Emerging Standards and Interoperability for Electronic Patient Records in NHS Scotland

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Emerging Standards and Interoperability for
Electronic Patient Records inNHS Scotland
Stephen Duffy
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Political Background

• Historical under investment
• NHS Modernisation Programme
• Multi-million pound reform of IT
• What is informing this modernisation?
• Succession of IMT Strategies

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Commercial Context
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• 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)

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EPR Infrastructure Model

• Supporting shared clinical information

Protocols Pathways Processes Standards Interfaces
Clinical Support
Enterprise-wide applications
Messages Transactions
Technical and Communications infrastructure
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eHealth Programme EPR 3 levels
Level 1 Local speciality electronic patient
records
GPASS
SCI DC
SCI Labs
SCI OP
AE
Cancer
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Level 2 Area Integrated Care Record
Area ICR
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Level 3 National Integrated Care Record
Area ICR
Area ICR
National ICR
Area ICR
Area ICR
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NHS 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

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Level 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
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Clinical 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

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HL7v3

• 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.

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SNOMED-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.

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SNOMED 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)

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SCI Store Viewer

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http//www.datadictionary.scot.nhs.uk
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eHealth eCare

• Social Care Data Standards (Phase 2)
• Single Shared Assessment (SSA)
• Multi-Agency Stores (MAS)
• De-Militarized Zones (DMZ)
• Informed consent model but

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eCare Architecture Level 4?
Social Work
MAS
SSA
Police
DMZ
Education
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Conclusion

• 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

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stephen.duffy_at_aapct.scot.nhs.ukweb links and
references to be posted