.12]
Medicines
Administration
[113.13-15]
E Booking [109]
NSF Support
Resource mgmt
health issue
mgmt
Major incident
mgmt
patient tracking
Scheduling
mgmt
[108, 114]
risk & warnings
mgmt
professional
Mental health
care relationship
Act admin mgmt
mgmt
Admission
Transfer
Discharge
Assessment
services [104]
Interventions
mgmt
Diabetes NSF
162
Cancer NSF
[163]
Coronary NSF
[164]
Children’s NSF
[166]
Demand &
Access mgmt
[107.8]
Image Acquisition 115.5
Patient &
Identification
Services
Older People’s
NSF [165]
Image Archive 115.6
Image Retrieval 115.7
Image Viewing 115.8
NSF Information
Long Term Care
Services [160]
NSF [168]
Hardcopy production
115.8.89
Prevention,
Screening,
Surveillance
[103]
Patient
Identification
[102]
Emergency
Services [122]
Screening Mgmt
Legacy Departmental
integration
Ambulance [154]
Ambulatory Care
Mgt
[107.6]
Legacy Reporting
integration
Maternity
Services [118]
Dental
[120]
Mental health
[161]
Domiciliary Care
Mgt
[107.5]
Duplicate Record
mgmt
In patient
Tracking
Social Care
Integration
Setting Specific Services
Registration [102]
Renal NSF [167]
Theatre
management [125]
Care pathways
105.6
Model Care
pathways &
plans 105.5
Care Planning
105.10 - 11
Enterprise Services
Sealed envelopes
[730.48]
Clinical Summary Access
[311]
View Spine data
Enterprise Directory
Services [350]
Update Spine data
Service directory
Prescribing Alerts
Service registration
maintenance
Certificate
management
Print prescription
NHS Direct
122
Clinical Summary Records
[200]
Store, maintain, retrieve
summary etc data
Demographics [211]
Duplicate Record mgmt
Update stored data
types
Clinical Performance
Management Information
Reporting
Screening
Registration &
Maintenance
Reporting
Prescribing
[113.6-11]
eMail
Dispensing 113.12
Terminology
Data Services
[380]
Address lookup &
validation
Reporting
including Statutory Reports
Secondary Data Uses [385]
Enterprise Application
Integration [360]
Create &
manage
Kbase
Data Transformation
360.4
Message validation 360.6
Pseudonymisation
Data storage
Data extract
Validation
Update patient
record
Electronic Booking Service
[109]
Analysis
Patient Personal Health
Information
(MyHealthSpace 311)
Workflow
101.7
Message structure
transformation & mapping
360.6
Transformation
Business Rules and
workflow 360.6
Data transfer
Medication mgmt
recording
Medicines
Administration
[113.13-15]
Manage
access
Workflow and Business
Rules Services [370]
Management Reports 311.19
External Interfaces
Enquiry
Support
Translation (coding)
360.5, 380.3
NHS No. Services
Patient trace & info
Create event, workflow
or alert
Medications Management
(EPS) [769]
Clinical audit
Data Sets
Interface Mechanisms
360.3
Care management
Patient incident
and complaint
mgmt
Search &
Lookup
Message Queue
360.1
Demographic
mgmt [102]
Patient Record
Access Control
[730.17]
Consent
management [730.1]
Information,
Knowledge and
Research
Services
Coordination,
Reminder, Alert
Routing 360.6
Error handling 360.6
Workflow management
EDI
360.16.7
Infrastructure
Disaster Recovery [720]
Devices
Data backup
Peripherals
Network Services
Deployment
Print
management
Scheduling
Services
Service Hosting
Connectivity
Document
Management
[116]
Replacement IS and IT
resources
Restore services
Reporting [385.7.17,
720.6.4, 600.5.5,
360.14.9]
Monitoring [360.6.8,
et al]
Fault management
[600]
Help desk Support
[600]
Data Quality
Services [736]
Diagram file: Conceptual IS IT services v10.vsd
Integration Architecture
Domain - Standards
• CFH is committed to HL7
 Use of V3 decision in 2003!
 Still needs development work and we will continue to
work within HL7
- e.g. HL7 Tooling Collaborative
(http://www.hl7toolingcollaborative.org/)
• Strategic alliance between HL7, ISO and Cen
 Agreed at joint meeting in Geneva, October 2006
 Aim to co-ordinate work programme and joint
standards
 Plan to pull in others SDOs to join (e.g. SNOMED)
Allow Incremental Rollout
• All care settings will be upgrading systems for
several years to come. A release from a supplier
could take 1-2 years to rollout across a cluster.
• Need to enable a way of transferring information
between systems which allows
 For different levels of SNOMED compliance of
systems
 And for those which are not compliant, to allow
the clinician to view the information
How do clinicians work?
• Need to be aware of information overload
 The right information is key
• Clinical coding teams
 Will be here for a while yet
• Business change in NHS will take a while
Need to enable increasing
coding of clinical flows
Snomed
Compliance
Benefits
Postcoordination
Postcoordination
Full
Pre-coord
Full
Pre-coord
Partial
Pre-coord
Partial
Pre-coord
Text
Text
Primary Physician’s
System
Provider of Care’s
System
Agenda
•
•
•
•
CFH Update and Why are we here?
Enterprise Architecture – Integration Domain
CFH and HL7 CDA
The Future
CFH and HL7 CDA
• In Q2 06 a decision was made to adopt HL7 Clinical
Document Architecture as the basis for all clinical
messages.
• This supports the vision of allowing messages to flow
between organisations and be processed at the
capability of the receiving system.
 The minimum would be to view the message as a
document.
 GP summary message v1 (MIM 4.2) is not HL7 CDA.
 Other MIM domains (Emergency, Discharge etc) are
being amended to be HL7 CDA compliant to be
published shortly.
About CDA – a reminder
• CDA documents carry a number of different pieces of
information:
 Metadata – information for document management e.g.
type of document
 Text – a textual representation of the clinical content
which is rendered for human readability
 Coded – a fully structured representation of the clinical
content which is used for decision support
Components of CDA
• The clinical content in a CDA Release 2 document is
stored in:
 Sections
- Allowing for classification and storage of narrative text
- NHS CfH will define business headings and CRE Type
sections

