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THE HEALTH iNNOVATOR
An Integrated Care Record ServiceThe Durham & Darlington Approach
The Simulator
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AGENDA
The Simulator………
Where did we come from and what did we learn?
Where are we now?
Architecture and the local domain
Demonstration of Simulator
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The D&D EHR Simulator
In parallel with the development of the EHR organisational architectural models by the SCHIN group involved in the Durham and Darlington EHR Project, which are designed to illustrate (via an Animator tool) the ethical and security framework for Electronic Health Record operations, the EHR Simulator is being developed.
The Simulator is to provide a mechanism for the deployment of those concepts using sample data in a test system which can be reviewed by stakeholder representatives.
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Original EHR Philosophy
Step 1 - Identify the Patients
Step 2 - Populate the base with history
Step 3 - Update with new data
Step 4 - Provide user access
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How the project evolved
Phase 1 – 09/00 – 09/01Testing the theory
Phase 2 – 09/02 – 06/02The reality
Phase 3 – 06/02 – presentThe way forward
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Phase 1 – The first year
Utilise a selection of established health care based software products to build the 4 elements:
Identify - a health community patient index
Populate - a data repository containing historical data extracted from primary and secondary care systems
Update - a series of updates based upon patient contacts with various institutions
Access - a number of web-based views of the repository for different user types
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Phase 1 – Key Lessons Learnt
Community Index- Patient Identification concept viable using standard toolsBUT………Need for ‘real time’ NSTS for maintenance
Patient Details- Concept viable using TextBase (structured) records
Web Access- Search, retrieve and display concepts viable using
standard tools
Repository- EPR schema insufficiently flexible to accomodate primary
care and wider community data HENCE………Build bespoke EHR repository
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Phase 2 - September 2001 – June 2002
Proceed with original philosophy using bespoke components:
– a new SQL repository based on an EHR schema– REAL GP and acute hospital system records (anonymised) to
populate repository– update transactions based upon a fictitious patient (to
mirror animator)
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Phase 2 – Key Lessons Learnt
Historical Data- High variability in quantity, quality and categorisation of data
from source systems
- Requires standardisation and consistency
e.g. fully implemented EPRs and data transfer capability (records and transactions)
Confidentiality- Evolving national (and DuDEHR project) position on informed
consent and access to patient data
- Requires architectural framework for data publication
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Phase 3 – Transaction Oriented EHR
Use GP/patient ‘mutual informed consent’ as initiator of individual EHRs
Move from repository oriented to transaction oriented design
Focus on ‘data publishing’, ‘transaction certification’ and provenance.
The Simulator to illustrate what we need............................
……………………………………………......………not what we have
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Phase 3 – The Simulator Today
Three core components:
Repository
Transaction Engine
Viewer
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Phase 3 – The Simulator Today
Three core components:
1 Repository – extension of previous model– Previous version reflected what could be done with
existing data– Now includes greater provenance support, strict
attribution of all data and relationships between items
– Based on how a transaction-based EHR could work, rather than what an EHR would have available today
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Phase 3 – The Repository•Here are a few Here are a few of the 30 tablesof the 30 tables
•Despite trying Despite trying to maximise to maximise simplicity, the simplicity, the repository is repository is still a maze of still a maze of relationships relationships
• This enforces This enforces provenance provenance tracking and tracking and maximise useful maximise useful connections for connections for the userthe user
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Phase 3 – The Simulator Today
Three core components:
2 Transaction Engine – based upon the Edward Jones story in the Animator
- Official messages still evolving nationally- Unofficial formats have been defined for the
Simulator, reflecting what we need- XML based (e-GIF compliant)- Support provenance and transactions through
references between messages- All messages are “certified”
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Phase 3 – The Messages
Universal message format includes “Envelope” and “Body
All messages are given a message number from the Certificate server
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Phase 3 – The Messages
Envelope includes details about the message:
– Source, – Destination(s), – Patient identity,– EHR storage flag, – Time sent– Certificate number– Associations with previous
messages– Problem associations
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Phase 3 – The Messages
Body contents are flexible, and incorporate all appropriate message types
– Prescriptions, Publications, Results, Orders, Bookings, Discharges & Admissions etc
Simple structures, but appropriate functionality
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Phase 3 – The Simulator Today
Three core components:
3 Viewer – refine appearance and enhance functionality
- Enables provenance viewing- Connects associated data items- Allows for selection of items by problem or event- Delivers benefits of message based system to the
end user
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Value of the Simulator To complement the Animator in informing debate
To provide a sample model to assist in EHR procurement in D&D and nationally
To highlight multiple issues in EHR design, construction and operation
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Introduction to demonstration (Mike Martin)
Demonstration
Questions
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