1. HL7 – Thanks a Billion! What’s been achieved with Spine Compliance and our first billion HL7 V3 messages…. Peter Dyke, Head of Industry Liaison NHS Connecting for Health peter.dyke@nhs.net 07834 602768

2. Agenda Quick recap on NHS National Programme for IT Delivery channels: LSP & ESP “Spine Compliance” & “LSP Compliance” How NHS CFH works with ESPs Learning points & looking forward Questions

3. National Programme for IT (NPfIT) £12.7bn programme initiated in 2001 (NHS Annual Budget = £95bn-ish) Provides new services for the NHS in England Choose and Book (CAB) 13,472,739 bookings made (33k per day, c. 50%) Electronic Prescriptions Service (EPS) 168,881,954 prescription messages issued (c 24%) GP2GP records transfer: 5,205 practices live, 475,248 records transferred Summary Care Record live: 240,040 records live on the spine New National Network (N3) >32,000 connections NHSmail almost 400,000 users, 983,142 average messages per day National Care Records Service “Spine” 569,581 smartcard users PACS 127 sites live Local Care Records Services (Local Service Providers – LSP) Data as of 22/2/09

4. Delivering NPfIT Delivered via two main routes (since 2004): Prime Contractors to NHS CFH – National Application Service Providers (NASPs) and Local Service Providers (LSPs) Via Existing Systems Providers (ESPs) with contracts already in place with NHS Trusts, PCTs or other care provider organisations..If a supplier hasn’t built it, a customer can’t use it..

5. NPfIT is delivered to users by LSPs and ESPs ESPs: The fragmented existing systems and supplier base will consolidate in the various market niches. A degree of integration with NPfIT will be required and enabled for these systems (e.g. CAB). A number of systems will cease to be supported within the NHS market ESPs: A number of existing systems will continue in use in the NHS market for a prolonged period or in niche and specialist areas. Users will require that these systems are integrated with NPfIT to the maximum extent possible e.g. GP Systems of Choice (GPSoC) LSP Services are deployed, in some cases incorporating former existing systems as part of their portfolio. 2004 0% 100% of NHS Clinical IT Systems Market ESPs: Care is delivered outside the traditional NHS boundary. Aligned specialist IT system markets exist: Social Care, Independent Sector, Community Pharmacy, Dentistry, Opticians etc. These are serviced by non-LSP suppliers whose integration with NPfIT may be enabled and optimised in support of improved patient care. “Today”

6. “Spine Compliance” “Spine” (NASP - BT) SSB Spine Security Broker PDS Personal Demographics Service PSIS Personal Spine Information Service SUS Secondary Uses Service SDS Spine Directory Service North, Midlands & Eastern (NME) LSP (CSC) London LSP (BT) Southern LSP (TBC) Agfa PACS (NE, E) Lorenzo GE PACS (NWWM) Millennium CRS Philips PACS Millennium CRS GE PACS “Local Service Providers” (LSPs) CAB Choose and Book (NASP - Atos/Cerner) Independent Sector (CAB, SUS, PDS) Existing NHS PAS (CAB, PDS) Community Pharmacy (EPS) GP Systems of Choice (GPSoC) (CAB, EPS, GP2GP, Summary Record) Social Care (PDS, CAF) “Existing System Providers” (66 suppliers, 80 systems, >20,000 sites) Others Urgent Care, Screening, ONS PACS etc 2004 2005 2006 2007+ Transaction Messaging Service (TMS) “Summary Care Record”

7. Spine Compliance vs. “LSP Compliance” NHS Care Records Service Spine CSC LSPBT LSP iSOFT (Lorenzo)Cerner (Millennium) System A System C System B Specialist 1..n System X System Z System Y Specialist or departmental functionality included within core Lorenzo/Millenium clinical application LSP provided specialist or departmental system from other supplier Existing Specialist or departmental system interfacing with LSP solution Direct spine connection for certain ESP systems System G “Spine Compliance” “LSP Compliance” Specialist 1..n

8. How we progresses work with ESPs.. NHS CFH Programme teams drive delivery TrustsPCTs Users Benefit.. Existing System Providers (ESPs) GPsLSPs Non-NHS ESPs deliver new services to one to 000’s of customer sites..or don’t.. EPSPACSCABGPSCR NHS Connecting for Health Choose and Book Picture Archiving Electronic Prescriptions Systems Of Choice SCPEA Social Care PDS Early Adopters PDS PDS Birth Notifications NHS CFH ESP team work with ESPs Deployment Live Service Design, Build, Test Define Requirements “Common Assurance Process” (CAP) Summary Care Record SUS Secondary Uses Service

9. Described in “Compliance Baseline Index” in “FileCM” PDS = Document NPFIT-FNT-TO-TIN-1023 (EXT PDS Folder) IG = Document NPFIT-FNT-TO-TIN-1031 (EXT IG Folder) Being “Spine Compliant” 1. PDS/IG “Foundation” Compliance Basic Connectivity (N3) Install link to NPfIT services, configure firewalls/routers to access Spine Patient Demographics Service (PDS) Access/Update “PDS Compliance” Ability for system & individual to access/update patient demographics – validate against NHS Number Ability to interact with TMS via EBXML/HL7V3/MIM with Spine Transaction Messaging (TMS) Access Control Framework (SDS, SSB) “IG Compliance” Ability for system, site and individual in their role to authenticate against and access the spine.

10. Being “Spine Compliant” (2) 2. Current Functionality PDS/IG Compliance (PDS = NPFIT-FNT-TO-TIN-1023, IG = NPFIT-FNT-TO-TIN-1031) Choose and Book (CAB) NPFIT-FNT-TO-TIN-1032 Electronic Prescriptions NPFIT-FNT-TO-TIN-1050 GP2GP Transfer NPFIT-FNT-TO-TIN-0402 Summary Record NPFIT-FNT-TO-TIN-0830 GP System Choose and Book (CAB) NPFIT-FNT-TO-TIN-1032 NHS Acute/ Community/ Mental Health or ISTC EPR/PAS Electronic Prescriptions NPFIT-FNT-TO-TIN-1050 Community Pharmacy Summary Record NPFIT-FNT-TO-TIN-0830 Urgent Care

11. Being “Spine Compliant” (3) 3. In pilot.. PACS Cluster Store Common Assessment Framework Birth Notifications PACSSocial Care Birth Notifications Pathology, Telehealth etc Note: Dotted line boxes indicate detailed Compliance Baseline is draft or not published PDS/IG Compliance (PDS = NPFIT-FNT-TO-TIN-1023, IG = NPFIT-FNT-TO-TIN-1031) Others

12. Learning Points Interoperability is achievable at scale Needs market-wide configuration control Mind the (vast) knowledge gaps Attend to basic governance structures Communication skills Foster a culture of mutual respect Understanding that LSP and ESP is “OK” Align supplier motivation & commercials End user engagement

13. Future Opportunities Even greater scale (double) Even greater clinical complexity Taking cost out across the value chain Users taking greater ownership Product Portfolio Discipline Education, Education, Education

14. HL7 – Thanks a Billion! Questions? Peter Dyke, Head of Industry Liaison NHS Connecting for Health peter.dyke@nhs.net 07834 602768