Entries
- The coded elements of the document
- These will be constrained from the CDA CSP using templates
ED Care Provision Event
Templates
• Templates will allow constraints to be applied to the
section, entries and roles of the CDA document
• The mechanism for templating is currently being
developed by Comms and Messaging
• It will allow for greater extensibility of the messages using
a modular approach as seen in MIM 4.1.04
• A library of templates will be maintained to meet
changing requirements
• The following classes will have templates applied:
 Sections
- e.g. Business Headings, CRE Types etc

Entries
- e.g. Clinical Statements

Roles
- e.g. author
Template List Identifier
• The template list identifier lists the allowable
templates in the same way a vocabulary lists the
allowable codes
• It allows for greater extensibility of the messages
as new templates can be added to the list
removing the necessity to update the base
model
• The format of the identifier will be:
NPFIT-nnnnnn#<type>
• Examples:
NPFIT-000001#Role
NPFIT-000002#ClinicalStatement
Section Template Example
The Template in ClinicalStatement is an abstract choice.
The template which will actually appear in it’s place in an instance is one from the
template list identifier NPFiT-000005#Section
Abstract Choice
Clinical Statement
Template Example
The Template in AuthorChoice is an abstract choice.
The template which will actually appear in it’s place in an instance is one from the
template list identifier NPFiT-000001#Role
Validation
• The instances will carry the generic CDA class names
and will be validated against the CDA schema
• The instances will be validated against the templates
using a validation tool set which could include schema,
schematron etc
CDA
Instance
Templates
What will this achieve?
• Flows to and from different care settings e.g.
Acute to GP
 Without all systems being
- HL7 v3 compliant
- Fully SNOMED compliant
• Earlier benefits from information flows through
CFH infrastructure (i.e. Spine)
Agenda
•
•
•
•
CFH Update and Why are we here?
Enterprise Architecture – Integration Domain
CFH and HL7 CDA
The Future
The Future
• Devices (MRI etc.)
 Will collect more and more data
• Life sciences industry and genomics
• Personalised health care?
Standards - Long and interesting journey ahead….
Summary
• CFH committed to HL7
 Key standard in its Enterprise Architecture
• CFH has decided to use HL7 CDA Release 2 for
clinical information flows
 Using templates to constrain part of the
document