NPf IT Interoperability The Role of HL 7

NPf. IT Interoperability The Role of HL 7 v 3 Dr. Tim Jones Enterprise Architect NPf. IT Programme Director Communications and Messaging Programme Manager National Clinical Advisory Board

Agenda • • • NPf. IT objectives Why HL 7 v 3? Development approach Building and equipping the teams Clinical Engagement Collaboration with other groups Engagement with HL 7 UK and Inc. Scope and timescales of work Invitation to become involved

Comms & Messaging Goals • Establish consistent approach to communications & messaging across the NHS – compliant with National Programme Architecture • Deliver messaging specifications in support of NP Delivery Objectives • Develop and iterative refinement of common information models underpinning all NHS developments

Simplified Conceptual Architecture Personal Tracing Demographics Service Workflow/ & Rules E- Booking/ ETP Security Core National Services Pointers to Patient Information National Services Broker Transaction and Messaging Spine Other National Services Transaction Management, Validation and Routing Personal Spine Information Services The Data Spine Health. Space Secondary Uses Network Infrastructure Non-secure domain Integration Layer Event Engine Browser based access Patient Centric Systems Integration Layer Event Engine Local Applications Application Other participants NHS local applications ‘Local’ Domains

Why HL 7 v 3? • Met fundamental requirements: – Can meet the evolving needs of the NHS • Designed to support granular clinical information exchange • Promise of plug and play interoperability – Widespread support • by users, policy makers and suppliers – International open standard • UK and Europe contribution to its development • NHS can take leading role to ensure fitness for purpose • Economies for NHS and its suppliers – Robust approach to development • Model-based • Standard development approach • Established international collaboration and balloting procedures

What needed to be addressed? • Development approach to meet NPf. IT delivery objectives • Trained and equipped standards’ development teams • Clinical involvement throughout • Collaboration with other organisations • Mode of engagement with HL 7

Changes in approach • Move NHS messaging into an international collaborative environment • NHS takes leading role in driving HL 7 v 3 standards development to meet evolving NHS needs • Employ iterative spiral rather than traditional waterfall approach • Change development approach to enable greater collaboration & reuse • Integrate into NPf. IT

Iterative Spiral Process Benefits Review Business Review Roll out Technical Review Requirements Analysis Domain Business Analysis Piloting Domain Modelling Sandpit Testing HL 7 Review Requirements Review Message Development Analysis Review Information Impact Review

CMP Workstreams • Manage overall delivery in a domain – Led by workstream manager • Business analysts in shared core team – Domain experts drawn from all groups – Collaboration through HL 7 processes • Business Analysis Deliverables: – – – Requirements statement Storyboards / scenarios Use Cases Flowcharts / activity diagrams Application roles Logical Data models (where applicable)

Core Technical Team • Produce HL 7 domain models by analysing workstream deliverables • Collaborate through HL 7 processes • Reconcile HL 7 and Data dictionary issues • Generate NHS common object model and mappings • Produce message and document definitions • Produce XML schemas • Produce Implementation Guides • Produce technical and HL 7 ballot documentation

HL 7 Training • In-house custom bootcamp – Series of training sessions a nd hands -on workshops • Joint and separate business and technical • Contributors, national and international • Mentor supported development – Team working on real problems – Supported by experts – Non-critical path activities

Tools support • Require enterprise strength tools to support collaborative development • Worked with international tools developers • Integration of existing tools into common development environment • Distributed repository access • Version and configuration management • MIF integration • Next step – integration of business analysis tools and deliverables

Vocabulary Team • Provide guidance on terminology issues – e. g. SNOMED CT migration • Leads development of terminologies required by messaging – e. g. Radiology bounded set, DMD&D • Help determine appropriate split between terminology and record structures • Represents NHS interests in HL 7 vocabulary workstream and SNOMED CT development

Roles of other teams • HL 7 – UK affiliate of HL 7 Inc. (International) – Provide supplier neutral input into standards development process • NDA Assurance – Ensure that the deliverables produced are fit for their business purpose. • NDA Sandpit – Technical testing of application roles and messages produced by the CM programme • NASP, LSP Implementation Teams – Pilot Interactions in Model Communities – Draw up draft/full ISB submissions – Perform post-implementation review • National Clinical Advisory Board – Provide authoritative clinical perspective: • Ensure that the work of the workstreams is prioritised according to clinical ROI • Highlight clinical issues, including change management, training and professional practice, setting up working groups where necessary • Sign off scope and business analyses

National Clinical Advisory Board • Accountable to: – the Ministerial Task-force and NPf. IT Board • Responsible for: – identifying key clinical interest groups and their concerns – advising all NPf. IT workstreams on clinical needs, priorities and key customers with whom to consult – ensuring clinical concerns are addressed either within the National Programme or by other key players as necessary – anticipating the effects of the implementation of the objectives of the NPf. IT on the clinical staff and their ways of working – keeping the clinical workforce informed about the developments and objectives of NPf. IT – obtaining political and policy support from those clinical staff and organisations with national influence – providing through its chairman (and to some extent its members) a champion for and spokesman on the clinical aspects of NPf. IT

