PREPARED BY

Connected Care Standardfor transfer of care

and shared care applications

Alastair_Kenworthy@moh.govt.nz

7 November 2012

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Connected Care Standard …

… An unexpected(-ly long) journey!

2010 Midland ‘core clinical dataset’

GP2GP

HISO 10040 HIEs

HISO 10041 – 2013 Q1/2

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Reference Architecture for Interoperability

SAG review

Vendor review

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Requisite standards for 2014

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The unstoppable march of CDA

RSD (HISO 10011) and ePharms (10030) based on HL7 version 2.4

Counties Manukau & Taranaki pilot PDF + v2 transport for eDS

Hutt Valley, Auckland and Canterbury referral solutions implement RSD, but in different ways …

GP2GP goes live with CDA + v2 transport

Counties eDS solution moves to CDA + v2 transport

NZePS built on CDA and SOAP web services

interRAI reports built on CDA and SOAP web services

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CDA solar system

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The changing world view

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Right side up architecture

PMS local environment

HIE (outside world)

Forms service interfaces are – CDA enabled both sidesXDS enabled on one side

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Connected Care Standard (HISO 10041)

10041.1 Referral Request

10041.2 Shared Health Summary

10041.3 Medications List

10041.4 Discharge Summary

10041.5 Health Event Summary

10041.6 GP2GP

10041.7 Ambulance ePRF

10043 CDA Common Templates (+ code sets)

10047 Comprehensive Clinical Assessment (interRAI)

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Development timetable

Release for consultation SpecificationsFebruary 2013 Discharge Summary

CDA Common TemplatesCommon Code Sets

March 2013 Shared Health SummaryMay 2013 Referral Request

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‘… a core set of personal health information …’

Required for 2014 OK if beyond 2014DemographicsAlerts and allergiesImmunisationsEncounters (admissions)Medications (discharge)Problems (conditions)Test resultsAppointmentsEnrolmentsHealthcare providersSupport people

Screening resultsEncounters of all kindsMedications (My List of Meds)Lifestyle risk factorsVitals (eg BMI)Advance directives

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From: Bob DolinSent: Tuesday, November 29, 2011 12:55 PMTo: Rishel,Wes; Pratt, Douglas (H USA); robert worden; Structured Documents WGSubject: RE: CDA or greenCDA

Hi Wes,

What is CCDA?

Thanks,

Bob

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Consolidated CDA

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Origins of CCDA

10040.3

GP2GP

10040.2

10041

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Makeup of CCDA

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CDA templates

A process of design by constraint

CDA clinical statements expressed within a fixed XML schema

CDA templates refine the basic model –

Reflecting business rules

Limiting unnecessary choices (optionality, code sets)

Often expressed as conformance statements – thou shalt …

Usually implemented as Schematron rules

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How NeHTA does templates

NeHTA specifications include (per eDS etc) –

1. openEHR Archetypes (content model)

2. Core Information Components (data requirements)

3. Structured Documents Template (abstract document model)

4. CDA Implementation Guide (templates)

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Our killer application

Having a SNOMED CT coded eDS would be like Xmas to GPs

Global general practice reference set has ~3500 concepts (July 2013)

Locally, all clinical systems SNOMED enabled from x date – 2015?

Typical ED reference set (NeHTA’s) comprises –

Reason for presenting (71 concepts)

Findings in presenting problem (222 concepts)

Diagnosis in presenting problem (244 concepts)

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Inside SNOMED

Concepts each have one fully specified name and any number of preferred terms and synonyms

Based on description logic alllowing reasoning about concepts and relationships

Topology is ‘small world’ and ‘scale free’ (easily navigated and organic growth)

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Problem 1: Makeup of our CDA document types

Section eDS SHS HES eRef

Alerts and allergies

Immunisations

Encounters

Medications list

Problems list

Test results

Appointments

Enrolments

Healthcare providers

Support people

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Problem 2: Adverse reactions dataset

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Problem 3: Care plans dataset