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This project aims to create an integrated clinical record service for the NHS in England, focusing on ethical foundations, patient consent, and clinical engagement. It involves developing educational tools and a simulated commercial product to inform architecture. The enterprise architecture covers organization, resources, functions, and technologies, with characteristics of openness, scalability, and flexibility. Work locations include primary care, hospitals, and out-of-hours services. The project facilitates cultural change, innovation led by clinicians, and local reconfiguration.
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Aims of the project • Create a grounded framework for a federated information service for the NHS in England • Create an environment in Durham and Darlington ready to procure an integrated clinical record service by the end of the project in September 2002
Customers of the project • NHS in England (national reference architecture) • Health Community in Durham and Tees Valley Strategic Health Authority area (1.2 million people)
Principles of the project • Ethical and Legal foundation for a shared information service • Based on informed patient consent • Prime inter-organisational clinical information source • Grounding in real clinical work • Engage clinicians in coherent design understanding (using ethnography)
Project themes • Ethical Framework • Security Framework • Ethnography • Educational tools to facilitate user engagement and informing the architecture (ANIMATORS) • Simulated commercial product reflecting the architecture (SIMULATOR) • Governance framework
Enterprise architecture • Projections of enterprise architecture cover: • Organisation • Resources • Functions • Technologies • Governance
Characteristics of the information service • Open • Flexible • Scaleable • Federable • Cope with legacy
Record architecture Terminology Classification Messaging ENV 13606 prENV 13940 Read, SNOMED, Drug dictionary HL7 Framework for other standards
Conceptualising problems in Architecture • Abstraction and Parsimony • Computing science • Exemplification and specificity • Medicine and surgery • To move toward shared understanding we exemplify concepts in animators
Location of work • Primary care • General practice / Multidisciplinary care teams • Transitional care • NHS Direct • Out of hours services • Paramedic /ambulance • Hospitals (Acute services) • A+E ; CCU; Acute medical wards
Context of work • Interdisciplinary Care pathways • Coronary heart disease • National Service framework • Co-ordinated care within and between health care organisations • Cultural issues of trust related to information sharing
From discourse to understanding • Coherence of vision of EHR • System vendors • NHS informaticians, clinicians, managers • Local and national policy • Academics
Facilitate cultural change • Clinically led innovation • Dynamic local reconfiguration • Informatics services as facilitators not leaders of the change process