Scottish NHS Developments

(and relationship with 13606)

Paul WoolmanXML Program ManagerNHS Scotland

Motivation

• NHS network• Electronic Clinical Communications

Implementation (ECCI)• Government policy

• Main information flows between primary and secondary care:

– Web based – XML & MS Web Services

– GP – Hospital referrals

– Electronic outpatient appointment booking

– GP Test ordering and results receiving

– Hospital – GP Discharge summaries and clinic letters

– Shared care (NHS – Social Services)

– Electronic Prescriptions

ECCI for the NHS Scotland

ECCI- A Rolling Programme:

– Phase 1 (started summer 2000):– Argyll and Clyde; Grampian; Highland;

Tayside; West Lothian

– Phase 2 (starting late autumn): – Ayrshire and Arran; Borders; Dumfries

& Galloway; Forth Valley; Lanarkshire; Orkney; Western Isles

– Phase 3 (starting spring ‘01): – Fife; Greater Glasgow; Lothian; Shetland

• - Scottish Birth Record 2002

• - National EHR pilot 2002

• Scottish Care Information (SCI)

• SCI Integration (NEON eBiz2000 national licence)

• SCI Store (passive EPR in EVERY Trust by 2004)

• SCI Applications (cardiology, discharge letter)

• SCI Standards (XML, Web services)

• Web based messaging with user interaction (not EDI)

Supporting Products

How it fits

GPASSpractice

non-GPASS

practice

Pharmacy

SC

I sh

are

d c

are

com

s.

PSD

XRay Labs PAS Labs

SCIOutpatients

SCIClinical

SC

I sh

are

d c

are

com

s.

SCIIntegration

SCI Store

Id XRay Lab1..xx NAD 3.2

Id Rx Rx..xx abc xyz

SCI Prescription

s

Hospital GP Community

Social Work

Web- b ased

Outpatients

National Electronic Health Record (EHR)

EHR

Id XRay Lab1..xx NAD 3.2

GP summary

Hospita eventsl

Patient

Emergencycare

EHR development

• Project started 2001 first phase complete end 2002• Joint work ongoing with NHS England• ENV 13606 prime candidate• Various problems identified• NHS profile required ??• Evaluating options for

– GP summary input– Hospital event input (referral, discharge)– Patient access– Overall architecture

Shared care with local authorities

Community NHSNeeds assessment

GATEWAY

Local authority home care

NHS Web services

Registration of Births

Maternity hospital

GATEWAY Registrar of Births & Deaths

Scottish Birth RecordNational Web site

Government Gateway

CHI (single NHS number)

XML

XML

SCI Store

• Passive EPR in 4-10 Trusts & expanding• Every Trust in Scotland (National policy 2001-

2004)• Initially NEON product modified in-house• Contains PAS, Labs, Documents, Referrals,

Discharges• Currently v1.2

• Issues – Migration path to full EPR

SCI Store Mk II Architecture

Data Store

Distribution Rules Processor

Coding Scheme Mapper

Central Directory Service

PKI

SCI Integration

SCI Store

Patient Index

Applications

CHI

Data Engine

Audit

Provide EHCR2Provide EHCR1

Request EHCR

Analysis

Provisional!

Based onENV 13606Architecture ??

XML Dictionaryfor NHS Scotland and

ENV13606Repository of standard XML tags reusable

fragments and Schema for clinical content

Motivation: nothing exists !

Started early 1999

Scope of Dictionary

• To support creation of Schema used in NHS

• Enable interoperability of clinical data between vendors

• clear definitions of elements matched to standard dictionary of terms.

Priorities• Discharge letter• Referral letter• Clinic letter• Lab results• Test ordering• GP-GP record exchange• Find CHI information• Request new CHI number• Provide Birth record• GP-EHR summary• Trust – EHR event

Standards development

• Make Public Open Schema• Include manufacturers (consensus)• Include professional bodies• Accreditation

- testing - conformance

Standards input & compromise• Sources

– SIGN publications, ISD published standards, XML implementations, existing EDIFACT messages, paper samples, Headings, READ, ENV13606

• Consultation

– Professional clinical bodies, manufacturers, pilot & test

• Implementation IT training & timing

– Short time scales

– Limited expertise & funding

– Realistic expectations

• Architecture considered for EHR and Store mk 2

• NHS Data Dictionary and XML Standards repository terminology

• Teeside confidentiality model incorporated into CareNet and SCI Store mk 2 (provisional)

• Schema closer relationship with ENV part 4

• Evaluate REALISTIC working solutions to NHS developments within given constraints

Current ENV 13606 work

Issues with ENV

• Migration path from current Store• Full working models in short supply (none ?)• R&D development vs scaleable maintainable

24x7x365 working model• Functionality & timescales for development• Skills shortage (industry vs academic)• OO database – R&D (only?)• Relational Database – Industrial strength,

scaleable, high performance - required

Requirements

• Relational design from slim NHS profile• Address confidentiality issues for deployment• Create real working models• Don’t change the standard (too much)

• Use now, 3yrs from now, or 20yrs from now ?

Web sites• Http://www.show.scot.nhs.uk/sci• http://www.show.scot.nhs.uk/ecci• http://scotland-xml.uk.eu.org