Information Standards in NHS Healthcare

1
Information Standards in NHS Healthcare

• Ian Green
• Senior Clinical Terminology Author
• UK Terminology Centre (UKTC)
• ian.green_at_nhs.net

2
Overview

• Standards
• The EHR
• SNOMED CT
• HL7v3
• Pathology
• The future

3
What are standards ?

• Standards have two different theoretical bases
• Document describing the properties of a good at
  national and/or international level
• Qualities, measures, performance or other
  attributes of a good to which others should
  conform at national or international level
• In the NHS the second is the chosen theoretical
  base and it has set up a number of mechanisms for
  assessing conformance for example the Health Care
  Commission

4
What Are NHS Information Standards?

• NHS Information Standards are information and
  communication technologies which achieve
  interoperability between independent computer
  systems functional interoperability and between
  independent users particularly patients,
  clinicians, and managers semantic
  interoperability in the NHS its communication
  partners

5
The importance of standards

• Help disseminate technologies and best practice
• Define key features of business concerned with
  product or service performance, safety,
  reliability and quality.
• INFORMATION STANDARDS ARE NEEDED WHENEVER DATA IS
  EXCHANGED

6
The Standards Solar System
Read
LRA
UML
SNOMED
HL7
SCG
V3
V2
ICD10
CDS
tinua
CFH
Data Dictionary
con
OPCS
openEHR
OHT
ISO Data Types
IHE
EHR
7
Placing the EHR at the centre of the Standards
Universe
Expressiveness Precision/rigour Searchability
ComparabilityBest Practice
Recording
Terminology
Collection / Presentation Models
Search and Retrieval Models
Classifications
EHR
Utility Categorisation Secondary use
Decision Making
Information Model
Communication Models
Registration and Location Models
Structure Detail Search Storage
Interoperability
Notify, Find
8
Standards in the context of an EHR
SNOMED CT, dmd
Expressiveness Precision/rigour Searchability
ComparabilityBest Practice
CUI, openEHR, SNOMED CT, CDS
Recording
Terminology
Collection / Presentation Models
HL7 V3, Spine, SNOMED CT
OPCS, ICD10, HRG, Data Dictionary
Search and Retrieval Models
Classifications
EHR
Utility Categorisation Secondary use
Decision Making
openEHR, HL7 RIM, CDA, Data Dictionary
HL7 V3, CDA, SNOMED CT, CDS
Information Model
Communication Models
Registration and Location Models
Structure Detail Search Storage
Interoperability
Notify, Find
Spine, SDS, PDS
9
What is a Clinical Terminology ?

• A clinical terminology is a structured collection
  of descriptive terms for use in clinical practice
  describing the care and treatment of patients.
• By using a terminology embedded in computer
  applications clinical staff can record patient
  information in a consistent manner.
• The recording of clinical data can be
  communicated in a standard way between healthcare
  systems and individuals.
• Organisations will be able to report on health
  trends based on the common terminology, confident
  that information collected from different NHS
  organisations is comparable.

10
SNOMED CT
Created by clinicians for clinicians SNOMED CT
(Systematized Nomenclature of Medicine Clinical
Terms) is a common language for recording and
sharing clinical knowledge.
11
What is SNOMED CT ?

• Joint development between the NHS and the College
  of American Pathologists (CAP) to develop an
  international clinical terminology.
• The healthcare industry standard of clinical
  terminology used in many countries. It is a
  vocabulary which aims to represent the words and
  phrases used in healthcare in a consistent way in
  association with unique codes that are
  recognisable by machines.
• A tool which can be used by clinicians,
  administrators and medical researchers to improve
  the health of patients through improved
  representation of clinical information.
• Licensed by the IHTSDO, through the UKTC
  (currently 10 countries still growing)

12
SNOMED CT

• SNOMED RT CTV3 (CAP / NHS)
• Created in 2002
• At present
• 283,000 Active concept codes
• 732,000 Active terms (descriptions)
• 923,000 Active defining relationships
• If you spent 1 minute examining each description,
• Working 40 hrs/week (2400 minutes/week), it would
  take 305 weeks (6 years) to examine all the
  active descriptions

13
SNOMED CT top level
14
Concepts and terms

• Each concept has one unambiguous preferred
  (fully specified in SNOMED CT) term
• Each concept may have any number of synonyms
• Synonyms may be shared with other concepts

15
Example Apple RAST

• FSN malus sylvestris specific IgE antibody
  measurement (procedure)
• Preferred apple RAST
• Synonym apple specific IgE antibody measurement
• Synonym malus sylvestris specific IgE antibody
  measurement
• Synonymf49 specific IgE antibody measurement

16
SNOMED CT structure
17
SNOMED CT in the UK

• SNOMED CT UK edition
• International release
• UK extension
• SCT subsets
• Cross-maps
• Documentation

18
SNOMED CT and laboratory

• Laboratory procedures hierarchy
• 37,000 concepts
• Organisms hierarchy
• 25,000 concepts
• Body structure hierarchy
• 31,500 concepts
• Specimen types hierarchy
• 1,000 concepts

19
HL7 (Health Language Seven)
20
HL7 version 3

• Comprehensive standard, definite and testable
• Define messages between systems to the degree
  that difficult negotiations and compromise can be
  totally eliminated or minimized
• XML (Extensible Mark up Language)
• Designed from the top down
• Can meet the evolving needs of the NHS
• Widespread support
• International open standard
• Robust approach to development

21
HL7 request message
22
HL7 report message
23
Using HL7v3

• Message development (storyboard)
• RIM
• Clinical statement
• CDA
• Vocabulary
• Development of laboratory request and report
  messages

24
Pathology background

• PMIP / EDIFACT report messaging only
• PBCL Pathology Bounded code list (Readv2)
• IT-focused domain
• Knowledgeable domain experts
• Well developed locally
• Requirement for improved governance and an agreed
  approach to change management
• Patient safety is paramount

25
The road ahead challenging times

• Requirement for better laboratory service
  communication (Carter Review)
• Increased demand for secondary usage of data
• Decreased availability of resources locally
• Requirement to work smarter . . . .
• Patient safety issues
• Increased automation

26
The road ahead strictly pathology

• Increased importance of order communications
  because of reduced training of generalists in
  pathology
• Change in delivery methods of pathology
  investigations
• Increasing patient centred delivery of healthcare
  POCT
• Increased pathology standardisation
• Workforce review changing roles

27
The road ahead some solutions

• SNOMED CT broad pathology coverage, continues
  to develop
• Defining editorial principles for laboratory
  content within SNOMED CT
• HL7v3 Laboratory messages request and report
• National catalogues potential to standardise
  requested pathology investigations
• Professional bodies engagement development and
  governance
• We need your help . . . .

28
(No Transcript)
29
Information Standards in NHS Healthcare

• Ian Green
• Senior Clinical Terminology Author
• UK Terminology Centre (UKTC)
• ian.green_at_nhs.net