2. , NPfIT and the International Input into HL7 HL7 UK Annual Conference London Nov. 2nd 2004 NPfIT and the International Input into HL7 HL7 UK Annual Conference London Nov. 2nd 2004 HL7v3 - A standard whose time has come Dr. Tim Jones Enterprise Architect & Design Authority NHS Care Record National Programme for IT

3. Agenda HL7v3 - a standard whose time has come HL7 an International Organisation Real V3 projects around the world Additional areas of UK input How NPfIT is using HL7v3 – Clinical Statements, Care Record Elements, business objects & record architecture Questions HL7v3 - a standard whose time has come HL7 an International Organisation Real V3 projects around the world Additional areas of UK input How NPfIT is using HL7v3 – Clinical Statements, Care Record Elements, business objects & record architecture Questions

4. HL7v3 A Standard whose time has come Where have we come from with v3? – 2001  Initial Draft of HL7v3 – 2002  NPfIT commit to central role of HL7v3 – 2003  First normative Elements of HL7 – 2004  NPfIT Message Implementation manual published  8 th V3 ballot Where have we come from with v3? – 2001  Initial Draft of HL7v3 – 2002  NPfIT commit to central role of HL7v3 – 2003  First normative Elements of HL7 – 2004  NPfIT Message Implementation manual published  8 th V3 ballot

5. HL7 an International Organisation Recent Working Group meeting in Atlanta – V3 coming of age party! – HL7 maturation into truly international organisation  HL7 affiliates in 28 Countries – Tributes paid to the considerable international efforts HL7 Board Advisory Committee – Recognised the need to behave as an truly international organisation Recent Working Group meeting in Atlanta – V3 coming of age party! – HL7 maturation into truly international organisation  HL7 affiliates in 28 Countries – Tributes paid to the considerable international efforts HL7 Board Advisory Committee – Recognised the need to behave as an truly international organisation

6. HL7v3 – It’s here, it’s real! Canada – National e-claims project England – NPfIT Programme Netherlands – Pharmacy, GP Summary, Claims Mexico – Instituto Mexicano del Seguro Social eHR New Zealand – Health Event Summary US – CDC Public Health Information Network – National Cancer Institute Bioinformatics Grid Canada – National e-claims project England – NPfIT Programme Netherlands – Pharmacy, GP Summary, Claims Mexico – Instituto Mexicano del Seguro Social eHR New Zealand – Health Event Summary US – CDC Public Health Information Network – National Cancer Institute Bioinformatics Grid

7. eClaims in Canada Right across Canada – All providers – All payors  Private and Public insurers Domains – Pharmacy – Chiropractic – Physiotherapy – Oral Health – Vision Care – Physicians (planned) Direct interface from practice management systems – Standard centrally provided HL7v3 API Generic claims, pharmacy and preferred accommodation – first messages to pass the HL7 v3 membership ballot Right across Canada – All providers – All payors  Private and Public insurers Domains – Pharmacy – Chiropractic – Physiotherapy – Oral Health – Vision Care – Physicians (planned) Direct interface from practice management systems – Standard centrally provided HL7v3 API Generic claims, pharmacy and preferred accommodation – first messages to pass the HL7 v3 membership ballot

8. NICTIZ in the Netherlands Objectives – Nationwide record of drug dispense information – GP professional summary – Claims and reimbursements Status – Pharmacy  First regions implementing – GP Professional Summary  3 vendor developments – Claims and reimbursements  HL7v3 development work started Objectives – Nationwide record of drug dispense information – GP professional summary – Claims and reimbursements Status – Pharmacy  First regions implementing – GP Professional Summary  3 vendor developments – Claims and reimbursements  HL7v3 development work started

9. IMSS in Mexico Healthcare Enterprise – Serving 60million affiliates of a population of 100 million  1077 out-patient clinics  223 General Hospitals  40 Tertiary referral Centres Phase 1 – Oct 2002 to June 2004 – Lab  Orders and results – Haemodialysis  Entrance, sessions and discharge events – Blood Bank  Observation order and event  Eligibility  Product storage and supply Planned – Out-patients – Transplants – Transfusions Healthcare Enterprise – Serving 60million affiliates of a population of 100 million  1077 out-patient clinics  223 General Hospitals  40 Tertiary referral Centres Phase 1 – Oct 2002 to June 2004 – Lab  Orders and results – Haemodialysis  Entrance, sessions and discharge events – Blood Bank  Observation order and event  Eligibility  Product storage and supply Planned – Out-patients – Transplants – Transfusions

10. New Zealand CDA CDA Pilots – Counties Manukau district Health Board – Lakes District Health Board Health Event Summary – Basis of EHR – Dataset mapped to CDA – Extensive international harmonisation Initial Focuses – Electronic Discharge Summary – Guideline-based referral Driving development of CDA v2 development – in conjunction with Australia CDA Pilots – Counties Manukau district Health Board – Lakes District Health Board Health Event Summary – Basis of EHR – Dataset mapped to CDA – Extensive international harmonisation Initial Focuses – Electronic Discharge Summary – Guideline-based referral Driving development of CDA v2 development – in conjunction with Australia

