What HL7 Made Possible Ken Smith –

 Senior Integration Specialist – BridgeForward  Integration Specialist – GOSH (formerly)

 Specialty Children’s Hospital  Tertiary Referral  Complex cases (multiple specialties)  Long term cases (seen over long periods of time)  Critical cases  Large international and private patient service

 Establish integrity of patient data across departmental systems  Exchange and make use of clinical information  Automate processing of billable costs for private patient billing

 Patient data has to be kept current across multiple systems  Has to be kept current over time  Updates have to be instantaneous  Updates have to account for different patient populations (NHS and private)

 PAS (iPM from iSOFT) the source of all patient data  PAS not accept patient data from other systems  Drip-feed (publish/subscribe)  Query/response

 Initially, no HL7 messages from PAS  Make do:  Poll extracts tables (simulate drip-feed)  Query of PAS database  Construct non-HL7 messages  Mitigated by few interfaces built at this stage

 Upgrade of PAS  Full set of HL7 messages, drip-feed and query/response  More interfaces, more quickly  Discovered variability in interpretations and requirements of HL7  Placement of NHS ID in drip feed and q/r  Formatting of data  Differences in coded value lists  Confidentiality

 Notification systems  Pathology results notification  Radiology results notification  Patient death notification  2 out of the 3 were failures  Failed to engage the clinicians

 Sharing clinical information much more difficult  Building a clinical application, not an integration  Clinical practices and applications highly localized (specialty and context)  Informatics (analysis) is as or more important than technology  HL7 2.x vs. HL7 3  Clinician involvement necessary (do it for them, not to them)  Greater challenge holds promise of greater rewards

 Recoverable/billable costs:  Pathology tests  Radiology tests  Pharmacy prescriptions  Route from source departments into Private Patient system

 Each department created spreadsheets of costs for each patient for specific time  Naturally, each spreadsheet in different format  Integration engine processed spreadsheets, and shoehorned different column formats into a proprietary, non HL7 message format  It was a pain from start to finish  If only…

 Starts and ends with HL7  HL7 2.x almost universal, but variable  HL7 transport neutral  No use of HL7 3.0  HL7 needs tools  Success with patient data easier to achieve  Goal is not to deliver healthcare IT integrations, but integration solutions that improve delivery of clinical care