1. HL7 Standards Strategic and Tactical Use Charlie McCay charlie@RamseySystems.co.uk

2. The Hat Trick Ramsey Systems –UK Healthcare Interoperability HL7UK –Use and development of HL7 standards for the UK Retinal Screening Project –Communications requirements to prevent blindness DMSP –Chronic care using HL7v3 structures GP2GP, ETP pilots, RACPC, PALZ, CFH

3. Agenda Interoperability – what is needed –Tactical needs –Strategic needs An Interoperability Framework –What and why What value does HL7 deliver

4. Tactical needs (Retinal Screening) Clinical reason to interoperate –thousands going blind without screening –Cohort of 2 million identified by GPs Commercial reason to interoperate –Savings on the cost of stamps –DoH targets create stronger market Technical capacity –Building on previous investment

5. Strategic needs Transferable clinical record extract –GP2GP, screening record transfer –Transfer of care Cross organisation condition management –Shared care, screening –Diabetes, Cancer, Heart Disease, etc Large-scale Transactional needs –ETP, appointments, etc

6. Cycles of Change Application architectures –Driven by technology, chance, and requirements –User interfaces, database structures, business objects Technical change Healthcare knowledge and best practice Political change NHS organisational change

7. Short and long-term Retinal images used to promote better patient management of diabetes Immediate access to letters and patient status information Cost and errors when re-keying Reusable applications

8. Interoperability Framework Requirements Scope constraints… Static information… Orchestration… Infrastructure… –PKI, directory services, transport Testing…

9. Scope Constraints Tactical –Agreed within communicating community –Reflect scale of existing data sharing agreements (not all national) –Tighter scope make testing easier Strategic –Document and share current practice –Develop best practice guidelines –Open specifications Leading to convergent solutions

10. Static information Tactical –Existing messages were possible –Expect to replace/evolve (short ROI) Message level wire format Strategic –Stable set of structures Eg for EHR - CDA, Patient Care –Template formalism (IHE, CCD, CFH…)

11. Orchestration Tactical –Textual definition of receiver responsibilities and trigger events –Add hoc diagram support Strategic –New HL7 dynamic model –Horizontal Workflow standards

12. Infrastructure PKI, directory services, transport Tactical –Reuse existing practice –Do what works Strategic –National / International consistency useful –Open specifications Leading to convergent solutions

13. Testing Implementation Conformance to –Implementation Guide (eg MIM) –Underlying standard (eg CDA) –Business Requirements Specification Conformance –Underlying standard and HDF –Requirements Developer and Author competency

14. Interoperability Framework Requirements Scope constraints Static information Orchestration Infrastructure –PKI, directory services, transport Testing

15. Collaboration Stakeholders –Suppliers –Users –Purchasers Interoperability specification development and maintenance requires active engagement from all three Many different specifications need to be harmonised

16. Is the framework too rigid? Much software and terminology not used consistently (or as designed) There is a need end to end for: –Agreement between users on meanings Narrow agreed use cases – sender knows how the information will be used Or –Common technical framework This is the strategic goal with HL7v3 use

17. What value does HL7 deliver constancy over the cycles of change –Interoperability specifications are its core business Open participation and specifications Maintenance and support facilities –Lists, meetings, wider ecosystem Established decision making structures –Least bad form of government

18. Next steps Iterative, collaborative, open process Increasing reuse of horizontal industry standards for parts of the framework Migration from narrow agreed use cases to generic processing against a framework –Early return on interoperability investment –Many small, safe steps