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Travel to HL7 kindly funded by Ocean Informatics

“NHS change challenge” Clinical content work in the NHS Tony Shannon Consultant in Emergency Medicine, LTH Clinical Consultant, NHS CfH. Travel to HL7 kindly funded by Ocean Informatics. Tony Shannon . M.B. B.Ch. B.A.O. Ireland Fellow of College of Emergency Medicine England

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Travel to HL7 kindly funded by Ocean Informatics

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  1. “NHS change challenge”Clinical content work in the NHS Tony ShannonConsultant in Emergency Medicine, LTHClinical Consultant, NHS CfH Travel to HL7 kindly funded by Ocean Informatics

  2. Tony Shannon M.B. B.Ch. B.A.O. Ireland Fellow of College of Emergency Medicine England Fellowship in Informatics USA MS in IT Management England Consultant in Emergency Medicine, Leeds Teaching Hospitals Clinical Consultant, NHS Connecting for Health Leeds, England

  3. Complex Systems • Many parts, Many interactions • Perpetual novelty • Difficult to describe/understand completely • Difficult to control/change • Identify simple rules • Self-organise • e.g. Weather, Economy, Internet, ED

  4. National Health Service in the UK • Established in 1948 by Labour Government • Huge • 3rd largest employer in world, largest in Europe, 1 million+ staff • 45+ million patients in England • Healthcare free to all at the point of care • Quality • Costly • Increasingly financially oriented • “Payment by Results” • “NHS Plan” = Service Reform (inc. IT) • e.g. Leeds Teaching Hospitals • City <1million population • 4 EDs; 110,000 + 90,000 census • 95%/98% “4 hour ED target”…

  5. Biggest civil IT programme in world • 10 year; based in Leeds, England • $20+ billion with commercial suppliers • 5 Regions of England • North East Cluster • 7.5 million population • 170,000 NHS staff • 23 Acute Hospitals • 12 Mental Health Trusts • 1200+ Primary Care practices • Care Record Service • contract £1 billion

  6. Hugely ambitious • Primary, Community, Hospitals, Mental Health • Contracts for several interim solutions • Aiming for a single strategic EHR solution • National Services • Single NHS patient identifier number • Service Directory • Choose and Book scheduling • Local Services • Care Record Service (Electronic Health Record) • Guideline based • Workflow integrated • Cross organisational working

  7. NHS + IT = Complex

  8. Change – Emergency Medicine

  9. Change - Management Drivers ? Benefits = Quality  Risk↓ Cost↓ Time↓

  10. Change - Software Engineering

  11. People+ Process + Technology in a “Model Community” Systems in Silos ?

  12. People • Challenge siloed thinking • Process • Look for simplicity within the complexity • ? Core generic processes in healthcare • Technology • Evolutionary approach • Process related IT requirements • esp. at the complex front end. i.e. ED charting • free text/dictation versus forms (e.g. T-system) • Aim to reuse • Distributed process-oriented SOA? • Balance central control and local innovation

  13. Process - Urgent Care Study • Identify top/corebusiness processes in Urgent Care • Identify and prioritise information/technology needs • Methodology • Stakeholders/ core Processes / IT Requirements • Site visits • NHS Direct • Ambulance Services • ED (4 in West Yorkshire) • Walk in Centre • GP Out of Hours

  14. A view of NHS process …

  15. A view of Generic Processesin Healthcare Strategic (++ patients) Performance management e.g. Audit Tactical ( > 1 patient) Resource Management e.g. staff, beds Referral in Operational (1 patient) Assessment Diagnostics Plan Care Deliver Care Sorting Referral Out

  16. Self care Angina diagnosis & 1st care plan GP Suspected MI: self-care advice given & ambulance requested NHS Direct Taken to A&E: given oxygen in transit Ambulance Returns to self / primary care Diagnosis confirmed: & patient stabilised Emergency Department Transferred to CCU to complete post-MI care Acute CCU time A journey through the NHS …

  17. Specific Patient Journeys IT Library Generic Generic Process IT Bricks

  18. A tale from Denmark …

  19. The Danish solution…

  20. OpenEHR • 15+ years of European & Australian R&D • Generic Process based EHR Architecture • Related to • European Standard (en13606) • ISO standard

  21. OpenEHR Templates (Toys) Specific Generic Archetypes (Bricks)

  22. Archetype • Reusable list of clinical statements • Useful for clinical documentation • Can be coded with terminologies e.g. Snomed CT

  23. Archetypes & Templates • Central control • Local flexibility

  24. Archetypes

  25. North, Midlands and East • 60% of England • Supplier • Contract with CSC • Single strategic EHR solution • Requirement & Design Stage • NHS “Clinical Content” needed • To support charting • Big Opportunity

  26. NHS input… example..

  27. Collaborative Evolvable Version control comments NHS content – inputs via wiki

  28. NHS input… e.g. Head & Neck examination

  29. Into Head & Neck exam archetype

  30. Archetypes can bind to codes…

  31. Archetypes available as XML/HTML etc…

  32. NHS Archetype library

  33. Archetypes configured in Templates solves central control + local need

  34. Template editor output as HTML/XML/Forms etc….

  35. OpenEHR content Templates (Toys) • Can be used for application UI • e.g. forms • Can be transformed into messages • e.g. HL7 CDA • Can be used for querying +/- Terminology Archetypes (Bricks)

  36. NHS template library

  37. .. for use in any supplier system

  38. .. for use in any supplier system

  39. openEHR content cycle.. • Clinical content will continue to evolve • Archetypes and templates are version controlled • Content changes • don’t impact application • if fit with openEHR

  40. Benefits of Archetypes • Quality • Better documentation - for complexity of healthcare • Via Standard Archetype + Flexible Templates • Can evolve over time - as medicine changes • Via version control • Balances central control and local innovation • Risk • Solid foundation for Decision Support • Time • Save time • Build templates fast • Cost • Save NHS money • Standard methodology – all can share • Non proprietary

  41. NHS Clinical Content Service • NHS Requirements • E-Care Pathways • Archetypes & Templates • Archetype outputs 150+ • Template outputs 20+ • Clinical Coding • Via SNOMED CT • Resource • Governance

  42. NHS Tech Office.. today Messaging Realisation with templates Logical View Business Use Case Story board Clinical Use Case Interactions Message Clinical Content Model HL7 Templates Clinical Templates HL7 Templates Clinical Archetypes RIM + Data Types + Terminology Reference Model, Types, Terminology

  43. NHS Tech Office.. tomorrow Messaging Realisation with templates Logical View Business Use Case Story board Clinical Use Case Interactions Message Clinical Content Model HL7 Templates Clinical Templates Auto Generated HL7 Templates Clinical Archetypes RIM + Data Types + Terminology Reference Model, Types, Terminology

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