Applications of XML in the NHS

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Applications of XML in the NHS

• Paul Woolman
• Standards Program Manager
• ISD

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Contents

• XML for
• Patient Records
• Publishing
• Communications

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Patient records

• Store clinical information as XML
• Structured documents
• Case notes
• Discharges
• Referrals
• Summary documents
• Structured data
• XML data model

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Information storage

• XML as the format for authoring and storage of
  documents
• Rather than Word .Doc, Rich Text Format, Text
• Clinical documents
• Metadata (description of documents)
• Latest Office applications (MS, SUN, Open)

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Examples

• Graphnet
• CSW
• Office
• Anaesthetic records
• Next 4 slides

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Office applications

• MS office, Sun, OpenOffice
• store use XML documents
• Infopath forms client
• Supports web services XML
• Build forms from xml schema

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Replacing Paper Forms
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Pasting a Theatre List
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Client Behaviour
XML SAX Writer
XSLT Transform (Optional)
XML Signature Encryption
SOAP Message
server
XSLT Transform (Optional)
XML Signature Encryption
SOAP Message
XML SAX Handler
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SCI Store
Web Server(IIS)
Database
Objects
ASP Pages
Browser (IE5.5)
Request Handlers
.NetFrame work
3rd Party Application
Request Handlers
Request Handlers
Web Service
Log
Log Handler
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Contents

• XML for
• Patient Records
• Publishing
• Communications

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Publishing
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Document Metadata

• Data about datadescriptions eg keywords
• Descriptive headings about documents
• Useful for filing, searching and cataloguing
• E-Government metadata standard
• HL7 Clinical Document Architecture
• need NHS Scotland standards

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SHOW NELH

• Main NHS portals
• HTML pages need manual updating
• XML data storage
• XML -gt HTML in active server pages
• Advantages
• Many views of single data
• Support clinical networks
• Support automated query tools

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NHS Data Dictionary

• Data definitions on web
• XML export selected definitions
• UML models designing XML schema refer to data
  definitions.
• New dictionary to tie all three together

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Contents

• XML for
• Patient Records
• Publishing
• Communications

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Communications
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Electronic Data Interchange

• Moving data from one computer to another
• Eg Patient referral from GP to hospital
• Replace older formats eg EDIFACT
• New forms of EDI with user interaction
• XML allows Graceful Degradation
• View messages if required

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GP records exchange

• Patient moves house or changes GP
• Records follow 4 weeks later
• Electronic exchange is quicker
• GPASS early implementations ongoing

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NHSScotland GPEX

• GPASS specific message
• GP exports XML document to PSD
• PSD send off to new GP update CHI
• New GP selectively imports record into new GPASS
• Currently in early implementation sites

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Scottish Birth Record

• Replaced SMR for births
• Added clinical information
• Make useful to clinical care
• Rolled out to all maternity units

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Concept

• Single web site in NHSnet
• Browser input from maternity units
• Link to PASs
• Link to new maternity systems
• Reduce data duplication
• Link to CHI
• Give baby new CHI number at birth

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Scottish Child Health Information Development
(SCHID) Project
Example of Hospital Data-flows
Want more information? www.show.scot.nhs.uk/sbr
alternatively tel [phone]
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Use of XML

• CHI link
• Maternity system
• Ongoing development

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Community Health Index (CHI)

• Mainframe application
• Green screen terminal input
• Need machine EDI input query

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Concept

• Casablanca XML to VMS transform application
• NHS Standard XML Schema
• Web server
• HTTPS and XML input to active server pages

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XML messages

• Register new patient
• Find patient
• Responses

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SCI integration

• SCI Store every health board
• Labs systems feed into Store
• E-Biz 2000 middleware XML

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Test requests and results reporting To achieve
this SCI first has to integrate existing hospital
systems and re-assemble the patients information
in a new system called SCI Store
OK
3.2

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SCI web services

• Electronic Transmission of Prescriptions
• Referrals to outpatients
• SCI Gateway
• David Brazier this afternoon

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E-Care

• Shared care records between health, social
  services, education and others
• Eg Shared Assessments
• Elderly
• Mental health
• children

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Single Shared Assessments

• Lots of work on data and definitions
• Based on paper versions
• Initiated by any party
• Involves patient/client and relatives/carers
• Involves independent sector
• Eg churches, voluntary orgs.

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Concept

• Server in demilitarized zone
• XML integration to health system
• XML integration to social work system
• Browser input

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E-care store

• Central data store
• Multiple identifiers CHI, Hospital nos., social
  work numbers
• XML Web Services for data exchange

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Virtual EHR portal

• Pull data from distributed systems
• Rearrange
• Present to viewer

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LA net
Internet
parent/child smartcard
NHSnet
GP SBR SIRS School SNS
NHS systems
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Health
Care
Personal Record
Name Alerts Demographics Carer
Allergies GP Teacher Health
Problems Social Worker Child Protection
Status Medications Section of
register Special Needs Status
Immunisations outstanding
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Health
Care
Personal Record
Interventions Health Social
Work School
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Health
Care
Personal Record
Name Who lives with me Interests Treatments
used outwith health service Special
Information you may want to know about me
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Virtual EHR Model
Patients
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NHSnet - a fully distributed Data Web
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The Semantic NHS Web
Local systems
SCI Gateway Discharge
e-Care Stores
EHR Gateway
SCI Stores via web services
SHOW2 Web service
EHR Store Mk 1.x Demographics Access
rights Pointers
CHI and child health systems r
SCI-DC
Web Browser
Terminology Definitions Schema Services -
NHS Dictionary and Grammar
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