Applications of XML in the NHS

Paul WoolmanStandards Program ManagerISD

Contents

XML for:Patient RecordsPublishingCommunications

Patient records

Store clinical information as XMLStructured documents

Case notesDischargesReferralsSummary documents

Structured dataXML data model

Information storage

XML as the format for authoring and storage of documentsRather than Word .Doc, Rich Text Format,

TextClinical documentsMetadata (description of documents)Latest Office applications (MS, SUN, Open)

Examples

Graphnet CSW OfficeAnaesthetic records…Next 4 slides…

Office applications

MS office, Sun, OpenOffice

store & use XML documentsInfopath forms client

Supports web services & XMLBuild forms from xml schema

Replacing Paper Forms

pre-opinstructions

Patient info

Case typepre-op

assessment

post-op instructions

labtest

results

Pasting a Theatre List

Client Behaviour

XML SAX Writer

XSLT Transform

(Optional)

XML Signature & Encryption

SOAP

Message

XML SAX Handler

XSLT Transform

(Optional)

XML Signature & Encryption

SOAP

Message

server

Web Server(IIS)

RequestHandlers

SCI Store

DatabaseObjectsASP

PagesBrowser(IE5.5)

.NetFramework

RequestHandlersRequest

HandlersWebService

3rd PartyApplication

LogLog

Handler

Contents

XML for:Patient RecordsPublishingCommunications

Publishing

Document Metadata

Data about data…descriptions eg keywords

Descriptive headings about documentsUseful for filing, searching and

cataloguingE-Government metadata standardHL7 Clinical Document Architectureneed NHS Scotland standards

SHOW & NELH

Main NHS portalsHTML pages need manual updatingXML data storageXML -> HTML in active server pagesAdvantages:

Many views of single dataSupport clinical networksSupport automated query tools

NHS Data Dictionary

Data definitions on webXML export selected definitionsUML models designing XML schema &

refer to data definitions.

New dictionary to tie all three together

Contents

XML for:Patient RecordsPublishingCommunications

Communications

Electronic Data Interchange

Moving data from one computer to another

Eg Patient referral from GP to hospitalReplace older formats eg EDIFACTNew forms of EDI with user interactionXML allows Graceful Degradation

View messages if required

GP records exchange

Patient moves house or changes GPRecords follow 4+ weeks laterElectronic exchange is quickerGPASS early implementations ongoing

NHSScotland GPEX

GPASS specific messageGP exports XML document to PSDPSD send off to new GP & update CHINew GP selectively imports record into

new GPASSCurrently in early implementation sites

Scottish Birth Record

Replaced SMR for birthsAdded clinical informationMake useful to clinical care Rolled out to all maternity units

Concept

Single web site in NHSnetBrowser input from maternity unitsLink to PAS’sLink to new maternity systems

Reduce data duplicationLink to CHI

Give baby new CHI number at birth

Scottish Child Health Information Development (SCHID) Project

Want more information? www.show.scot.nhs.uk/sbr alternatively tel: 0131 551 8046

Example of Hospital Data-flows

Patient ID and demographics

Clinical data

PAS

SBR

CHI/UPI

Paper

Other Child Systems

Clinical System

INTERNAL

EXTERNAL

INTERNAL AND EXTERNAL

Use of XML

CHI linkMaternity systemOngoing development

Community Health Index (CHI)

Mainframe application Green screen terminal inputNeed machine EDI input & query

Concept

Casablanca XML to VMS transform application

NHS Standard XML SchemaWeb serverHTTPS and XML input to active server

pages

XML messages

Register new patientFind patientResponses

SCI integration

SCI Store – every health boardLabs systems – feed into Store E-Biz 2000 middleware & XML

XRay Labs PAS otherGPASS

practicenon-GPASS

practicecommunity/MH system

Id XRay Lab1..xx OK 3.2OK 3.2

SCI Store

OK 3.2

communitypharmacy

Test requests and results reportingTo achieve this SCI first has to integrate

existing hospital systems and re-assemble the patient’s information in a

new system called SCI Store

SCIIntegration

SCI web services

Electronic Transmission of PrescriptionsReferrals to outpatientsSCI Gateway

David Brazier this afternoon

E-Care

Shared care records between health, social services, education and others

Eg Shared AssessmentsElderlyMental healthchildren

Single Shared Assessments

Lots of work on data and definitionsBased on paper versionsInitiated by any partyInvolves patient/client and

relatives/carersInvolves independent sector

Eg churches, voluntary orgs.

Concept

Server in demilitarized zoneXML integration to health systemXML integration to social work systemBrowser input

E-care store

Central data storeMultiple identifiers – CHI, Hospital nos.,

social work numbersXML Web Services for data exchange

Virtual EHR portal

Pull data from distributed systemsRearrangePresent to viewer

NHSnet

Education??Education??

LA net

parent/child+ smartcard

parent/child+ smartcard

GP SBR SIRS School SNS

NHS systemsNHS systems

Internet

Integrated Children’s Services RecordHealth Care Personal Record

Name: Alerts:

Demographics:

Carer: Allergies:

GP:

Teacher: Health Problems:

Social Worker:

Child Protection Status:

Medications:

Section of register:

Special Needs Status: I mmunisations outstanding:

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: I mmunisations outstanding:

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: I mmunisations outstanding:

Health Care Personal Record

I nterventions:

Health:

Social Work:

School:

Health Care Personal Record

I nterventions:

Health:

Social Work:

School:

Health Care Personal Record

Name:

Who lives with me:

I nterests:

Treatments used outwith health service:

Special I nf ormation you may want to know about me:

Health Care Personal Record

Name:

Who lives with me:

I nterests:

Treatments used outwith health service:

Special I nf ormation you may want to know about me:

CH System

Social CareSocial Care

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:

Health Care Personal Record

Interventions:

Health:

Social Work:

School:

Health Care Personal Record

Name:

Who lives with me:

Interests:

Treatments used outwith health service:

Special Information you may want to know about me:

‘Virtual’ EHR Model

EPR

Acute

EPR

Commun

EPR

MH

‘EPR’

GP

A&E OoH NHS24GP

Patients

XML web views of systems

Portal

NHSnet - a fully distributed Data Web

End-user client

DataPublishers/owners

The Semantic NHS Web

Web Browser

EHR Store Mk 1.xDemographicsAccess rightsPointers

EHR Gateway

SCI Gateway Discharge

Local systems

e-Care Stores

SCI Stores via web services

CHI and child health systems r

SCI-DC

SHOW2Web service

Terminology; Definitions; Schema; Services

- NHS Dictionary and Grammar