The Complexity of Healthcare Communication Charlie McCay Ramsey Systems Ltd

Introduction – Charlie McCay Developed clinical systems for 10 years NHS national initiatives Design work for GP2GP, ETP and others Standards conformance CFH Logical Record Architecture Interoperability for English Retinal Screening Program Standards Past Chair of HL7UK and of HL7 XML work group Chair of HL7 International Technical Steering Committee Board member of HL7 International

Developed clinical systems for 10 years

NHS national initiatives

Design work for GP2GP, ETP and others

Standards conformance CFH Logical Record Architecture

Interoperability for English Retinal Screening Program

Standards

Past Chair of HL7UK and of HL7 XML work group

Chair of HL7 International Technical Steering Committee

Board member of HL7 International

Interoperability is not everything

However… More information is in an electronic form Healthcare is more distributed Community, clinics, etc Related activity in many organisations NHS organisational change continues Healthcare is more regulated Information is needed to design and implement policy, as well as to deliver care Increased demand for information reuse

More information is in an electronic form

Healthcare is more distributed

Community, clinics, etc

Related activity in many organisations

NHS organisational change continues

Healthcare is more regulated

Information is needed to design and implement policy, as well as to deliver care

Increased demand for information reuse

GP2GP – an example GPs were given computers to type scripts They evolved to be useful for medical records Evolution happened with competing suppliers 10% of patients move practice every year, and their records need to follow them. Manual transcription is expensive and error prone. A standard was needed

GPs were given computers to type scripts

They evolved to be useful for medical records

Evolution happened with competing suppliers

10% of patients move practice every year, and their records need to follow them. Manual transcription is expensive and error prone.

A standard was needed

Why Healthcare Information Standards? To reduce cost and risk when sharing data Interfaces need to be specified Explicit use of a standard Plagiarised use of a standard To support a market for information tools Record browsers and editors Decision support and clinical audit Improve application design To avoid diversity that does not add value Maintaining many interfaces is expensive, risky, and brittle for suppliers and users

To reduce cost and risk when sharing data

Interfaces need to be specified

Explicit use of a standard

Plagiarised use of a standard

To support a market for information tools

Record browsers and editors

Decision support and clinical audit

Improve application design

To avoid diversity that does not add value

Maintaining many interfaces is expensive, risky, and brittle for suppliers and users

Standards and commodities Evolving Proprietary Systems Developed in response to customer and market demand Information structures locked into supplier – information silos Needs a fluid marketplace (many products and purchasers) Proprietary systems built to specification Expensive to sell, build and maintain Specification needs to be good Buyer determines what is needed Standards based solutions Constrained by available standards Tracking the standards can be costly (development and testing) Modular solutions Standards based interfaces Evolving proprietary approach internally

Evolving Proprietary Systems

Developed in response to customer and market demand

Information structures locked into supplier – information silos

Needs a fluid marketplace (many products and purchasers)

Proprietary systems built to specification

Expensive to sell, build and maintain

Specification needs to be good

Buyer determines what is needed

Standards based solutions

Constrained by available standards

Tracking the standards can be costly (development and testing)

Modular solutions

Standards based interfaces

Evolving proprietary approach internally

Types of standard Enterprise Architecture Framework HL7 SAEAF Structural Framework Standards HL7 RIM, CDA, Clinical Statement EN 13606 Terminology and classifications Snomed, Read, ICD, … Domain Specific Standards and Profiles HL7 Domains, CCD, IHE PCC, NHS CFH MIM, … Kettering Discharge, PMIP, …

Enterprise Architecture Framework

HL7 SAEAF

Structural Framework Standards

HL7 RIM, CDA, Clinical Statement

EN 13606

Terminology and classifications

Snomed, Read, ICD, …

Domain Specific Standards and Profiles

HL7 Domains, CCD, IHE PCC, NHS CFH MIM, …

Kettering Discharge, PMIP, …

HL7 and HL7UK Products Suite of HL7 standards for messaging, services, documents, decision support, process Projects Developing standards and profiles Workgroups Open communities of expertise National Affiliates -- HL7UK Community of interest in the UK Technical Meetings, road shows, conference

Products

Suite of HL7 standards for messaging, services, documents, decision support, process

Projects

Developing standards and profiles

Workgroups

Open communities of expertise

National Affiliates -- HL7UK

Community of interest in the UK

Technical Meetings, road shows, conference

Suggested simplifying tactics Don’t break what works Clear business case for interoperability Anticipate then measure the benefits Evolving process in Architectural Framework Many small projects with concrete deliverables Avoid diversity that does not add value Less “not invented here”, plan to converge Be aware of existing solutions (standards) Be aware of the costs of diversity Be pragmatic – look for commodities: “ what can be done?” as well as “what do we want?”

Don’t break what works

Clear business case for interoperability

Anticipate then measure the benefits

Evolving process in Architectural Framework

Many small projects with concrete deliverables

Avoid diversity that does not add value

Less “not invented here”, plan to converge

Be aware of existing solutions (standards)

Be aware of the costs of diversity

Be pragmatic – look for commodities:

“ what can be done?” as well as “what do we want?”