6th HL7 International Affiliates Conference Taiwan
HL7 UK and NHS IT Integration Strategies
Philip Firth
IM&T Strategy Implementation ManagerWrightington, Wigan & Leigh NHS Trust
HL7 UK
• HL7 UK membership growing steadily
Organisation Personal BenefactorTotal
• 2003 62 77 6 145• 2004 97 109 10 213• 2005 91 118 9 218
• Adoption of HL7 as the messaging standard for the NHS National Programme for IT has been a major catalyst for growth
HL7 UK – Services to members
• Web services– Access to important information – eg. NPfIT MIM– Communication
• Training opportunities – HL7v3 etc
• HL7v3 Primer: approximately 2300 sold
• Technical Committee - regular 2 day meetings throughout the year (free to members)
• NHS Implementer conferences (free to NHS)
• HL7UK annual conference (next November 2-3)
HL7 UK Repository
HL7 UK Website Repository
An important source of information, particularly the NPfIT Message Implementation Manual (MIM)
What is going on in the UK?
• NHS Connecting for Health (England only)
– National Programme for IT in the NHS
• Mandated to build an information infrastructure to improve patient care
in England
• Covers all NHS organisations in England
– >100K doctors, >380K nurses, 50 million patients
• Represents an investment of £2.3billion (US$ 3.8billion) over the first
3 years, with further funding to end of 10 years >£6billion
NPfIT Key Targets
• NHS Care Records Service (NCRS)– Every patient's medical and care records will be held
electronically and will eventually be available securely online.
• Choose and Book (electronic booking of hospital appointments)
• GP2GP
• Electronic Transmission of Prescriptions (ETP)
• New National Network (N3)
• Picture Archiving and Communications Systems
How NCRS will work• A summary of care and clinical history will be held on a
national database (the ‘Spine’) to ensure that important patient information is always accessible.
• More in-depth details will be held locally where most care is delivered. – records of conditions, medication, operations, tests, X-rays, scans
and other results
• Links to local information will be available from the summary record
• Key clinical information will also still be stored on Existing
IT Systems – a major integration challenge for the NHS
• HL7v3 being used predominantly for integration with the Spine and other National Applications, eg. eBooking, ETP, GP2GP
• NPfIT is using HL7v3 foundations, and contributing to the development of domain models
• NHS V3 message specifications contained in the Message Implementation Manual (MIM)
• MIM available to HL7UK members via website
• HL7 v2.x for integration with existing systems
NPfIT – the role of HL7
GP2GP
• GP2GP a very early V3 adopter
• NHS sponsored / supplier supported
• use RIM / Datatypes / Tools and model EHR structure
• feedback into CDA and clinical statement
Primary CareLSP / Existing
Choose & Book
Slots (provide and fill)Referral
OOH Encounter **
NHSDEncounter **
Scope of Clinical Messaging in Phase 1
Any Spine / NCRSAccredited
System
Spine Query
Secondary CareLSP / Existing
PoCDischarge Report
(Inpatients)or
PoCCare Event
Report(Out Patients)
PoC Disch or Care Event Report
ETP
Pharmacy
PrescribeCancel
Full / PartialDispense
Spine
Medication Updates
SAP
SAP Encounter(PoC Care
Event Report)
GP2GP
DiagnosticImaging
DIReport
DI Report
DIEncounter
DI Requestor
Care EventReport
(Primary Care)
PoC
Emergency Admission Notification **
A&EA&E Report **
Mental Health
AdmDisch
CPA Summary
Adm / Disch /CPA SummaryNotifications
NOTE: Flows marked with ** are also sent to Spine but not shown on this diagram for ease of reading
Wigan - Background
• IM&T Strategy– Best of Breed– Keep departmental systems that work– Build EPR using web development and systems
integration
• Development 3 yrs down the line …
• Lots of HL7 v2 interfaces
• Project in place to send discharge letters to GPs using HL7 v3
Wigan – Local issues
• Data quality – a huge issue for the NHS
• Consistent person referencing – NHS Number, but not all systems/people use it– Patients rarely know their own NHS Number
• Poor IT literacy skills (major contributor to poor data)
• Poor IT Infrastructure
• Availability of funding– Local funding scarce – major NHS cost pressures– Just got £100K+ funding to develop a integration
platform for linking existing systems with CfH
• Time– Lots to do in a limited timescale
• Resources– Recruitment and retention is a major issue– Skills needed are in short supply (.NET, XML, SQL etc)– NHS wages cannot compete with private sector
Wigan – Local issues
• CfH is stepping into gear, – Wigan: Theatres 2006, new PAS 2007 …
• Replacement of NHS IT systems will not happen overnight in Acute Hospital Trusts
• Key existing departmental systems may not be replaced before 2010
• Existing Systems integration is therefore a key issue for Acute Hospital Trusts – which has breathed new life into HL7v2
Wigan – Getting ready for CfH
Bridging the gap between local and national applications
HL7v2 to link existing systems to CfH applications
HL7v3 for systems interoperability for national applications and the Spine