Terminology ServiceNHS Connecting for Health

Roger Tackley

Working Group Meeting May 2005

IMS responsibilities• NHS Terminology Service (Read, SNOMED CT)• Healthcare Resource Group (HRG) service• Classifications (ICD10, OPCS4) service• National Intervention Classification (NIC) ….??• NHS Data Dictionary service• Clinical Datasets Development• NHS Organisation Codes Service• Information Governance toolkit• NHSnet security, access, and audit services

NHS Terminology Service– development of new concepts/terms– creation of clinical subsets– changes– error correction– cross mapping to classifications– cross mapping to NHS data dictionary– cross mapping to Clinical datasets– cross mapping to HL7 items– distribution– education– support.

Terminology Service

Provides:• Terminology Update and Distribution service -

TRUDAffects• Personal Spine Information Service - PSIS• Secondary Uses Service - SUS• Personal Demographic Service – PDS• Electronic Transfer of Prescriptions - ETP• Choose & Book

Common Solution ProgrammeTerminology Group

• To review the disconnect between clinical BPPDG work and the TS

• Meets monthly• SNOMEDCT CDROM• DOS ….?• New website being developed by NCFH TS for

registering subsets etc

SecondaryUses

Service

Transaction &Messaging Service

ElectronicBookingService

PersonDemographics

Service

PersonalSpine

InformationService

HL

7v3

Social CarePrimary /

CommunityMental Health Acute Care Pathology Ambulance

Simplified Conceptual Architecture

Event Engine

Workflow/Rules

OtherNationalServices

Transaction Management, Validation and Routing

The DataSpine

NationalServicesBroker

LocalApplication

LocalApplication

Event Engine

CoreNationalServicesE- Booking/

ETP

Transaction and Messaging Spine

Integration Layer

Non-secure domainNon-secure domainNon-secure domain-Network Infrastructure

Workflow& Rules

OtherNationalServices

Transaction Management, Validation and Routing

NationalServicesBroker

LocalApplication

LocalApplications

NHS local applications

LocalApplication

Event Engine

LocalApplication

Event Engine

LocalApplication

Event EngineIntegration Layer

Other participantsPatient Centric Systems

TracingPersonal

DemographicsService

SecuritySecurityPointers to

PatientInformation

CoreNationalServices

‘Local’Domains‘Local’

Domains

PersonalSpine

InformationServices

Browser basedaccess

Browser basedaccess

E- Booking/ETP

Transaction and Messaging Spine

SecondaryUses

HealthSpace

LocalApplications

The Spine – clinical events through time

LSP

Patient info

Broken Leg

Patient visits A&E

Patient info

LSP

Back Pain

Patient visits GP

LSP

Patient info

Chest infection

Patient visits hospital

Spine

The information flow is repeated over time

Clinical Record

Derived classification terms

PSIS SUS

HES PBROther clinical users

Data flows

Coders

Approved chunkClinical info eg discharge summary

PbR- Terminologies & Classifications

Read v2 CT-V3

4 byte 26,000V2 75,000

These will besuperseded

by SNOMED CT

c 260,000

Terms - forOperational use

Classifications - forretrospective use

Groupings - forlater analysis

Healthcare Resource Groups

ICD-10

c. 500

OPCS –will become NIC

SNOMED CT –Terms and Concepts

dm+d

c. 15,000 c. 7,000

c. 400,000 concepts

c. 50,000

Primary careSecondary care

MedicalDevices

Feed for Payment by Results

Currently entered manually

but will be mapped from Terms

Mappings up to

Mappings up to

Questions?

More detail to follow about NWCS, SUS and PBR

……………………

If you want it!

SUS Version 1 – mid 2005

Secure

DataBase

SUS

Online

i Mac

Provider

LegacyProvider

LegacyProvider

Legacy

Commissioner

LegacyCommissioner

LegacyCommissioner

Legacy

EDIFACT

or XML

EDIFACT

or XML

LSP

Instance

Real - time

reporting

NWCS

XML

DTS

TMS

Hospital Provider & PbR Spell

• All CDS data received by NWCS pulled in to SUS PbR and is available for inspection

• Starts by creating hospital provider spell and then excluding in accordance with DH algorithm

PbR Spell0

Episodes In PbR PbR Excluded episodes

Hospital Provider Spell Static definition

Used to define PbR APC Currency - likely to change

Episodes in Hospital Provider Spell

Derivations• Wide range of derivations relating to the dominant spell• Well babies (probably)• Critical care days in qualifying and non-qualifying

episodes• Re-admission flag for 14 day re-admissions

Less than readmit interval

HPS n- Emergency Admission n

HPS = Hospital Provider Spell Readmit interval = 14 days

Less than readmit interval

HPS 3 - Emergency Admission 2

Less than readmit interval

HPS 2- Emergency Admission 1

Initial HOSPITAL PROVIDER SPELL

Architectural Overview SUS

Core Secure DB

(Data warehouse)

DatamartDatamart

DatamartDatamart

Analysis Layer

Presentation Layer Ardentia

Ardentia/Oracle

Oracle Data

Warehouse Builder

Deeply simplified…

Data Management Layer

Models & Messages

Terminology, Classification and Groupings, includingSNOMED, ICD, NIC, HRGs and dm+d

Data Dictionary

Data ModelReference InformationModel

To be rationalised into aSingle underlying model

Clinicaldatasets

Comm-issioningdatasets

Pathologyresults

HL7 v3 Messages

Technical standards (eg XML)Security

NCASP NWCS to GPs to TMS

Language

Model

Messages

Protocols