1. Scottish NHS Developments (and relationship with 13606) Paul Woolman XML Program Manager NHS Scotland

2. Motivation NHS network Electronic Clinical Communications Implementation (ECCI) Government policy

3. 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

4. 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

5. 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

6. How it fits GPASS practice non-GPASS practice Pharmacy SCI shared care coms. PSD XRay Labs PAS Labs SCI Outpatients SCI Clinical SCI shared care coms. SCI Integration SCI Store Id XRay Lab1.. xx NAD 3.2 Id Rx Rx.. xx abc xyz SCI Prescriptions HospitalGP Community Social Work

7. Web-basedWeb-based

8. OutpatientsOutpatients

9. National Electronic Health Record (EHR) EHR Id XRay Lab1.. xx NAD 3.2 GP summary Hospita eventsl Patient Emergency care

10. 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

11. Shared care with local authorities Community NHS Needs assessment GATEWAY Local authority home care NHS Web services

12. Registration of Births Maternity hospital GATEWAY Registrar of Births & Deaths Scottish Birth Record National Web site Government Gateway CHI (single NHS number) XML

13. 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

14. 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 EHCR 2 Provide EHCR 1 Request EHCR Analysis Provisional ! Based on ENV 13606 Architecture ??

15. XML Dictionary for NHS Scotland and ENV13606 Repository of standard XML tags reusable fragments and Schema for clinical content Motivation: nothing exists ! Started early 1999

16. 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.

17. 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

18. Standards development Make Public Open Schema Include manufacturers (consensus) Include professional bodies Accreditation -testing -conformance

19. 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

20. 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

21. 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

22. 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 ?

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