1. Applications of XML in the NHS Paul Woolman Standards Program Manager ISD

2. Contents XML for: Patient Records Publishing Communications

3. Patient records Store clinical information as XML Structured documents Case notes Discharges Referrals Summary documents Structured data XML data model

4. Information storage XML as the format for authoring and storage of documents Rather than Word.Doc, Rich Text Format, Text Clinical documents Metadata (description of documents) Latest Office applications (MS, SUN, Open)

5. Examples Graphnet CSW Office Anaesthetic records… Next 4 slides…

6. Office applications MS office, Sun, OpenOffice store & use XML documents Infopath forms client Supports web services & XML Build forms from xml schema

7. Replacing Paper Forms pre-op instructions Patient info Case type pre-op assessment post-op instructions lab test results

8. Pasting a Theatre List

9. Client Behaviour XML SAX Writer XSLT Transform (Optional) XML Signature & Encryption SOAP Message XML SAX Handler XSLT Transform (Optional) XML Signature & Encryption SOAP Message server

10. Web Server(IIS) Request Handlers SCI Store Database Objects ASP Pages Browser (IE5.5).Net Frame work Request Handlers Request Handlers Web Service 3 rd Party Application Log Handler

11. Contents XML for: Patient Records Publishing Communications

12. Publishing

13. Document Metadata Data about data…descriptions eg keywords Descriptive headings about documents Useful for filing, searching and cataloguing E-Government metadata standard HL7 Clinical Document Architecture need NHS Scotland standards

14. SHOW & NELH Main NHS portals HTML pages need manual updating XML data storage XML -> HTML in active server pages Advantages: Many views of single data Support clinical networks Support automated query tools

16. NHS Data Dictionary Data definitions on web XML export selected definitions UML models designing XML schema & refer to data definitions. New dictionary to tie all three together

17. Contents XML for: Patient Records Publishing Communications

19. Electronic Data Interchange Moving data from one computer to another Eg Patient referral from GP to hospital Replace older formats eg EDIFACT New forms of EDI with user interaction XML allows Graceful Degradation View messages if required

20. GP records exchange Patient moves house or changes GP Records follow 4+ weeks later Electronic exchange is quicker GPASS early implementations ongoing

21. NHSScotland GPEX GPASS specific message GP exports XML document to PSD PSD send off to new GP & update CHI New GP selectively imports record into new GPASS Currently in early implementation sites

22. Scottish Birth Record Replaced SMR for births Added clinical information Make useful to clinical care Rolled out to all maternity units

23. Concept Single web site in NHSnet Browser input from maternity units Link to PAS’s Link to new maternity systems Reduce data duplication Link to CHI Give baby new CHI number at birth

24. Scottish Child Health Information Development (SCHID) Project Want more information? www.show.scot.nhs.uk/sbr alternatively tel: 0131 551 8046www.show.scot.nhs.uk/sbr Example of Hospital Data-flows Patient ID and demographics Clinical data PAS SBR CHI/UPI Paper Other Child Systems Clinical System INTERNAL EXTERNAL INTERNAL AND EXTERNAL

25. Use of XML CHI link Maternity system Ongoing development

26. Community Health Index (CHI) Mainframe application Green screen terminal input Need machine EDI input & query

27. Concept Casablanca XML to VMS transform application NHS Standard XML Schema Web server HTTPS and XML input to active server pages

28. XML messages Register new patient Find patient Responses

29. SCI integration SCI Store – every health board Labs systems – feed into Store E-Biz 2000 middleware & XML

30. XRay Labs PAS other GPASS practice non-GPASS practice community/ MH system Id XRay Lab1.. xx OK3.2OK3.2 SCI Store OK3.2 community pharmacy Test requests and results reporting To achieve this SCI first has to integrate existing hospital systems and re- assemble the patient’s information in a new system called SCI Store SCI Integration           

31. SCI web services Electronic Transmission of Prescriptions Referrals to outpatients SCI Gateway David Brazier this afternoon

32. E-Care Shared care records between health, social services, education and others Eg Shared Assessments Elderly Mental health children

33. Single Shared Assessments Lots of work on data and definitions Based on paper versions Initiated by any party Involves patient/client and relatives/carers Involves independent sector Eg churches, voluntary orgs.

34. Concept Server in demilitarized zone XML integration to health system XML integration to social work system Browser input

36. E-care store Central data store Multiple identifiers – CHI, Hospital nos., social work numbers XML Web Services for data exchange

37. Virtual EHR portal Pull data from distributed systems Rearrange Present to viewer

38. NHSnet Education?? LA net parent/child + smartcard parent/child + smartcard GP SBR SIRS School SNS NHS systems Internet Integrated Children’s Services Record CH System Social Care

39. HealthCarePersonal Record Name: Alerts: Demographics: Carer: Allergies: GP: Teacher: Health Problems: Social Worker: Child Protection Status: Medications: Section of register: Special Needs Status: Immunisations outstanding:

40. HealthCarePersonal Record Interventions: Health: Social Work: School:

41. HealthCarePersonal Record Name: Who lives with me: Interests: Treatments used outwith health service: Special Information you may want to know about me:

42. ‘Virtual’ EHR Model EPR Acute EPR Commun EPR MH ‘EPR’ GP A&EOoHNHS24 GP Patients XML web views of systemsPortal

43. NHSnet - a fully distributed Data Web End-user client Data Publishers/owners

44. The Semantic NHS Web Web Browser EHR Store Mk 1.x Demographic s Access rights Pointers EHR Gateway SCI Gateway Discharge Local systems e-Care Stores SCI Stores via web services CHI and child health systems r SCI-DC SHOW2 Web service Terminology; Definitions; Schema; Services - NHS Dictionary and Grammar