1. Content of e-pathways: Common structures and language Anne Casey FRCN Editor, Paediatric Nursing Adviser in Informatics

2. Common structures and language F Why are common structures and languages needed? F What is meant by ‘common’? F How are standards being developed? F Who is involved? F Further information

3. Why? F Communication between professionals and electronically F Comparison: variance analysis, audit, research, performance, costing etc F Link to ‘knowledge’: decision support Meaning & Interoperability

4. ‘What do you mean by.. F Bed rest F Nutritional supplement F Clinical guideline F Diagnosis F pre-condition for intervention

5. For team communication … ‘.. the multi-disciplinary team agreeing on an ideal patient journey from which to guide what happens in reality’ (Page and Herbert 2003) Clarification of terms and concepts (towards) Standard Clinical Definitions

6. In the context of electronic records… ‘ Without standardisation of concepts and definitions (to describe care pathways), software designers will have no consistency on which to base their designs’ (Page and Herbert 2003) Standard Care Pathway Conceptual Structure

7. In the context of electronic records… ‘If clinical information is to be transferred and exchanged electronically, a standard clinical terminology is a necessary installation in clinical systems. There would be problems in exchange of information for clinical or managerial purposes if multiple vocabularies were used within the NHS.’ (www.nhsia.nhs.uk/snomed/pages/ct_general.asp)www.nhsia.nhs.uk/snomed/pages/ct_general.asp Standard Clinical Terminology

8. Standard for e-pathways F NHS Care Record: structural elements (NPfIT) F International Record Structure standards – HL7, ISO, CEN F Page and Herbert 2003 F Structures in Use (migration)

9. SNOMED Clinical Terms Evaluation & testing in vitro, vivo, silico SNOMED CT - a terminological resource for use in electronic systems to support recording, communication and retrieval of clinical (multi-disciplinary) information USE IN SYSTEMS WITH FEEDBACK VIA ONLINE REQUEST MECHANISM

10. How are standards being developed? F National Clinical Guidelines F Information Standards for the NHS F Information Standards Board (England) – Requirement – Existing standard / new development – Approval – Implementation (NPfIT) F SNOMED Clinical Terms

11. Information Standards Board (England) F Scope includes NHS Data Dictionary, Clinical Data Sets and standards that facilitate interoperability and data integration F Examples: e-gif, HL7, diabetes user dataset F Information Standards Advisory Board: rigorous review of processes, testing and consultation F www.isb.nhs.uk

12. Information Standards Group (Scotland) F Co-ordination liaison, review, production and dissemination of Information Standards in Scotland; part of Information and Statistics division reporting to the NHS (Scotland) IM&T Programme Board. F Seat on ISB (England) F www.isdscotland.org

13. Standards Development Local use National level: Health service & Government International level: ISO TC215 & HL7 Regional level: e.g Europe CEN TC251 WHO centres ICN PCN NNA Nurse

14. Clinical Standards Technical Standards Terminology Standards Security and Confidentiality Standards Information Standards recording exchanging comparing receiving Standards in Context

15. Reference & Further Information F Herbert and Page 2003 Developing e- pathway standards in DeLuc and Todd (eds) E-Pathways: Computers And The Patient's Journey Through Care F www.nhsia.nhswww.nhsia.nhs F www.snomed.org