Transforming Government using Open Standards

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Transforming Government using Open Standards
Jagdip Grewal Chief Technical Architect 29th
October 2007
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Agenda

• Business Context
• Enterprise Architecture Context
• Services in an Enterprise Architecture
• Using standards to enable integrated healthcare
• Integration challenges
• UK Government Enterprise Architecture

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Our Objectives

• To deliver a 21st century health service through
  efficient use of technology to
• Enable and improve Access and Choice
• Enable care pathways and patient focus
• Improve accuracy in treatment
• Create opportunities for improved efficiency
• Create opportunities for real NHS reform

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Demographic Challenge

• Ageing Population
• 2001 over 60s gt than under 18s
• 2050 4 times as many needing care
• At 4 times the current cost
• while the number available as carers declines

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The need for change
Has overburdened the system
A Changing Health Environment

• 1,200 Patients dying each year from medication
  errors
• 5,000 procedures cancelled each year
• 5 of patient safety incidents due to
  documentation errors

• Life expectancy increased to 75 years
• 9 million people over 65 and increasing
• Population more mobile
• Greater long term chronic illness
• Patients more educated on health and want greater
  involvement

• The NHS in 2002
• Patient records held on paper
• Highly variable usage of IT
• Lots of home-grown specialist systems
• Continuing reliance on 1970s mainframes

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Challenges

• Local procurement of IS/IT Systems by GPs,
  Trusts etc
• Disparate Technologies, 1000s of suppliers
• Limited data sharing
• Lack of standardisation
• Lots of paper
• Little leverage of NHS buying power

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The answer

• National Programme for IT
• Launched Spring 2002 by 21st Century IT policy
  document
• Mobilisation from Q1 2003
• Procurement completed Q1 2004
• Services based contracts
• Local and National Suppliers
• 6bn of IT services contracted over ten years

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Scope
Secondary Uses Service
chooseandbook
Analysing National Health Trends
Patient Choice

• Largest civil IT project in the world
• 40,000 GPs
• 80,000 other doctors
• 350,000 nurses
• 300 hospitals
• 10 year programme
• 50m patients
• 1.344m healthcare workers

Electronic Prescriptions Service
N3
New National Network
Picture Archiving Communications Service
NHSmail
Healthspace
Secure E-mail for all NHS workers
Web Access for Patients
National Local Care Record Services
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and what does it look like
Multiple and Disparate Channels
3 Suppliers with differing Architectures
120 Different Supplier Accredited Systems to
integrate
Integration required with set of common services
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Programme Challenges

• Hundreds of different applications and suppliers
• Large scale systems e.g. Prescriptions at 500tps
• End Users with differing requirements and
  geographically distributed
• Diverse (often legacy) Supplier Technologies
• Lack of Standards
• Desire to Use COTS packages avoid bespoke
• Evolution in requirements and functionality
• Data availability, quality and integrity is
  critical
• Enterprise Architecture required to define
  overall End to End approach

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Agenda

• Business Context
• Enterprise Architecture Context
• Services in an Enterprise Architecture
• Using standards to enable integrated healthcare
• Integration challenges
• UK Government Enterprise Architecture

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EA - Context
Medical Advances
NASP
NHS CFH
LSP/ESP
Policy
Outcomes Better Patient Care Reduced Cost Lower
waiting Times
Clinical Processes
Patient Demand
We may all have different perspectives but we can
make our lives much easier by talking the same
language.
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The bigger picture - In support of traceability
(simplified view)
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NHS relationship map
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Agenda

• Business Context
• Enterprise Architecture Context
• Services in an Enterprise Architecture
• Using standards to enable integrated healthcare
• Integration challenges
• UK Government Enterprise Architecture

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Enterprise Architecture Domain View
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Conceptual Services what we do
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E.g. Demographics

