Systems Integration in an NHS Hospital Trust using HL7 V2 and XML Andrew Sergeant ICT Development Manager Island and Portsmouth Health ICT Service (IPHIS)

Introduction IPHIS provides ICT services to : Portsmouth Hospitals NHS Trust Portsmouth City PCT Hampshire PCT Hampshire Partnership Trust Approx 96 GP Practices In total nearly 10,000 users.

Portsmouth Hospitals NHS Trust One of the largest Acute Trusts in England serving 1 million people in SE Hampshire, Isle of Wight and the Channel islands.

Current Projects EPR and CHR (South Central SHA EPR System) Multiple system interfacing projects (e.g. PAS ADT to Renal, Pathology to EPR) Electronic forms and electronic workflow Clinical correspondence system EDM Business Intelligence New Intranet, Extranet, WWW site Virtualisation (including storage and application)

Integration Issues More than 41 existing interfaces between systems Interfaces written using different technologies Lack of skilled staff to maintain existing interfaces and write new ones Inability to meet new challenges posed by national objectives, e.g. CRS

Solution Adopt a new Integration Engine Specify new standards and adhere to them rigorously Use object oriented principles to encourage code re- use Simplify interface development Train developers to support one and not multiple technologies Solution must be flexible and adaptable to meet new requirements as many uncertainties, e.g. CRS Needs to be feature rich Must be affordable!

BizTalk Server 2006 Chosen as Trust Integration Engine : Supports current Microsoft skills in development team XML based HL7 Accelerator for creation of HL7 2.x messages Other BPM features supported (e.g. RFID Manager in 2006 R2 and 2008 releases).

BizTalk Overview

Orchestration Designer

BAM & Rule Engine

BAM Reporting & KPIs

Challenges Document existing interfaces Develop standard methods of implementing message exchange between systems (orchestrations) Other coding standards (e.g. common exception handling for error messages) Upgrading to latest releases of software (currently a 2 year cycle) Uncertainties, e.g. CRS revised timetable (therefore PAS Gap analysis delayed).

POC Interface Blood Gas Analyser – Department of Critical Care to Trust EPR and CIS systems. HL7 to HL7 (2 different versions of HL7 v2) HL7 to XML (EPR) via Web Service

Outcome Rapid development within timescales Minor issues regarding deployment and support Further interfaces commissioned

New Interfaces IoW PAS to Fujitsu CRIS PAS to EDM PAS ADT to Renal (Proton) In all of the above cases SQL Server database to XML to HL7 V2.x

Issues Developer Training and support Initial development work outsourced Disaster recovery (DR) Cost of upgrade as licensing costs have changed (BizTalk Server cost has essentially doubled since we bought our licences!)

Future CRS Issues New interface development Support for new technologies, e.g. RFID and mobility solutions (e.g. alerts) Workflow and BI support.

Technical Challenges Developer Training, recruitment and retention Upgrade path to support new releases A large number of legacy interfaces to migrate (approximately 41) Many other projects competing for resource, e.g. EDM, Web Technologies, eForms and workflow.

Conclusions Integration issues typical for an NHS Acute Trust Slow, but gradual move to a new standard (Gartner estimate major BPM initiatives can take up to 10 years to implement!) CRS and other Connecting for Health initiatives are a moving target Support for XML Web Services useful for maintaining future flexibility.

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