6 th HL7 International Affiliates Conference Taiwan HL7 UK and NHS IT Integration Strategies Philip Firth IM&T Strategy Implementation Manager Wrightington, Wigan & Leigh NHS Trust

HL7 UK

HL7 UK membership growing steadily OrganisationPersonalBenefactorTotal Adoption of HL7 as the messaging standard for the NHS National Programme for IT has been a major catalyst for growth

HL7 UK – Services to members Web services –Access to important information – eg. NPfIT MIM –Communication Training opportunities – HL7v3 etc HL7v3 Primer: approximately 2300 sold Technical Committee - regular 2 day meetings throughout the year (free to members) NHS Implementer conferences (free to NHS) HL7UK annual conference (next November 2-3)

HL7 UK Repository HL7 UK Website Repository An important source of information, particularly the NPfIT Message Implementation Manual (MIM)

National Perspective

What is going on in the UK? NHS Connecting for Health (England only) –National Programme for IT in the NHS Mandated to build an information infrastructure to improve patient care in England Covers all NHS organisations in England –>100K doctors, >380K nurses, 50 million patients Represents an investment of £2.3billion (US$ 3.8billion) over the first 3 years, with further funding to end of 10 years >£6billion

NPfIT Key Targets NHS Care Records Service (NCRS) –Every patient's medical and care records will be held electronically and will eventually be available securely online. Choose and Book (electronic booking of hospital appointments) GP2GP Electronic Transmission of Prescriptions (ETP) New National Network (N3) Picture Archiving and Communications Systems

How NCRS will work A summary of care and clinical history will be held on a national database (the ‘ Spine ’) to ensure that important patient information is always accessible. Spine More in-depth details will be held locally where most care is delivered. –records of conditions, medication, operations, tests, X-rays, scans and other results Links to local information will be available from the summary record Key clinical information will also still be stored on Existing IT Systems – a major integration challenge for the NHS

HL7v3 being used predominantly for integration with the Spine and other National Applications, eg. eBooking, ETP, GP2GP NPfIT is using HL7v3 foundations, and contributing to the development of domain models NHS V3 message specifications contained in the Message Implementation Manual (MIM) MIM available to HL7UK members via website HL7 v2.x for integration with existing systems NPfIT – the role of HL7

GP2GP GP2GP a very early V3 adopter NHS sponsored / supplier supported use RIM / Datatypes / Tools and model EHR structure feedback into CDA and clinical statement

Primary Care LSP / Existing Choose & Book Slots (provide and fill)Referral OOHEncounter ** NHSD Encounter ** Scope of Clinical Messaging in Phase 1 Any Spine / NCRS Accredited System Spine Query Secondary Care LSP / Existing PoC Discharge Report (Inpatients) or PoC Care Event Report (Out Patients) PoC Disch or Care Event Report ETP Pharmacy Prescribe Cancel Full / Partial Dispense Spine Medication Updates SAP SAP Encounter (PoC Care Event Report) GP2GP Diagnostic Imaging DI Report DI Report DI Encounter DI Requestor Care Event Report (Primary Care) PoC Emergency Admission Notification ** A&EA&E Report ** Mental Health Adm Disch CPA Summary Adm / Disch / CPA Summary Notifications NOTE: Flows marked with ** are also sent to Spine but not shown on this diagram for ease of reading

NHS Messaging Standards - MIM

Local Perspective

Wigan - Background IM&T Strategy –Best of Breed –Keep departmental systems that work –Build EPR using web development and systems integration Development 3 yrs down the line … Lots of HL7 v2 interfaces Project in place to send discharge letters to GPs using HL7 v3

Wigan – Local issues Data quality – a huge issue for the NHS Consistent person referencing –NHS Number, but not all systems/people use it –Patients rarely know their own NHS Number Poor IT literacy skills (major contributor to poor data) Poor IT Infrastructure

Availability of funding –Local funding scarce – major NHS cost pressures –Just got £100K+ funding to develop a integration platform for linking existing systems with CfH Time –Lots to do in a limited timescale Resources –Recruitment and retention is a major issue –Skills needed are in short supply (.NET, XML, SQL etc) –NHS wages cannot compete with private sector Wigan – Local issues

CfH is stepping into gear, –Wigan: Theatres 2006, new PAS 2007 … Replacement of NHS IT systems will not happen overnight in Acute Hospital Trusts Key existing departmental systems may not be replaced before 2010 Existing Systems integration is therefore a key issue for Acute Hospital Trusts – which has breathed new life into HL7v2 Wigan – Getting ready for CfH

Bridging the gap between local and national applications HL7v2 to link existing systems to CfH applications HL7v3 for systems interoperability for national applications and the Spine

Summary CfH in full swing Major system integration challenges for the NHS at local and national level HL7 UK is providing a key supporting role in the development of the messaging standards required for CfH HL7 UK making a major contribution to the development of HL7v3, early adopters etc