1. NHS CFH – Approach to Data Standards Interoperability Laura Sato Informatics Standards Lead, Data Standards & Products Chair, NHS CFH EHR Content Technical Advisory Group

2. Overview NHS CFH Data Standards NHS CFH ‘content modelling’ Fitting the standards together

3. 1. NHS CFH Data Standards

4. ISB stdsLSPs Data Standards and Products in the National Programme (adapted from K. Lunn) ETPChoose & Book SUS etc. Messaging (HL7 V3, CDA) Terminologies and Classifications (SNOMED CT, Read, ICD10, OPCS) Data Dictionary (UML, Commissioning Data Sets) Development Programmes Data Standards And Products DS&P provide a broad range of services to all development programmes in the National Programme for IT, and to the NHS in General Data Capture/Requirements Content Modelling (CEN13606, openEHR)

5. NHS CFH Data Standards (from K. Lunn) Terminologies Read CTV3 SNOMED CT DM+D Classifications OPCS ICD10 Cross maps Data Dictionary Commissioning Data Sets Messaging HL7 V3 for Spine CDA + V3 Templates Content Modelling Clinical Archetypes (CEN13606/openEHR) openEHR Templates (e.g. data capture content models)

6. 2. NHS CFH Content Modelling

7. Types of NHS data ‘content’ specifications 1.Application to application interface content -Data sharing - messages and documents (e.g. NHS Message Implementation Manual, HL7) 2.User interface content -Data capture (e.g. emerging regional models and NHS Common User Interface specification) -Data display (e.g. as above) 3.Content to support national abstractions / queries / policies -Data definition (e.g. NHS Data Dictionary) -Data submission (e.g. Commissioning Data Sets) -Data queries (e.g. resource groups) 4.?Future -Content to support ad hoc queries / views of clinical data, e-Care Pathways or decision support (e.g. ‘normal forms’ of records data supporting machine reasoning)

8. Background to use of openEHR & ISO/CEN 13606 Interest expressed by NHS vendors, informatics groups and clinicians wanting - -better or more explicit alignment across NHS data specifications -non-proprietary detailed data requirements definitions to feed into application designs Do once, re-use many -clinicians (data capture) -software developers (code, data) -NHS application purchasers (requirements) -NHS data specifications developers (avoid conflicts, save time, devote scarce resources to build shared specs.) Note: The 3 regions within the NHS National Programme for IT are ‘virtual’ -neither patients nor clinicians want to see significant variability (e.g. in data constraints) between ‘Cerner-land’ and ‘iSoft-land’ Preliminary study of feasibility of use (Oct.-Dec. 2006) Pilot use – clinical data capture requirements for Emergency and Maternity care (Feb.-May 2007) – report available soon

9. Summary of findings openEHR content models are very accessible to clinicians The reference model is expressed in clinician-friendly terms (compositions, sections, entries, observations, instructions, actions, etc.) The modelling technique encourages clinicians to think in terms of the user interface (model structures and constraints are clinician-driven) - ‘clinicians are in the driver’s seat’ Support the re-use of detailed data capture / human-readable requirements (constraints) across projects, prior to developing specific implementation models Makes the re-use of structures very easy for modellers The technique supports rapid models development Change alerts are cascaded through the repository More work is needed to explore how complex SCT-binding to archetypes and templates would be done More work is needed to explore the feasibility of automatically transforming between openEHR and V3 models

10. The 13606/openEHR approach Three layers of models: Reference Model classes based on record structure (e.g. section, entry, etc.) data types harmonisation work with HL7 is in progress (sponsored by NHS CFH) current analysis underway to review compatibility of structural vocabularies and semantic interoperability with HL7 V3 Archetypes statement specifications -‘maximal’, globally applicable (one archetype for blood pressure to support all use cases) Templates use-case specific compositions and constraints -e.g. for data capture, for reports / analysis, for messaging, etc.

