Interoperability in Urgent and Emergency Care
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Brief overview of the things that have been achieved in the UK NHS Urgent and Emergency Care System. The challenges ahead, the approach we need to take.
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Interoperability in Urgent and Emergency Care
- 1. Tony Yates Digital SME NHS England Interoperability
- 2. High Level Architecture 111 Triage System Pathways DOS OOH Services 999 Services PDS SCR GP Surgery Clinical Dashboards A&E, MIU, Other Spine Mini Service CDA OOH Interaction CDA GP Interaction GP Interaction CDA GP Dashboard Interaction CDA A&E Interaction HL7 V3 Dispatch Request Repeat Caller Service National Systems CDA RCS Interactions CheckCapacitySummary/ getServiceDetailsById Full Trace SimpleTrace ReadOnlyQuery ODS CSV Practice Import CDA OOH Interaction
- 3. Over 3 million ambulances have been dispatched electronically
- 4. Over have been sent electronically 10 million OOH messages
- 5. Most has been sent electronically GP correspondence
- 6. All calls right from the beginning traced against PDS
- 7. There is more to do!
- 8. MUCH MORE!
- 10. Interoperability Source: https://en.wikipedia.org/wiki/Conceptual_interoperability • Not to be seen as just a “techie” concept • Its about how we get • To achieve this, need to think on how we “deliver this in the service” • Professional buy-in and prioritisation • Improving patient experience • System/vendor functionality • Levers and incentives • Aligning with the wider NIB Interoperability strategy on enabling information sharing through open interfaces the pertinent information to the professional at the point of care where it adds value
- 11. Supporting the maturity of the estate Source: https://en.wikipedia.org/wiki/Conceptual_interoperability Structured APIs using strategic terminology (SNOMED and dm+d) • View information Structured APIs with existing coded information HTML View • Automated prompting and alerting in all cases • Automated clinical decision- support • Consolidate information • Pertinent information displayed Sending System Receiving System Sending systems moving up the maturity of information sharing -> means that systems using this information can still move at different speeds without constraining innovation Structured APIs using strategic terminology (SNOMED and dm+d) Structured APIs with existing coded information HTML View
- 12. Interoperability Layers Level 1 •Technical Interoperability, means we have a way of electronic communication •e.g. sms, messenger, skype etc. Level 2 •Syntactic Interoperability, common data structures are in place •e.g. Email, Twitter API, Facebook etc. Level 3 • Semantic Interoperability, the meaning of the data is shared • e.g. Flight bookings, banking transactions etc. Source: https://en.wikipedia.org/wiki/Conceptual_interoperability
- 13. Same at both sides? Not always! Source: https://en.wikipedia.org/wiki/Conceptual_interoperability Senders •Semantic Senders (almost) •Ensure we send the right thing •Check the structure & •Check the conformance Receivers • Syntactic Receivers • Check the structure (CDA) • Accept or reject • Upgrades are value driven when they are needed
- 14. The Requirements • Sort out the PEM • Access to Records • Support clinical hub workflow across a range of skills • Open up repeat caller to 999, OOH, Clinical Hubs • Provide semantic codes flagged on SCR • Make the DOS API more flexible • Support other clinical content sets in ITK • Enable 999 to send into 111 • NHS Number Tagging • Inter Clinical Hub transfers • Endpoint registry not dependent on the DOS • OOH Ambulance Dispatch • Booking In Hours, Out of Hours, Out of Area
- 15. Interoperability Source: https://en.wikipedia.org/wiki/Conceptual_interoperability Thinking about what this means for the patient
- 19. It’s not always about standards
- 20. How do we do this?
- 21. Together!
Editor's Notes
- Say Thanks Not about boxes
- Which is a minimum of 2 minutes quicker than any other solution before. On an 8 minute ambulance request, those minutes are vital
- With synchronous acknowledgements, giving patients the instant peace of mind they will be contacted or have an appointment
- When either referred to Primary Care or For Information Signal to Noise ratio needs addressing and the quality of the messaging, this shows how fundamental it is to understand needs not just the outputs we can generate
- We know that taking demographics is a slow process, and think it’s something we can help address Enabling Access to SCR to be a much easier challenge
- We haven’t cracked booking nationally yet Or out of area dispatch
- Before we talk about the what, lets ensure we all understand interoperability
- Explain how we have extended the range of capabilities London SPN sharing for example
- Explain that Level 3 isn’t always what we want or need. Level 3 is expensive and takes a long time.
- Explain how we have extended the range of capabilities London SPN sharing for example
- These are good solutions, but we need to understand the problems we are trying to solve with them
- Patient Journey Mapping
- Patients!!! Workforce!!!! how is it going to work when the technology fails, gives great insights into what adds the most value to the people using the system. Things we learned by doing it with 999 in the early initial 111 pilots: Primary Reason for call Scene Safe Police Required Update Messages Call Closed The worst thing you can do is sit in a room trying to design this without observing users.
- Real insights can be gained. Give some examples.
- That’s when true transformation can happen. It doesn’t mean we can’t have ideas, but we haven’t made it easy for the people using the technology to service patients. PRC DEMOGRAPHICS PDS SCR SPN EOL Triage DOS
- Start with the early implementers Observe patients, users and their workarounds Build a shared national picture not a central national picture