1. PREPARED BY Connected Care Standard for transfer of care and shared care applications Alastair_Kenworthy@moh.govt.nz 7 November 2012

2. Connected Care Standard … … An unexpected(-ly long) journey!  2010 Midland ‘core clinical dataset’  GP2GP  HISO 10040 HIEs  HISO 10041 – 2013 Q1/2 2

3. Reference Architecture for Interoperability SAG review Vendor review 3

4. Requisite standards for 2014 4

5. The unstoppable march of CDA RSD (HISO 10011) and ePharms (10030) based on HL7 version 2.4 Counties Manukau & Taranaki pilot PDF + v2 transport for eDS Hutt Valley, Auckland and Canterbury referral solutions implement RSD, but in different ways … GP2GP goes live with CDA + v2 transport Counties eDS solution moves to CDA + v2 transport NZePS built on CDA and SOAP web services interRAI reports built on CDA and SOAP web services 5

6. CDA solar system 6

7. The changing world view 7

8. Right side up architecture PMS local environment HIE (outside world) Forms service interfaces are – CDA enabled both sides XDS enabled on one side Forms service interfaces are – CDA enabled both sides XDS enabled on one side 8

9. 9 Connected Care Standard (HISO 10041) 10041.1 Referral Request 10041.2 Shared Health Summary 10041.3 Medications List 10041.4 Discharge Summary 10041.5 Health Event Summary 10041.6 GP2GP 10041.7 Ambulance ePRF 10043 CDA Common Templates (+ code sets) 10047 Comprehensive Clinical Assessment (interRAI)

10. Development timetable Release for consultationSpecifications February 2013Discharge Summary CDA Common Templates Common Code Sets March 2013Shared Health Summary May 2013Referral Request 10

11. ‘… a core set of personal health information …’ Required for 2014OK if beyond 2014 Demographics Alerts and allergies Immunisations Encounters (admissions) Medications (discharge) Problems (conditions) Test results Appointments Enrolments Healthcare providers Support people Screening results Encounters of all kinds Medications (My List of Meds) Lifestyle risk factors Vitals (eg BMI) Advance directives 11

12. From: Bob Dolin Sent: Tuesday, November 29, 2011 12:55 PM To: Rishel,Wes; Pratt, Douglas (H USA); robert worden; Structured Documents WG Subject: RE: CDA or greenCDA Hi Wes, What is CCDA? Thanks, Bob 12

13. Consolidated CDA 13

14. Origins of CCDA 10040.3 GP2GP 10040.2 10041 14

15. Makeup of CCDA 15

16. CDA templates 16 A process of design by constraint CDA clinical statements expressed within a fixed XML schema CDA templates refine the basic model –  Reflecting business rules  Limiting unnecessary choices (optionality, code sets) Often expressed as conformance statements – thou shalt … Usually implemented as Schematron rules

17. How NeHTA does templates NeHTA specifications include (per eDS etc) – 1.openEHR Archetypes (content model) 2.Core Information Components (data requirements) 3.Structured Documents Template (abstract document model) 4.CDA Implementation Guide (templates) 17

18. 18 Our killer application Having a SNOMED CT coded eDS would be like Xmas to GPs Global general practice reference set has ~3500 concepts (July 2013) Locally, all clinical systems SNOMED enabled from x date – 2015? Typical ED reference set (NeHTA’s) comprises –  Reason for presenting (71 concepts)  Findings in presenting problem (222 concepts)  Diagnosis in presenting problem (244 concepts)

19. 19 Inside SNOMED Concepts each have one fully specified name and any number of preferred terms and synonyms Based on description logic alllowing reasoning about concepts and relationships Topology is ‘small world’ and ‘scale free’ (easily navigated and organic growth)

20. Problem 1: Makeup of our CDA document types SectioneDSSHSHESeRef Alerts and allergies Immunisations Encounters Medications list Problems list Test results Appointments Enrolments Healthcare providers Support people 20

21. Problem 2: Adverse reactions dataset 21

22. Problem 3: Care plans dataset 22