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Architecting Data Standards to Enable Service Interoperability

Dr Ken LunnDirector of Data Standards www.connectingforhealth.nhs.uk

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NHS Connecting for Health

Supports the National Health Service in providing better, safer care by delivering computer systems and services that improve how patient information is stored and accessed.

http://www.connectingforhealth.nhs.uk/

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Facts and Figures (May 11 2009)Choose and Book: Over 15 million (15,072,205) bookings have been made to date. Choose and Book has achieved over 33,000 bookings in a single day.

Electronic Prescription Service (EPS)Over 190 million (190,185,502) prescription messages have now been transmitted

electronically. 7,950 GP practices have had technical upgrades to the new system. 6,499 of these

practices are actively operating the Electronic Prescription Service (EPS). 2,644,857 prescriptions messages were transmitted first week of May.

GP2GP has now been used for 569,215 medical record transfers. 5,106 GP practices are now actively operating GP2GP.

N3: N3 is one of the largest Virtual Private Networks (VPN) in the world, with 1.2 million employees having access.

PACS: There are 127 Picture Archiving and Communications System (PACS) from NHS Connecting for Health now live across England.

NHS Care Records Service258,488 Summary Care Records have now been uploaded to the Spine.

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Data Standards and Products Mission

To develop, maintain and support a comprehensive range of clinically-related data standards that effectively support healthcare within the NHS in an integrated and holistic manner, facilitating the delivery of a full longitudinal healthcare record for patients that can support a diverse set of secondary uses.

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The problem we have today is …

http://en.wikipedia.org/wiki/Image:Confusion_of_Tongues.png

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Bad habits make for poor interoperability

http://en.wikipedia.org/wiki/File:Zwei_zigaretten.jpgPermission is granted to copy, distribute and/or modify this document under the terms of the GNU Free Documentation License , Version 1.2 or any later version published by the Free Software Foundation; with no Invariant Sections, no Front-Cover Texts, and no Back-Cover Texts. A copy of the license is included in the section entitled "GNU Free Documentation License".

Smoking Definition 1:Heavy Smoker > 20 cigarettes per day

Smoking Definition 2:Heavy Smoker > 15 cigarettes per day

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Which standards do you prefer?

Released under the Creative Commons Attribution 2.0 license by itsphotographer, José M Macías.http://en.wikipedia.org/wiki/File:Meccano_locomotive.jpg

This file is licensed under Creative Commons Attribution ShareAlike 2.0http://en.wikipedia.org/wiki/File:Lego_train_layout_at_National_Train_Show_2005.JPG

Meccano?

Lego?

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Services transfer data

from the Wikimedia Commons

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Standards make things work

ISO 6346 is an international standard managed by the International Container Bureau (BIC) for coding, identification and marking of shipping containers used within intermodal freight transport as part of containerization. It establishes:an identification system with:

an owner code, commonly known as BIC codean equipment category identifier a serial number a check digita size and type code a country code operational marks

http://en.wikipedia.org/wiki/ISO_6346

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The container standard is rigorous and detailed

TANK CONTAINER20T6

TANK CONTAINER20T5

TANK CONTAINER20T4

TANK CONTAINER20T3TANK CONTAINER20TD

FLAT (FIXED ENDS)20P1FLAT (FIXED ENDS)20PF

INSULATED CONTAINER

20H0INSULATED CONTAINER

20HR

GENERAL PURPOSE CONT.

20G1

GENERAL PURPOSE CONT.

20G0GENERAL PURPOSE CONT.

20GP

DescriptionCodeDescriptionCode

ISO Size TypeISO Type Group

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Making services work

Rigorous data standards• Terminology

• Classifications• Data elements

• Data modelsLimited overlaps between standards

Standardised content as well as structureHarmonised standards

Linking products (e.g. cross maps)

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Operational System

Operational Standard

Data Models

Data Elements

User Interface

Terminology Classifications

Standards RequirementFundamental Standards

Clinical Practice

User Interface

Services / Messages

Architecture for data standards

Professional Standards

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Standards

Professional Standards• Agreed, authoritative, professional practice

standardsOperational Standards

• Agreed, authoritative data standards that directly support implementation of operational systems

Fundamental Standards

• Agreed, authoritative components out of which operational standards are constructed

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Professional Standards

Generic medical recordkeeping standardsThis document sets the standards for general medical

note-keeping by physicians in hospital practice. These standards (see overleaf) have been developed by the Health Informatics Unit (HIU), which is part of the Clinical Standards Department of the Royal College of Physicians (RCP), London and were supported by NHS Connecting for Health.

Purpose of the standardsThe purpose of these standards is to:

• maximise patient safety and quality of care• support professional best practice• assist compliance with Information Governance

and NHS Litigation Authority (CNST) Standards.http://www.rcplondon.ac.uk/clinical-standards/hiu/Pages/Health-Informatics-Unit.aspx

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Operational Standards

Secondary Use DatasetsSpine Messaging (HL7 V3 and CDA)

• Demographics• E-Prescribing

• Summary Care Record• Discharge

• Emergency DepartmentPatient Banner on User Interface

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Fundamental Standards

SNOMED CT (Clinical Terminology)ICD10 (Disease Classification)

Cross Maps (e.g. SNOMED CT to ICD10)Data Dictionary – data element definitions

Archetypes or Data ModelsPrescribing User Interface

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Content is King

A standard structure is important, but …

You need standard content to make it worthwhile

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SNOMED CT as a fundamental standard

SNOMED CT is a rich terminologyIt has a high number of concepts

It has an international organisation that manages structure and content

The UK Terminology Centre localises and contributes to the international edition

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386,965Core

194,154Drug Extension

38,938UK Extension

The Concept totals for April 2009 are:

The number of concepts added to the UK extensions over the period ’07 – present:

13,77211,272Apr 09

11,9483,012Oct 08

15,3133,420Apr 08

7,1011,405Oct 07

5,556908Apr 07

DrugClinicalRelease

(The April 2009 figure includes about 9000 concepts 'demoted' from the core which is why it is out of proportion to the other releases)

Product Release Statistics for SNOMED CT in the UK

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Where is the NHS?

Standardising on SNOMED CTDeveloping a Logical Record Architecture

• Knowledge artefacts • Data models • Terminology bindings• Not terminology neutral• Emphasis on querying

National Spine for England• Demographics• Summary Record• E-prescribing• And more …

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National Agenda

Professional Standards and Authority essentialInternational Standards are vitalInternational Standards need localisationKeep the standards few and comprehensiveHarmonisation is costly, but essentialFocus on the big wins first

• Demographics• Medications• Diagnosis• Allergies• Key Findings

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International Agenda

SDO’s need to collaborateHarmonisation needs to be a priority

• Terminology and Classifications• Terminology and Information Model

There is no comprehensive data model content standard that is populated – we need one

National initiatives need to collaborate and drive the standards agenda

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