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HL7 v3 , EN ISO 13606 and SNOMED CT – using in harmony? 17 th March 2010 Dr Steve Bentley – DS&P NHS Connecting for

HL7 v3 , EN ISO 13606 and SNOMED CT – using in harmony? 17 th March 2010 Dr Steve Bentley – DS&P NHS Connecting for Health. Outline. Describe the standards – solar system Approaches to standards Adopt Adapt Ignore Compliance and /or Conformance Current Approach in the English NHS

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HL7 v3 , EN ISO 13606 and SNOMED CT – using in harmony? 17 th March 2010 Dr Steve Bentley – DS&P NHS Connecting for

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  1. HL7 v3 , EN ISO 13606 and SNOMED CT – using in harmony?17th March 2010Dr Steve Bentley – DS&P NHS Connecting for Health

  2. Outline • Describe the standards – solar system • Approaches to standards • Adopt • Adapt • Ignore • Compliance and /or Conformance • Current Approach in the English NHS • Commitments to SCT and HL7 • LRA approach • Challenges ahead

  3. Read ISO/CEN The Standards Solar System LRA UML SNOMED HL7 V3 V2 ICD10 CDS tinua Data Dictionary NHS con OPCS openEHR OHT ISO Data Types IHE EHR

  4. Approach to Standards • Adopt • Take a standard as is and implement • Can this ever happen? • National/Local variation • Doesn’t quite meet the particular use case • Standards have optionality built in – may need specifying

  5. Approach to Standards • Adapt • Take a standard and adapt it to fit a particular use case • May need to join a number of standards • Example • NHS England's use of HL7 v3 CDA for discharge messaging.

  6. Approach to Standards • Ignore • Develop in house • Conflicting standards pick one instead of another

  7. What is the effect of this? • All implementations of standards are adaptations of standards – some more than others • Interoperability is either limited to the zone of agreement or limited by the commonality in the standards adaptations • Information exchange across boundaries will be difficult • England to Scotland • England to Europe • Health IT suppliers need to be able to cope with the variations

  8. Compliance or Conformance • What does conformance or compliance with a standard mean • How would we measure it? • Who is the judge?

  9. Logical Record Architecture for Health And Social Care • Definition - the LRA is a set of integrated and internally consistent abstract data and semantic definitions linked to specific health records business requirements and objectives. • The LRA is an approach to the use of multiple standards for multiple use cases whilst attempting to maintain commonality.

  10. LRA Sausage Machine Message specs (MiM) Requirements: Laws, guidelines,Frameworks, standards etc Archetypes/templates Clinical Models Queries, Analyses

  11. Key Components of the Logical Record Architecture • BS CENISO 13606 - 1 • SNOMED CT • HL7/ISO Datatypes • UCUM

  12. High Level Domain Analysis

  13. Detailed Data Definitions

  14. An exampleBlood pressure

  15. SNOMED CT Constraints • Blood Pressure Measurement • 243796009 | situation with explicit context |: • { 363589002 |associated procedure |= << 46973005 |blood pressure taking | • , 408730004 | procedure context | = < 288532009 |context values for actions | • , 408731000 | temporal context |= < 410510008 |temporal context value | • , 408732007 |subject relationship context |= < 125676002 | person | • } • Systolic Blood pressure • 243796009 | situation with explicit context | : • { 246090004 | associated finding |= << 271649006 | systolic blood pressure | • , 408729009 |finding context |= < 410514004 |finding context value | • , 408731000 |temporal context |= < 410510008 |temporal context value | • , 408732007 |subject relationship context | = < 125676002 | person| • }

  16. What as the LRA achieved? • LRA releases • Release 1 – Description of the methodology and examples • Release 2 – Renal and Maternity models initial developments • Release 3 – (due end of March 2010) Full modelling for Haemodialysis Go to http://www.connectingforhealth.nhs.uk/systemsandservices/data/lra

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