Project Rationale Dr Nick Booth

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

Framework for other standards Record architecture Terminology Classification Messaging ENV prENV Read, SNOMED, Drug dictionary HL7

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

Technical Animator