Title: Emerging Standards and Interoperability for Electronic Patient Records in NHS Scotland
1Emerging Standards and Interoperability for
Electronic Patient Records inNHS Scotland
Stephen Duffy
2Political Background
- Historical under investment
- NHS Modernisation Programme
- Multi-million pound reform of IT
- What is informing this modernisation?
- Succession of IMT Strategies
3Commercial Context
4- 15 Health Board Areas
- Scotland is too small a
- country to be able to justify
- continuing with a multitude
- of similar but incompatible
- systems.
- Electronic Clinical
- Communications
- Implementation (ECCI)
- Scottish Care Information
- (SCI)
5EPR Infrastructure Model
- Supporting shared clinical information
Protocols Pathways Processes Standards Interfaces
Clinical Support
Enterprise-wide applications
Messages Transactions
Technical and Communications infrastructure
6eHealth Programme EPR 3 levels
Level 1 Local speciality electronic patient
records
GPASS
SCI DC
SCI Labs
SCI OP
AE
Cancer
7Level 2 Area Integrated Care Record
Area ICR
8Level 3 National Integrated Care Record
Area ICR
Area ICR
National ICR
Area ICR
Area ICR
9NHS Scotland Technical Architecture
- A framework for products/services and standards
to avoid.. - Duplication of effort and cost
- Increased cost of ownership
- Dilution of skill and experience
- Difficulty in replication
- National Infrastructure
- Cornerstones
- Preferences
- Standards
- Flexibility
10Level 3
Technical Infrastructure SCI model
National Services
UPI CHI
Transaction Services SCI Gateway
NHS Board SCI Store
NHS Board SCI Store
Level 2
Level 2
SCI Integration
SCI Integration
AE
AE
GP
OP
GP
PAS
Labs
PACS
Labs
PACS
Cancer
Cancer
Level 1
Level 1
11Clinical Information Standards
- Functional vs Semantic interoperability
- Messaging
- HL7v3 SNOMED-CT
- Primary - Clinical support
- Secondary Research Education
- National Clinical Data Dictionary
- Curbing local dialects ambiguity causes errors
12HL7v3
- Clinical statement pattern (derived from the RIM)
- Act, Role and Entity classes
- Mood
- Reference Information Model (RIM)
- Object-oriented
- XML Clinical Document Architecture
- Consensus process involving NHSIA
- Unambiguous few constructs
- Part of the solutionnot enough for semantic
interoperability.
13SNOMED-CT
- Synergy with HL7v3
- provides clinical terminology for the statement
pattern - Models relationships between concepts
- Gives them context e.g. who, when, what,
how of clinical findings - Mapping to ICD-10 nomenclature
- SNOMED-CT terminology will be implemented
throughout NHSScotland.
14SNOMED CT Encoded CAP Cancer Checklists
- Diagnoses (malignant melanoma)
- Tumor stages (Tumor gt 2cm)
- Procedures (Transurethral prostatectomy)
- Specimens (Tissue specimen from breast)
- Pathological findings (Dysplasia, Calcification,
Stenosis)
15SCI Store Viewer
16http//www.datadictionary.scot.nhs.uk
17eHealth eCare
- Social Care Data Standards (Phase 2)
- Single Shared Assessment (SSA)
- Multi-Agency Stores (MAS)
- De-Militarized Zones (DMZ)
- Informed consent model but
18 eCare Architecture Level 4?
Social Work
MAS
SSA
Police
DMZ
Education
19Conclusion
- 1 patient / person, 1 record
- Individual vs population care
- The most important entity for frontline
clinicians will always be the patient - Emerging standards and interoperability to
support EPR offer increasingly credible, reliable
and compatible data for analysis, research and
education of the population - Lisbon 2005 - Realising the full potential
20stephen.duffy_at_aapct.scot.nhs.ukweb links and
references to be posted