Comms & Messaging Process

NPf. IT engagement with HL 7 UK • NPf. IT is a Benefactor Member of HL 7 UK • NPf. IT regularly participates in HL 7 UK Technical Committee meetings and has a representative on the HL 7 UK Board • HL 7 UK is the main forum for open communications from NPf. IT about messaging plans and specifications – HL 7 UK has a member list server dedicated to NPf. IT-specific communications

Communicating Plans • NPf. IT posts project documentation on the HL 7 UK members website – informing members about planned domains, scopes, and business requirements – inviting informal review and comment

Technical Review and Approval • NPf. IT posts draft message specifications to the HL 7 UK members website – for review and informal comment • NPf. IT intends to – post NHS implementation profiles of HL 7 V 3 for members – propose UK standard localisations of V 3 for HL 7 UK approval

Technical Review and Approval (cont) • First planned HL 7 ballot – e. Booking message suite – first quarter of 2004 • Technical approvals from HL 7 UK will be coordinated with NHS ISB approvals – e. Booking ISB submission for Draft Standard status planned for Spring 2004

NPf. IT and HL 7 International • NPf. IT is a Benefactor member of HL 7, Inc. • NPf. IT has developed message design tools suitable for use by HL 7 members worldwide – will be presented at HL 7’s January meetings in the USA • NPf. IT will be working with HL 7 UK to influence international HL 7 development – through international votes and UK proposals for change • NPf. IT regularly participates in HL 7, Inc. working group meetings

NPf. IT and HL 7 International (cont) • NPf. IT is working with BSI IST/35 – To encourage further alignment across standards from : • HL 7 • ISO • CEN

Messaging Phasing • Tied into ICRS implementation phases – Phase 1 • Release 1 June 2004 • Release 2 December 2004 – Phase 2 • Release 1 June 2005 • Release 2 June 2006 – Phase 3 • Release 1 December 2008

Phase 1 Release 1 Messages • e. Booking – All messages to support service • Personal Demographic Service – Create record, trace, retrieval and update demographics, process birth and death notifications • Legitimate Relationships – Create and maintain carer relationships • Central role in access control

Phase 1 Release 2 Messages #1 • Transfer of care – – – Generic referral Emergency admission notification Out of hours & NHS direct reports Notification of sectioning under MH act Generic Clinic letter Generic Discharge letter • ICRS Record – – – Maintain patient problem list Allergies and adverse reactions PMIP pathology results Diagnostic Imaging results Single Assessment Process Care Programme Approach

Phase 1 Release 2 Messages #2 • e. TP – Prescription and dispensing – PPA, pharmacist to patient, other prescribers • Other – GP 2 GP messages – Begin / end episode / encounter / intervention – Clinical spine record • Add patient • Prescribe – Screening • Entry, exit and status change in screening protocols • Record screening result – Terminology service • PDS – Change GP

Phase 2 Release 1 Messages • Secondary uses – Including NWCS flows • Assessment and review messages – Diabetes, Cancer, CHD, children, Renal, and LTMC • Ordering & results – Diagnostic Imaging orders – Pathology orders & results (HL 7) • Care pathways – Begin, end, and status change care pathway messages • Other – PDS Health. Space messages

Phase 2 Release 2 Messages • PSIS Healthspace – Patient access to record • Referrals – Generic tertiary referral • Attendances – Walk in centre – pharmacy

Phase 3 Messages • Orders and results – Remaining modalities • Referral – Generic community • Alerts – Clinical warning from national services • Knowledge Sources – Cochrane – Clinical Evidence – Other information sources

Nascent Standards work • NCAB Cancer group development of standard conceptual model for care pathways / protocols / guidelines. . . – To allow unambiguous description of best practice collaborative care – To support creation of interoperable as well as integrated care pathways – System suppliers with varying systems’ models should be able to represent and implement pathways and elements of pathways without degradation of meaning or function • Intended collaboration with HL 7 Decision Support and other international groups

If you want to join the party. . • Get involved in message development – Join HL 7 UK if not a member • must join HL 7 UK to be able to have access to HL 7 materials and participate in meetings – Subscribe to the dedicated mailing list • Go to: http: //lists. hl 7. org. uk/mailman/listinfo/nhsnpfit – Respond to subsequent invitations to express interest in working on workpackages announced via mailing list – Attend analysis & design sessions as appropriate – Participate in HL 7 UK and Inc. technical and other meetings

If you a supplier to the NHS… • Get involved with Systems messaging implementation – Contact Phil Sissons • Supplier. Liaison@npfit. nhs. uk – Engage through Intellect • Whether or not an existing Intellect member • Contact Laurence Harrison & Sureyya Cansoy sureyya. cansoy@intellectuk. org • Register which message flows you will be implementing – – Attend follow-up message implementation workshops Receive communications standards Implement the messages in your systems Engage with NPf. IT for conformance testing in NPf. IT sandpit and LSP Model communities – Work with customers and LSPs in planning, migration and roll out

Thank you for your attention Questions? tim. jones@npfit. nhs. uk