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Applications of XML in the NHS. Paul Woolman Standards Program Manager ISD. Contents. XML for: Patient Records Publishing Communications. Patient records. Store clinical information as XML Structured documents Case notes Discharges Referrals Summary documents Structured data

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Applications of xml in the nhs

Applications of XML in the NHS

Paul Woolman

Standards Program Manager

ISD


Contents
Contents

XML for:

  • Patient Records

  • Publishing

  • Communications


Patient records
Patient records

  • Store clinical information as XML

    • Structured documents

      • Case notes

      • Discharges

      • Referrals

      • Summary documents

    • Structured data

      • XML data model


Information storage
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)


Examples
Examples

  • Graphnet

  • CSW

  • Office

  • Anaesthetic records…

  • Next 4 slides…


Office applications
Office applications

  • MS office, Sun, OpenOffice

    store & use XML documents

  • Infopath forms client

    • Supports web services & XML

    • Build forms from xml schema


Replacing paper forms

Patient info

pre-op

instructions

Case type

pre-op assessment

lab

test

results

post-op instructions

Replacing Paper Forms



Client behaviour
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


Sci store
SCI Store

Web Server(IIS)

Database

ASP

Pages

Objects

Browser

(IE5.5)

Request

Handlers

3rd Party

Application

.NetFrame

work

Request

Handlers

Request

Handlers

Web

Service

Log

Log

Handler


Contents1
Contents

XML for:

  • Patient Records

  • Publishing

  • Communications



Document metadata
Document Metadata

  • Data about data…descriptions eg keywords

  • Descriptive headings about documents

  • Useful for filing, searching and cataloguing

  • E-Government metadata standard

  • HL7 Clinical Document Architecture

  • need NHS Scotland standards


Show nelh
SHOW & NELH

  • Main NHS portals

  • HTML pages need manual updating

  • XML data storage

  • XML -> HTML in active server pages

  • Advantages:

    • Many views of single data

    • Support clinical networks

    • Support automated query tools


Nhs data dictionary
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


Contents2
Contents

XML for:

  • Patient Records

  • Publishing

  • Communications



Electronic data interchange
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


Gp records exchange
GP records exchange

  • Patient moves house or changes GP

  • Records follow 4+ weeks later

  • Electronic exchange is quicker

  • GPASS early implementations ongoing


Nhsscotland gpex
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


Scottish birth record
Scottish Birth Record

  • Replaced SMR for births

  • Added clinical information

  • Make useful to clinical care

  • Rolled out to all maternity units


Concept
Concept

  • Single web site in NHSnet

  • Browser input from maternity units

  • Link to PAS’s

  • Link to new maternity systems

    • Reduce data duplication

  • Link to CHI

    • Give baby new CHI number at birth


Patient ID and demographics

PAS

EXTERNAL

INTERNAL

SBR

CHI/UPI

Clinical data

INTERNAL AND EXTERNAL

Clinical System

Other Child Systems

Paper

Scottish Child Health Information Development (SCHID) Project

Example of Hospital Data-flows

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


Use of xml
Use of XML

  • CHI link

  • Maternity system

  • Ongoing development


Community health index chi
Community Health Index (CHI)

  • Mainframe application

  • Green screen terminal input

  • Need machine EDI input & query


Concept1
Concept

  • Casablanca XML to VMS transform application

  • NHS Standard XML Schema

  • Web server

  • HTTPS and XML input to active server pages


Xml messages
XML messages

  • Register new patient

  • Find patient

  • Responses


Sci integration
SCI integration

  • SCI Store – every health board

  • Labs systems – feed into Store

  • E-Biz 2000 middleware & XML


SCI Store

Id XRay Lab1..

OK

OK

3.2

3.2

xx

GPASS

practice

SCI

Integration

community/

MH system

community

pharmacy

Labs

other

PAS

non-GPASS

practice

XRay

Test requests and results reporting

To achieve this SCI first has to integrate existing hospital systems and re-assemble the patient’s information in a new system called SCI Store

OK

3.2


Sci web services
SCI web services

  • Electronic Transmission of Prescriptions

  • Referrals to outpatients

  • SCI Gateway

  • David Brazier this afternoon


E care
E-Care

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

  • Eg Shared Assessments

    • Elderly

    • Mental health

    • children


Single shared assessments
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.


Concept2
Concept

  • Server in demilitarized zone

  • XML integration to health system

  • XML integration to social work system

  • Browser input


E care store
E-care store

  • Central data store

  • Multiple identifiers – CHI, Hospital nos., social work numbers

  • XML Web Services for data exchange


Virtual ehr portal
Virtual EHR portal

  • Pull data from distributed systems

  • Rearrange

  • Present to viewer


Education??

Social Care

Integrated Children’s Services Record

CH System

LA net

Internet

parent/child

+ smartcard

NHSnet

GP SBR SIRS School SNS

NHS systems


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

A&E

OoH

NHS24

GP

Portal

XML web views of systems

EPR

Acute

EPR

Commun

EPR

MH

‘EPR’

GP

‘Virtual’ EHR Model

Patients


Nhsnet a fully distributed data web

Data

Publishers/owners

End-user

client

NHSnet - a fully distributed Data Web


The semantic nhs web
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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