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Connected Care Standard     for transfer of careand shared care applications                   Alastair_Kenworthy@moh.govt...
Connected Care Standard …… An unexpected(-ly long)journey! 2010 Midland ‘core  clinical dataset’ GP2GP HISO 10040 HIEs...
Reference Architecture for Interoperability                                              SAG review                       ...
Requisite standards for 2014                               4
The unstoppable march of CDARSD (HISO 10011) and ePharms (10030) based on HL7 version 2.4Counties Manukau & Taranaki pilot...
CDA solar system                   6
The changing world view                          7
Right side up architecture              PMS local          Forms service interfaces are –           environment           ...
Connected Care Standard (HISO 10041)10041.1 Referral Request10041.2 Shared Health Summary10041.3 Medications List10041.4 D...
Development timetableRelease for consultation   SpecificationsFebruary 2013              Discharge Summary                ...
‘… a core set of personal health information …’Required for 2014             OK if beyond 2014DemographicsAlerts and aller...
From: Bob DolinSent: Tuesday, November 29, 2011 12:55 PMTo: Rishel,Wes; Pratt, Douglas (H USA); robert worden;Structured D...
Consolidated CDA                   13
Origins of CCDA              10040.3                10041                   GP2GP                           10040.2       ...
Makeup of CCDA                 15
CDA templatesA process of design by constraintCDA clinical statements expressed within afixed XML schemaCDA templates refi...
How NeHTA does templatesNeHTA specifications include (per eDS etc) –1.   openEHR Archetypes (content model)2. Core Informa...
Our killer applicationHaving a SNOMED CT coded eDS would be like Xmas to GPsGlobal general practice reference set has ~350...
Inside SNOMED Concepts each have one fully specified name and any number of preferred terms and synonyms Based on descript...
Problem 1: Makeup of our CDA document typesSection                eDS    SHS      HES    eRefAlerts and allergiesImmunisat...
Problem 2: Adverse reactions dataset                                       21
Problem 3: Care plans dataset                                22
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Connected Care Standard for transfer of care and shared care applications

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Alastair Kenworthy
Ministry of Health
(Wednesday, Interoperability Workshop)

Published in: Health & Medicine
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Connected Care Standard for transfer of care and shared care applications

  1. 1. Connected Care Standard for transfer of careand shared care applications Alastair_Kenworthy@moh.govt.nz 7 November 2012 PREPARED BY
  2. 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. 3. Reference Architecture for Interoperability SAG review Vendor review 3
  4. 4. Requisite standards for 2014 4
  5. 5. The unstoppable march of CDARSD (HISO 10011) and ePharms (10030) based on HL7 version 2.4Counties Manukau & Taranaki pilot PDF + v2 transport for eDSHutt Valley, Auckland and Canterbury referral solutions implementRSD, but in different ways …GP2GP goes live with CDA + v2 transportCounties eDS solution moves to CDA + v2 transportNZePS built on CDA and SOAP web servicesinterRAI reports built on CDA and SOAP web services 5
  6. 6. CDA solar system 6
  7. 7. The changing world view 7
  8. 8. Right side up architecture PMS local Forms service interfaces are – environment CDA enabled both sides XDS enabled on one side HIE (outside world) 8
  9. 9. Connected Care Standard (HISO 10041)10041.1 Referral Request10041.2 Shared Health Summary10041.3 Medications List10041.4 Discharge Summary10041.5 Health Event Summary10041.6 GP2GP10041.7 Ambulance ePRF10043 CDA Common Templates (+ code sets)10047 Comprehensive Clinical Assessment (interRAI) 9
  10. 10. Development timetableRelease for consultation SpecificationsFebruary 2013 Discharge Summary CDA Common Templates Common Code SetsMarch 2013 Shared Health SummaryMay 2013 Referral Request 10
  11. 11. ‘… a core set of personal health information …’Required for 2014 OK if beyond 2014DemographicsAlerts and allergiesImmunisations Screening resultsEncounters (admissions) Encounters of all kindsMedications (discharge) Medications (My List of Meds)Problems (conditions) Lifestyle risk factorsTest results Vitals (eg BMI)Appointments Advance directivesEnrolmentsHealthcare providersSupport people 11
  12. 12. From: Bob DolinSent: Tuesday, November 29, 2011 12:55 PMTo: Rishel,Wes; Pratt, Douglas (H USA); robert worden;Structured Documents WGSubject: RE: CDA or greenCDAHi Wes,What is CCDA?Thanks,Bob 12
  13. 13. Consolidated CDA 13
  14. 14. Origins of CCDA 10040.3 10041 GP2GP 10040.2 14
  15. 15. Makeup of CCDA 15
  16. 16. CDA templatesA process of design by constraintCDA clinical statements expressed within afixed XML schemaCDA 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 16
  17. 17. How NeHTA does templatesNeHTA 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 applicationHaving a SNOMED CT coded eDS would be like Xmas to GPsGlobal 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) 18
  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) 19
  20. 20. Problem 1: Makeup of our CDA document typesSection eDS SHS HES eRefAlerts and allergiesImmunisationsEncountersMedications listProblems listTest resultsAppointmentsEnrolmentsHealthcare providersSupport people 20
  21. 21. Problem 2: Adverse reactions dataset 21
  22. 22. Problem 3: Care plans dataset 22
  23. 23. 23

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