11. Additional UK Participation NPfIT and HL7 UK active in all relevant SIG and technical committees Highlights: – New Clinical Statement SIG  Continued evolution of standard  Fortnightly conference calls – New TermInfo SIG  Focus on synergistic combined use of SNOMED CT and HL7v3 – Guideline SIG  HDM modelling of guidelines & other related areas – E.g. care pathways input from NHS  Tie in with Patient Care DMIM development – Templates  Substantial UK input from HL7 UK and NPfIT  Being used at design and runtime NPfIT and HL7 UK active in all relevant SIG and technical committees Highlights: – New Clinical Statement SIG  Continued evolution of standard  Fortnightly conference calls – New TermInfo SIG  Focus on synergistic combined use of SNOMED CT and HL7v3 – Guideline SIG  HDM modelling of guidelines & other related areas – E.g. care pathways input from NHS  Tie in with Patient Care DMIM development – Templates  Substantial UK input from HL7 UK and NPfIT  Being used at design and runtime

12. How is the English NHS using v3? Very clinically-focused – Based on the “Clinical Statement” model  allows very expressive representation of clinical language  Tightly coupled with SNOMED CT Clinical Statement Message Pattern – Harmonisation with global HL7 communities:  Patient Care  Structured Documents (CDA)  Orders and Observations Persistent Clinical statements – basis of shared PSIS record as Care Record Elements Very clinically-focused – Based on the “Clinical Statement” model  allows very expressive representation of clinical language  Tightly coupled with SNOMED CT Clinical Statement Message Pattern – Harmonisation with global HL7 communities:  Patient Care  Structured Documents (CDA)  Orders and Observations Persistent Clinical statements – basis of shared PSIS record as Care Record Elements

13. What is a Clinical Statement? "An expression of a discrete item of clinical (or clinically related) information that is recorded because of its relevance to the care of a patient” – i.e. an elemental unit of clinical meaning An HL7 Act with an id whose attribute and relationship “signature” conforms to the Clinical Statement pattern – Including the Acts context and related id-less Acts and inseparable Acts – i.e. a molecular unit of clinical meaning  Therefore potentially recursive and complicated "An expression of a discrete item of clinical (or clinically related) information that is recorded because of its relevance to the care of a patient” – i.e. an elemental unit of clinical meaning An HL7 Act with an id whose attribute and relationship “signature” conforms to the Clinical Statement pattern – Including the Acts context and related id-less Acts and inseparable Acts – i.e. a molecular unit of clinical meaning  Therefore potentially recursive and complicated

14. Clinical Statement Relationships Simple and rich links between Clinical Statements – E.g. fulfilment, causation, outcome Three mechanisms – ActRelationships  XML containment – ActRefs  Pointers – StatementRelationships  Observation of relationship between Acts  More expressive SNOMED CT types  Independent context from source Act Basis of update semantics – Through clinical statement supersession Simple and rich links between Clinical Statements – E.g. fulfilment, causation, outcome Three mechanisms – ActRelationships  XML containment – ActRefs  Pointers – StatementRelationships  Observation of relationship between Acts  More expressive SNOMED CT types  Independent context from source Act Basis of update semantics – Through clinical statement supersession

15. Clinical Statement Message Pattern All messages based on harmonised Clinical Statement Message Pattern Use of templates – “templateId” attribute identifies elements based on more abstract model  Identifies a class in an HL7 Model template (RMIM) to which a class conforms  Permits swifter parsing of message instances – Work underway on Templates as building blocks  E.g. “Super CMETs with interfaces” All messages based on harmonised Clinical Statement Message Pattern Use of templates – “templateId” attribute identifies elements based on more abstract model  Identifies a class in an HL7 Model template (RMIM) to which a class conforms  Permits swifter parsing of message instances – Work underway on Templates as building blocks  E.g. “Super CMETs with interfaces”

16. Care Record Elements A common record structure underlying the NHS Care Record – Care Record Element Types – Care Record Element Relationships Flexible and extensible to facilitate views for: – all potential users – in all integrated care settings – for all types of event A common record structure underlying the NHS Care Record – Care Record Element Types – Care Record Element Relationships Flexible and extensible to facilitate views for: – all potential users – in all integrated care settings – for all types of event

17. Care Record Element Types Personal Demographics Care Events Documents and Correspondence Problems and Issues Diagnoses Findings Social Context Family History Personal Demographics Care Events Documents and Correspondence Problems and Issues Diagnoses Findings Social Context Family History Procedures Medication Record Personal Preferences Care Pathways Goals and Outcomes Risks and Warnings Functioning and Wellbeing Additional Record Locations Procedures Medication Record Personal Preferences Care Pathways Goals and Outcomes Risks and Warnings Functioning and Wellbeing Additional Record Locations

18. NHSCR Record Architecture Fundamental CREs – Basis of the record architecture across the NHS Care Record Two basic modes of access – Data transfer  Standard messaging and all updates – User interactive  e.g. user waiting for results ACRS abstraction layer – Business object based  i.e. useful chunks of clinical information – Facilitates swift access to “current” data – Provides future support of declarative fine-grained query access – Simplified XML return formats for rapid consumption Fundamental CREs – Basis of the record architecture across the NHS Care Record Two basic modes of access – Data transfer  Standard messaging and all updates – User interactive  e.g. user waiting for results ACRS abstraction layer – Business object based  i.e. useful chunks of clinical information – Facilitates swift access to “current” data – Provides future support of declarative fine-grained query access – Simplified XML return formats for rapid consumption

19. Questions