11. Language analogy (adapted from an Ocean Informatics presentation) Reference model is like a grammar – i.e. the rules for constructing sentences Terminology is the dictionary of words Archetypes are the rules for constructing meaningful sentences (or term compositions) Without such rules, we can construct an infinite number of grammatically correct but clinically meaningless sentences e.g. -“fractured earlobe” -“suture of left eyelash” Templates are the rules for assembling sentences to fit a business use (e.g. documents, forms or reports in a consistent that are fit-for-purpose)

12. Example archetype with template

19. Current draft models hundreds of archetypes were needed to support 30 data capture (Maternity and Emergency) templates developed for the North / West / East / Midlands of England – publicly available online in the openEHR repository an NHS repository has been established for trials of models with refined design rules (e.g. complex SCT binding)

20. Draft models ‘production’ repository HTML Templates - http://svn.openehr.org/knowledge/templates/dev- uk-nhs/gen/html/ http://svn.openehr.org/knowledge/templates/dev- uk-nhs/gen/html/ HTML Archetypes mindmap index - http://svn.openehr.org/knowledge/TAGS/dev-uk- nhs/Lorenzo_3.5/pub/ContentRelease- 1.0.1/archetypes/gen/html/en/ArchetypeMap.html.tx t http://svn.openehr.org/knowledge/TAGS/dev-uk- nhs/Lorenzo_3.5/pub/ContentRelease- 1.0.1/archetypes/gen/html/en/ArchetypeMap.html.tx t experimental / emerging ‘national’ repository https://svn.connectingforhealth.nhs.uk/svn/public/ Plan to join repositories in Jan./Feb. 2008

26. Benefits of using 13606 / openEHR content models Strongly supports clinical engagement Current tools are designed for the clinical viewpoint, particularly for data capture Can provide detailed and consistent implementation guidance on coded term data capture within the context of specific clinical statements Should be possible to share a single set of archetypes to support requirements across NHS CFH programmes (e.g. Common User Interface, Data Dictionary, messaging) and across implementation projects Replacing ad hoc and un-reusable approaches to data requirements documentation

27. Some experimental work…

31. Implementation-driven content modelling 1.North, Midlands and East Programme for IT NHS CFH content modelling has been chosen as the means to define data requirements for the LSP data capture user interface Recent work: -Emergency, Maternity, Mental Health, ENT, generic Discharge Summary, Outpatient clinical letters 2.London Programme for IT NHS CFH content models were included in recent advice given for a shared vaccinations record A pilot use of content models within acute care is imminent 3.Southern Programme for IT Talks about the potential use of content models for data capture are just beginning

32. 3. Views on fitting standards together

33. HL7 scope (adapted from OHT – Nov. 2007) Clinical Use Case Clinical Content Model Clinical Content Model Components Reference Model, Types, Terminology Logical View Business Use Case

34. HSSP scope (adapted from OHT – Nov. 2007) Clinical Use Case Clinical Content Model Clinical Content Model Components Reference Model, Types, Terminology Logical View Business Use Case

35. 13606/openEHR scope (adapted from OHT – Nov. 2007) Clinical Use Case Clinical Content Model Clinical Content Model Components Reference Model, Types, Terminology Logical View Business Use Case

36. SNOMED CT scope (adapted from OHT – Nov. 2007) Clinical Use Case Clinical Content Model Clinical Content Model Components Reference Model, Types, Terminology Logical View Business Use Case

37. Standards compatibility / interference (adapted from OHT – Nov. 2007) Clinical Use Case Clinical Content Model Model Components Reference Model, Types, Terminology Business Use Case Clinical Use Case Clinical Content Model Model Components Reference Model, Types, Terminology Business Use Case Clinical Use Case Clinical Content Model Model Components Reference Model, Types, Terminology Business Use Case Clinical Use Case Clinical Content Model Model Components Reference Model, Types, Terminology Business Use Case HSSP13606/openEHRHL7 SNOMED CT Business / Clinical (human) Communication Technical (machine) Communication Focus / Strength:

38. User Interface Human Readable Representations Capture DisplayReport Selection Criteria Storage Communication Representations (inter-application) Storage Retrieval Representations (virtual views) Other systems or applications Representational forms Graphic adapted from D. Markwell, CIC, 2007

39. Thanks for your attention Any questions? For more info: email laura.sato@nhs.net