• Within local Services Domain
• Set of services required to be implemented by
  local systems
• Within Enterprise Services Domain
• Set of services required to be implemented by
  national service provider for all 60m patients
• Set of compliance docs from NHS CFH
• Covering requirements to be met by systems
  implementing those services
• MIM for message definitions and example process
  flows
• Principles - loose coupling, search local first,
  update local first
• What is to be tested and verified during
  integration testing

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Logical Applications
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Agenda

• Business Context
• Enterprise Architecture Context
• Services in an Enterprise Architecture
• Using standards to enable integrated healthcare
• Integration challenges
• UK Government Enterprise Architecture

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The role for standards

• Explicit from the outset.
• The standards base evolves and grows
• Standards chosen to maximise interoperability and
  to meet different integration requirements
• Use of ebXML, (https, SOAP, XML) - reliable
  asynchronous messaging for patient demographic
  updates
• Web Services and WS standards e.g. WS-A
  lightweight synchronous messaging for patient
  demographic queries
• Use of SNOMED CT
• Use of HL7 v3 (ETP, CB, PDS) and CDA v2
  (Clinical Documents)
• Lots more.
• Objective is to federate the design
  responsibility to the systems providers, working
  within a framework of standards and
  specifications

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Not just technical standards

• Common User Interface (CUI) - Microsoft and NHS
  CFH (http//www.mscui.org/)
• Knowledge authorship to allow Knowledge Support
  (KBS) and Decision Support into all aspects of
  the implementation
• The International Health Terminology Standards
  Development Organisation
• SNOMED CT
• Charter Members (Australia, Canada, Denmark,
  Lithuania, New Zealand, United Kingdom United
  States)
• A drug database The Dictionary of Medication
  and Devices (dmd)
• Standards by which we accredit systems as safe to
  implement and exchange information

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Elective / Passive Decision Support same
component in all local solutions
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Standard drug dictionary

• A standard drug dictionary for all systems
• We (and Australia) have chosen to make and
  maintain a new one called dmd (The dictionary of
  medications and devices)
• NB. This is NOT decision support but a standard
  way of naming and structuring medication and
  devices so that decision support and complex
  rules based content can be added with predictable
  results.

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Dmd and SNOMED CT (300,000 terms)

• Both dmd and SNOMED have a central core with
  local additions

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Standards enable supplier expansion

• The use of Open Standards for integration (ebXML,
  HL7) has enabled an expansion in number of
  suppliers to the programme
• Leverages existing knowledge capital and
  established standards
• Allows suppliers to build COTS packages based
  upon industry standards. Move away of bespoke
  development
• Allows plug and play of new services
• Standardisation reduces overall testing
  complexity
• To meet business objectives we have integrated
• 100s of supplier applications
• Access from private corporate WAN (N3) as well as
  internet aggregators for high street access

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What have we achieved so far? - some numbers
(at 08/10/07)

• 17,454 instances of systems connected into the
  national services which allows in a typical day
• 190,000 prescription messages issued
  electronically (18 of all prescriptions)
• 19,000 Choose and Book electronic bookings
• 1,400,000 queries to be recorded on the patient
  demographic system enabling letters to be posted
  to the correct address and patient information to
  be handled more efficiently
• These are deployed via the 20,662 connections to
  N3 (the national NHS WAN)
• 380,350,622 images have been stored using PACS
  from NHS CFH
• There are 394,367 Smartcard holders who are
  registered and approved for access to systems

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Whats next - more clinical Information flows
between systems
Emergency Dept Discharge
Patient info
GP System
Patient visits GP
Acute System
Patient visits Emergency Dept
Update GP Summary
Emergency Dept Discharge
Patient info
Acute System
Patient visits hospital
Discharge
Enabled by standards (HL7v3 and HL7 CDA v2 over
ebXML (https/SOAP/XML) and central messaging
services (TMS)
Discharge
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Agenda

• Business Context
• Enterprise Architecture Context
• Services in an Enterprise Architecture
• Using standards to enable integrated healthcare
• Integration challenges
• UK Government Enterprise Architecture

