NHS Modelling Efforts – ISO13606 adoption and beyond

1. NHS Modelling Efforts – ISO13606 adoption and beyond Dr. Rahil Qamar Siddiqui Health and Social Care Information Centre, NHS, England

2. Background: Information Standards use in UK • The Health and Social Care Act 2012 states that the following must have regard to an Information Standard published under the Act:

3. Information Standards development Source: www.hscic.gov.uk

4. Implementing Standards • NHS Data Dictionary for Care ? • Data recording/ record keeping • Terminology Binding • The Information Standards Delivery department provides the building blocks to enable development and implementation of information standards

5. HSCIC.GOV.UK -> Information Standards

6. HSCIC.GOV.UK .. With DD4C

7. The DD4C Process ..(1)

8. The DD4C Process ..(2)Phase 1 Existing Content Catalogue • SNOMED CT Subsets • Data Collections • NHS Messaging Specs • Royal Colleges Headings • Define metadata of all content • Metadata model based on ISO 13119 Publish Harmonise • ISO13606-based logical models for Royal Colleges headings • ISO13606-based logical models for clinical record keeping Publish

9. Catalogue Metadata

10. Logical Models for Care ..(1) • The aim

11. Logical Models for Care ..(2)

12. Logical Models for Care ..(3)

13. Logical Models for Care ..(4) • Discharge Summary • Outpatient • Referrals • Diagnosis • Blood Pressure • Medications .... • ISO13606-based models for Royal College headings • ISO13606-based models for record keeping External Reference Resources SNOMED CT International CIMI Models SemanticHealthNet patterns CONTSys Internal Reference Resources Logical Record Architecture (LRA) SNOMED CT UK Extensions

14. Example: Royal Colleges Headings

15. Level one: High level (discussion) models

16. Level one: High level Examination Finding

17. Level two: Logical modelsBottom-up modelling approach ..(1) CLINICAL STATEMENT SUB-PARTS: CLUSTER & ELEMENT • Where clinical statements have a more complex structure, each of the sub-parts of a clinical statement should be modelled as independent, reusable models using the ITEM classes: CLUSTER and ELEMENT. • These clinical statement sub-parts may represent both the core data describing parts of a statement and, optionally, other detailsthe • examination method (technique and/or device used), • the patient’s physical state, • assertion status such as presence/absence, normality/abnormality indicators of the core value. • When modelling a clinical statement sub-part it is appropriate to start at the CLUSTER class as the ISO 13606 Reference Model allows for nesting of CLUSTERs within CLUSTERs as well as inclusion of one or more ELEMENTs which hold the actual data

18. CLUSTER: Blood Pressure Measurement

19. CLUSTER: Blood Pressure Measurement State

20. Level two: Logical modelsBottom-up modelling approach ..(2) CLINICAL STATEMENT: ENTRY • Clinical Statements in this document refer to clinical observations, requests, results, actions, plans, instructions, intentions, interpretations, reasoning etc. which may have a simple or a more complex structure. • Each of the CLUSTERs represents a single, indivisible, and reusable clinical statement sub-part which are then collectively modelled in an ENTRY, which is used to record information in an EHR as a single, indivisible clinical statement. The ENTRY class also helps to provide the set of context attributes that help to facilitate the safe interpretation of the clinical statement.

21. ENTRY: Blood Pressure

22. Level two: Logical modelsBottom-up modelling approach ..(3) COLLECTIONS: SECTION • The term Collections is used to refer to a group of clinical statements which might be viewed together under a common heading for human consumption. These collections are modelled using the CONTENT class: SECTION. • Within DD4C, the SECTION class should be used only when implementation-specific requirements warrant the need for headings such as is the case with the Royal Colleges headings. • NOTE: Else the CLUSTER and ENTRY models should be used to logically model the clinical content irrespective of how it is desired to be viewed by specific user communities.

23. SECTION: Vital Signs

24. SECTION: Examination Findings

25. Level two: Logical modelsBottom-up modelling approach ..(4) ORGANISERS: COMPOSITIONs and FOLDERs • Collections of clinical statements could be included in high-level organiser groups to which authoring, attesting, and auditing information can be associated. These organisers help in human readability, storage, and communication rather than machine computability and semantics. • COMPOSITIONs are typically used to communicate extracts of records both internally within an organisation such as Admission and Handover records, as well as records that might be communicated externally such as Discharge, Outpatients, and Referral records. Each instance of a COMPOSITION is about a single subject of care.

26. COMPOSITION: Outpatients

27. Logical Models for Care .. (5) • The project started mid-November 2013 • First batch of logical models to be produced by end of April 2014 • Royal College Headings • 2-3 detailed headings e.g. Vital Signs, Diagnosis, Procedures • Medications (which includes Dose Syntax) • Dose Syntax, LRA models, other NHS work, Reviewing Scottish work on Medications (using openEHR archetypes) • Terminology Binding strategies underway. All ‘clinical’ logical models to be bound to SNOMED CT appropriately. • ‘Demographic’ logical models along with participant information to be included as per requirements.

28. Logical Models for Care ..(6) • Future Aspirations! NICE - National Institute for Health and Clinical Excellence

29. Thank you Questions? rahil.siddiqui@hscic.gov.uk