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Scottish NHS Developments
(and relationship with 13606)
Paul WoolmanXML Program ManagerNHS Scotland
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Motivation
• NHS network• Electronic Clinical Communications
Implementation (ECCI)• Government policy
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• 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
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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
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• 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
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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
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Web- b ased
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Outpatients
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National Electronic Health Record (EHR)
EHR
Id XRay Lab1..xx NAD 3.2
GP summary
Hospita eventsl
Patient
Emergencycare
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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
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Shared care with local authorities
Community NHSNeeds assessment
GATEWAY
Local authority home care
NHS Web services
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Registration of Births
Maternity hospital
GATEWAY Registrar of Births & Deaths
Scottish Birth RecordNational Web site
Government Gateway
CHI (single NHS number)
XML
XML
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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
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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 ??
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XML Dictionaryfor NHS Scotland and
ENV13606Repository of standard XML tags reusable
fragments and Schema for clinical content
Motivation: nothing exists !
Started early 1999
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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.
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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
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Standards development
• Make Public Open Schema• Include manufacturers (consensus)• Include professional bodies• Accreditation
- testing - conformance
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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
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• 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
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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
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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 ?
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Web sites• Http://www.show.scot.nhs.uk/sci• http://www.show.scot.nhs.uk/ecci• http://scotland-xml.uk.eu.org