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Integration The Challenges

• Large number of suppliers and growing
• Each supplier footprint is different can
  consume different services
• Suppliers in different phases of development
• Business critical services cannot be stopped
  for more than a few hours
• We cannot lose data
• Data must only flow from accredited applications
  running from authorised endpoints originating
  from users with the relevant roles
• Large numbers of endpoints, systems and users
• Strict Information Governance Rules

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Challenges Service Definition

• Right Granularity ? To high and they are subject
  to constant change. To Low and it can result in
  significant increases in message flow.
• Generic or Specific business process ? The level
  of business logic can impact the re-usability of
  the service.
• What SLAs ? Services that are used for many
  business functions may have varying SLA needs
  these must be balanced against cost
• Trade off between performance and extensibility
• What security model ? Whilst some aspects of
  information security can be centralised others
  must be federated

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Challenges Compatibility

• FORWARD and BACKWARD
• A change to a service can impact many
  applications and suppliers
• Each system needs to be fully tested before it is
  accredited for deployment !!!
• The more versions we support the less scope we
  have to add new capabilities
• Translation services are required to accommodate
  supplier applications running at different
  versions

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Services usage can be different to expectation

• All local systems will integrate with Summary
  Care Record
• SCR provides a set of services to enable this in
  different ways

Summary Care Record
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Agenda

• Business Context
• Enterprise Architecture Context
• Services in an Enterprise Architecture
• Using standards to enable integrated healthcare
• Integration challenges
• UK Government Enterprise Architecture

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Cross Government Enterprise Architecture

• CTO Council formed in Sept 2005. The aim is to
  support the CIO Council through the optimisation
  of the use of IT resources across the public
  sector.
• Strategic value of xGEA is to identify
  opportunities for collaboration and reuse across
  government.
• Without a business and IT Blueprint for
  Government an Enterprise Architecture
  avoidable cost would be incurred as IT is
  developed in islands.

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So where do the CTO Council sit?
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xGOV EA Domains and Leads
STRATEGY Andrew Stott (Cabinet Office)
CHANNEL DOMAIN Terry Hawes (HMRC)
PROCESS DOMAIN John Wailing (Home Office)
INFORMATION DOMAIN Pete Desmond (DWP)
INFORMATION ASSURANCE DOMAIN Marc Hocking
(Cabinet Office)
INTEGRATION DOMAIN Inderjit Singh (NHS CfH)
SERVICES MANAGEMENT DOMAIN Paul McAvoy (DWP)
APPLICATION DOMAIN TBD
INFRASTRUCTURE DOMAIN Andrew Bull (HMRC)
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xGov EA Context

• The majority of the work of the CTO council is
  structured around the xGov EA through the Domain
  Teams.
• The Domain Team leads collectively form the
  Architecture Review Board (ARB) whose purpose is
  to
• Oversee the development of cross-Government
  Enterprise Architecture xGEA
• Oversee the development and operation of the
  clearing house process for exemplars
• Assesses the fitness for purpose of proposed
  exemplars (managed services and solutions) for
  reuse across the public sector
• Resolves overlaps between domains
• Provides a forum for peer reviews

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Capturing EXEMPLARS at various levels

• A hosted service that is offered to others

• A packaged service including code, design that
  can be rebuilt

• The approach to providing the service

• Experiences gained implementing the service

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Clearing House Process and Domain ToR Detailed
Process Flow
Business Idea X Architecture Priority 1 CIO
Gate Status Viability Primary Domain
Infrastructure Secondary Domain Channels
Business Idea X
Business Idea X Architecture Priority 1 CIO
Gate Status Viability Primary Domain
Infrastructure Secondary Domain Channels
Re-used Business artefact
eRoom
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Summary

• Use a service based Enterprise Architecture to
  enable a common language
• Set standards and frameworks that permit
  increasing levels of interoperability and
  interaction across multiple suppliers
• Be aware of the challenges of integrating
  multiple suppliers