Health Informatics Standardisation - educational, informative and normative

Transcription

1 Health Informatics Standardisation - educational, informative and normative William Grimson, Chair: NSAI s Health Informatics Standards Consultative committee

2 What do you observe?

3 What do you observe? there is a clear purpose an architecture that has been fully validated component based functionality that has been well tested cooperative working repeatable etc,

4 Health Informatics standards: just one part of a very complex environment

5 Standards Is it near the Tipping point? Adoption of Healthcare information systems using standards? 2. Is the adoption rate increasing or decreasing? 1. What % of information systems in healthcare, including clinical applications, are based on standards?

6 Can HI Standards have a Tipping point? What will cause a tipping point in HI standards? (a) Economics? (b) Legislation? (c) Patient pressure? (d) Clinician led? (e) Vendor led? (f) Merged SDOs?

7 In the meantime

8 NSAI HISC s scope EHR Architecture and Information Models TC 251 WG 1 & ISO TC 215 WG 1 Nursing and Health Terminology CEN TC 251 WG 2 ISO TC 215 WG 3 Network Management, Security Safety and Interoperability CEN TC 251 WG 4 & ISO TC 215 WG 7 / WG 2 Pharmacy : ISO TC 215 WG 6 CEN

9 Four points about HI standards 1. The pursuit of HI standards is rational 2. The less technical the underlying subject matter and the more that human aspects prevail the harder it is to make progress 3. Without the appropriate level of leadership and commitment progress is going to be slow 4. Even if the end goal is a normative one, in the process there are strong educational and informative benefits.

10 Need to focus (prioritise)

11 Strategies, strategies, strategies Most strategies that address the use of IT in healthcare mention the need to support interoperability and that systems should facilitate patient-centred delivery of care.

12 Patient-centred

13 How does this all translate into standardisation activity? methodical engineering approach consensus building involving domain experts partitioning of concerns performing evaluation & technology assessment leading, eventually, to certification (compliance)

14 Partitioning of concerns (ODP Ref Model)

15 Copyright 1999 Tom Culpepper, and Tim Brinson Reference Model for Open Distributed Processing (RM-ODP) Relating to the Healthcare Domain Purpose, scope, policies. Enterprise Viewpoint Registration Order Communications Scheduling Results Retrieval Business rules and content to be supported by the system. Information NCPDP X12 Viewpoint HL7 DICOM CEN TC251 ISO TC215 Loinc Snomed CPT ICD DRG Encapsulation of capability, separation of functionality, and interface definition. Distributed interactions & mechanisms between the components. Computational Viewpoint Engineering DCE JavaBeans Viewpoint CORBA DCOM ISO/OMG Unified Modeling Language (UML) PIDS TQS COAS RAD CIAS ISO/OMG Interface Definition Language (IDL) Java C++ SmallTalk COBOL Win32 Unix MVS Description of the implementation of the system. Technology Viewpoint Standards Conformance

16 The medics need to dance with the computer scientists & engineers! Requires strong clinical leadership Requires clinical leadership married to technical expertise Enterprise Viewpoint Computational Viewpoint Registration Information NCPDP X12 Viewpoint HL7 DICOM Order Communications Scheduling ISO/OMG Unified Modeling Language (UML) PIDS CEN TC251 ISO TC215 Loinc Snomed TQS COAS RAD CIAS ISO/OMG Interface Definition Language (IDL) CPT ICD Results Retrieval DRG Requires strong multidomain technical leadership Engineering DCE JavaBeans Viewpoint CORBA DCOM Technology Viewpoint Standards Conformance Java C++ SmallTalk COBOL Win32 Unix MVS

17 Making it happen (now)

18 A trio of standards ContSys (Standard EN13940) defines a system of concepts to support continuity of care EHRcom (Electronic Health Record Communication standard EN 13606) defines an information architecture for communicating part or all of the Record of a single subject of care (patient) Health Informatics Service Architecture (HISA) (ENV 12967) is a standard for the construction of a modular open system to support healthcare applications.

19 In simple terms How do we wish to describe the steps needed for the care of a patient? What information do we need to follow the patient and how do we communicate it? What type of technical information infrastructure do we need to support and facilitate the above and other related activities?

20 Cannot change everything at once! How do we wish to describe the steps needed for the care of a patient? What information do we need to follow the patient and how do we communicate it? What type of technical information infrastructure do we need to support and facilitate the above and other related activities? Open to change with evolving medical advances and organisational approaches Ideally should be flexible enough to support patient care under different careflow regimes Don t want the basic infrastructure to have to keep changing but it should be capable of been extended, hence a modular design

21 EN13606 two level model 1: Reference Model Standard defines an abstract model that supplies building blocks that are the domain of the informatician / techie. Composition Extract Entry FolderRIC Folder Element

22 EN13606 two level model 2: Archetypes Domain experts use Ref Model building blocks to construct structured collections of clinical object definitions - Archetypes Archetypes help define a record that users require. Archetypes can be exchanged or held in a repository. Archetypes constrain the building blocks Signature elemen Element Composition Bone Profile Entry Ca Extract Folder

23 Part of record to be communicated Document contains contains EHR Extract Folder Composition CEN EHRcom Reference contains Model Recorded observation/ evaluation/action... Container for value contains contains contains contains contains Section Entry Cluster Element Data value 5.6 contains

24 loose vs constrained information and the need for domain expertise Technician s Loose definition reference model Entry element Domain Experts constrained definition reference model Entry element + Domain/context specific constraints(e.g. archetypes,cda templates) ( Valid Blood Pressure, 1) must have systolic, diastolic, posture, activity parts 2) posture must be one of {sitting, standing lying} 3) activity must be one of. Different formats for shared info. Blood pressure systolic diastolic mean or Blood pressure systolic diastolic posture activity Single format for shared info. Blood pressure systolic diastolic posture {sitting, standing, lying} activity { } 24

25 An architecture s

26 An example of progress (never too late!)

27 A major new Professional Records Standards Body (PRSB) has been launched to promote the development of health and care records based on common record keeping standards. The PRSB, which is intended to become the primary source of knowledge and expertise on health and social care record keeping standards, is backed by nearly all the royal medical colleges. A central aim will be to make sure that the requirements of those who provide and receive care can be fully expressed in health and social care records. It will also provide guidance for those working on technical implementation of the standards.

28 PRSB will aim to ensure that records reflect the way health and social care professionals work together to deliver care; reflect best practice; and enable good outcomes for patients and service users. It will also work to make sure that records standards generate aggregate data that are valid and comparable. Founding members of the PRSB include: the Royal College of Physicians, National Voices, the Allied Health Professions Federation, Royal College of Nursing, Association of Directors of Adult Social Services, Royal College of General Practitioners, The BCS, the Chartered Institute for IT, the Academy of Royal Medical Colleges, the Royal College of Pathologists, the Royal College of Psychiatrists, the Royal College of Surgeons of England, and the Royal College of Paediatrics and Child Health.

29 We need stronger leadership I hope that the new PRSB will introduce some sense of order into the standards space and deliver the standards we all need that are fit for purpose. For far too long health information and interoperability standards have been dominated by turf wars and people have not got on with the job. Part of the problem has been that there are just too many bodies. To name just fifteen: ISO TC215; CEN TC251; BSI IST/35; ISB; HL7 International; IHTSDO; DICOM; IHE; OMG; Continua Alliance; OpenEHR; Open Health Tools; MHRA; TSA; HSCIC (ITK),. The whole point of standards is to "introduce order" - at present we have a shambles. Tim Benson

30 Finally the tipping point required will probably only occur with strong and empowered

31