Philip Scott Head of IT Projects & Development Portsmouth Hospitals NHS Trust Co-chair, HL7 UK NHS Implementers group HL7 UK Conference – October 2006 When is a standard not a standard? The case for unifying LSP approaches to local interfacing

Why discuss this? There is an opportunity now to mitigate migration/maintenance problems down the line as CRS deployments progress There is an opportunity to win over clinical enthusiasm for “yet another system” If an Enterprise Architecture is being adopted, the “Enterprise” must be complete and not have holes or gaps round the edges Aim: generate discussion not give answers

Topics Are standards a good idea? But we’ve already got standards! But what about …? Are there workable solutions? Questions

Are standards a good idea? Yes “Enable clinical semantic interoperability” Jolly good! Well that’s alright then The end (nearly…)

But we’ve already got standards! Clinical information content: Snomed CT Electronic messaging: HL7 v3 But – what about now?

What about… Existing non-HL7 message flows supporting operational needs PMIP and things hanging off it or disguised inside it Discharge summaries, clinic letters, OOH… “Legacy” system interoperability Information flows outside MIM scope

1 - NASP Interface – HL7 V3 2 - Existing Systems Interface – HL7 2UK (VA.2) 3 & 4 - Departmental Systems Interface – HL7 V2.3/V2.4 CSC Alliance

Fujitsu

BT Have market forces simplified this already?

HL7 v2 alone does not offer semantic consistency (to say the least) When you’ve seen one… [laugh now] “Rampant optionality” Given Benson’s eq.1: Therefore: Information flows outside MIM scope

Other issues of scope: Realm (home countries, Europe, world) Service (NHS, social care, police, YOT, housing, education…) And more immediately for England: Provider type (NHS, private sector, military) LSP region (cross-cluster flows) LSP sub-units (deployment groups ≠ clinical networks, initial “external” visibility = 0)

Information flows outside MIM scope Current approach is pragmatic commercial reality rather than “ruthless standardisation” CSC: UK vA.2, v2.3, v2.4 BT: UK A.2? Fujitsu: v2.3 Which v2.3? Which v2.4? Which UK A.2? Issues: Maintenance: no re-use possible, upgrades complex Risk of varying semantics or data quality workarounds Cross-boundary flows: specialty systems, cancer networks, ISTCs, tertiary referrals, lab to lab

Are there workable solutions? Use IHE profiles Develop HL7 v2.5 UK (?) Change to HL7 v3 (UK?) Develop Logical Models HL7 UK NHS Implementers subgroup favoured some sort of logical model to constrain v2 Certifiable testing (≈ sandpit etc)

And what about…? “Legacy” systems interoperability Needed until children grow up (at least) Eventually true EPR, not for some years Specialty systems will have to co-exist Repositories for unsolicited results will have to co-exist (not to mention EDM) Can we make it easier for clinicians?

Legacy system interoperability HL7 CCOW Few applications have it out of the box Some add-on products offer CCOW-like behaviour/functionality Front-end integration may be easier in some cases than a messaging interface Clinicians will bite your hand off for patient context synchronization

Legacy system interoperability GOSH is procuring a solution via OJEU PHT is currently procuring via Catalist LSPs apparently take varying stances (flavours of No) Is CFH interested…? Could be low-hanging fruit!

Legacy system interoperability

Conclusion There is an opportunity NOW to mitigate migration/maintenance problems down the line as CRS deployments progress There is an opportunity to win over HUGE clinical enthusiasm for “yet another system” If an Enterprise Architecture is being adopted, the “Enterprise” must be COMPLETE and not have holes or gaps round the edges Discuss…