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Applications of XML in the NHS

Applications of XML in the NHS. Paul Woolman Standards Program Manager ISD. Contents. XML for: Patient Records Publishing Communications. Patient records. Store clinical information as XML Structured documents Case notes Discharges Referrals Summary documents Structured data

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Applications of XML in the NHS

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  1. Applications of XML in the NHS Paul Woolman Standards Program Manager ISD

  2. Contents XML for: • Patient Records • Publishing • Communications

  3. Patient records • Store clinical information as XML • Structured documents • Case notes • Discharges • Referrals • Summary documents • Structured data • XML data model

  4. Information storage • XML as the format for authoring and storage of documents • Rather than Word .Doc, Rich Text Format, Text • Clinical documents • Metadata (description of documents) • Latest Office applications (MS, SUN, Open)

  5. Examples • Graphnet • CSW • Office • Anaesthetic records… • Next 4 slides…

  6. Office applications • MS office, Sun, OpenOffice store & use XML documents • Infopath forms client • Supports web services & XML • Build forms from xml schema

  7. Patient info pre-op instructions Case type pre-op assessment lab test results post-op instructions Replacing Paper Forms

  8. Pasting a Theatre List

  9. Client Behaviour XML SAX Writer XSLT Transform (Optional) XML Signature & Encryption SOAP Message server XSLT Transform (Optional) XML Signature & Encryption SOAP Message XML SAX Handler

  10. SCI Store Web Server(IIS) Database ASP Pages Objects Browser (IE5.5) Request Handlers 3rd Party Application .NetFrame work Request Handlers Request Handlers Web Service Log Log Handler

  11. Contents XML for: • Patient Records • Publishing • Communications

  12. Publishing

  13. Document Metadata • Data about data…descriptions eg keywords • Descriptive headings about documents • Useful for filing, searching and cataloguing • E-Government metadata standard • HL7 Clinical Document Architecture • need NHS Scotland standards

  14. SHOW & NELH • Main NHS portals • HTML pages need manual updating • XML data storage • XML -> HTML in active server pages • Advantages: • Many views of single data • Support clinical networks • Support automated query tools

  15. NHS Data Dictionary • Data definitions on web • XML export selected definitions • UML models designing XML schema & refer to data definitions. • New dictionary to tie all three together

  16. Contents XML for: • Patient Records • Publishing • Communications

  17. Communications

  18. Electronic Data Interchange • Moving data from one computer to another • Eg Patient referral from GP to hospital • Replace older formats eg EDIFACT • New forms of EDI with user interaction • XML allows Graceful Degradation • View messages if required

  19. GP records exchange • Patient moves house or changes GP • Records follow 4+ weeks later • Electronic exchange is quicker • GPASS early implementations ongoing

  20. NHSScotland GPEX • GPASS specific message • GP exports XML document to PSD • PSD send off to new GP & update CHI • New GP selectively imports record into new GPASS • Currently in early implementation sites

  21. Scottish Birth Record • Replaced SMR for births • Added clinical information • Make useful to clinical care • Rolled out to all maternity units

  22. Concept • Single web site in NHSnet • Browser input from maternity units • Link to PAS’s • Link to new maternity systems • Reduce data duplication • Link to CHI • Give baby new CHI number at birth

  23. Patient ID and demographics PAS EXTERNAL INTERNAL SBR CHI/UPI Clinical data INTERNAL AND EXTERNAL Clinical System Other Child Systems Paper Scottish Child Health Information Development (SCHID) Project Example of Hospital Data-flows Want more information? www.show.scot.nhs.uk/sbr alternatively tel: 0131 551 8046

  24. Use of XML • CHI link • Maternity system • Ongoing development

  25. Community Health Index (CHI) • Mainframe application • Green screen terminal input • Need machine EDI input & query

  26. Concept • Casablanca XML to VMS transform application • NHS Standard XML Schema • Web server • HTTPS and XML input to active server pages

  27. XML messages • Register new patient • Find patient • Responses

  28. SCI integration • SCI Store – every health board • Labs systems – feed into Store • E-Biz 2000 middleware & XML

  29. SCI Store Id XRay Lab1.. OK OK 3.2 3.2 xx GPASS practice SCI Integration community/ MH system community pharmacy Labs other PAS non-GPASS practice XRay Test requests and results reporting To achieve this SCI first has to integrate existing hospital systems and re-assemble the patient’s information in a new system called SCI Store OK 3.2

  30. SCI web services • Electronic Transmission of Prescriptions • Referrals to outpatients • SCI Gateway • David Brazier this afternoon

  31. E-Care • Shared care records between health, social services, education and others • Eg Shared Assessments • Elderly • Mental health • children

  32. Single Shared Assessments • Lots of work on data and definitions • Based on paper versions • Initiated by any party • Involves patient/client and relatives/carers • Involves independent sector • Eg churches, voluntary orgs.

  33. Concept • Server in demilitarized zone • XML integration to health system • XML integration to social work system • Browser input

  34. E-care store • Central data store • Multiple identifiers – CHI, Hospital nos., social work numbers • XML Web Services for data exchange

  35. Virtual EHR portal • Pull data from distributed systems • Rearrange • Present to viewer

  36. Education?? Social Care Integrated Children’s Services Record CH System LA net Internet parent/child + smartcard NHSnet GP SBR SIRS School SNS NHS systems

  37. Health Care Personal Record Name: Alerts: Demographics: Carer: Allergies: GP: Teacher: Health Problems: Social Worker: Child Protection Status: Medications: Section of register: Special Needs Status: Immunisations outstanding:

  38. Health Care Personal Record Interventions: Health: Social Work: School:

  39. Health Care Personal Record Name: Who lives with me: Interests: Treatments used outwith health service: Special Information you may want to know about me:

  40. A&E OoH NHS24 GP Portal XML web views of systems EPR Acute EPR Commun EPR MH ‘EPR’ GP ‘Virtual’ EHR Model Patients

  41. Data Publishers/owners End-user client NHSnet - a fully distributed Data Web

  42. The Semantic NHS Web Local systems SCI Gateway Discharge e-Care Stores EHR Gateway SCI Stores via web services SHOW2 Web service EHR Store Mk 1.x Demographics Access rights Pointers CHI and child health systems r SCI-DC Web Browser Terminology; Definitions; Schema; Services - NHS Dictionary and Grammar

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