Interoperability at Great Ormond Street Hospital

1. Interoperability at Great Ormond Street Hospital What HL7 Made Possible Ken Smith – ken.smith@bridgeforward.net www.bridgeforwardsoftware.net

2. Ken Smith Senior Integration Specialist – BridgeForward Integration Specialist – GOSH (formerly)

3. Great Ormond Street Hospital Specialty Children’s Hospital Tertiary Referral Complex cases (multiple specialties) Long term cases (seen over long periods of time) Critical cases Large international and private patient service

4. GOSH Ambitions Establish integrity of patient data across departmental systems Exchange and make use of clinical information Automate processing of billable costs for private patient billing

5. Patient Data Requirements Patient data has to be kept current across multiple systems Has to be kept current over time Updates have to be instantaneous Updates have to account for different patient populations (NHS and private)

6. Patient Data – PAS Centric PAS (iPM from iSOFT) the source of all patient data PAS not accept patient data from other systems Drip-feed (publish/subscribe) Query/response

7. Patient Data – Phase 1 Initially, no HL7 messages from PAS Make do: Poll extracts tables (simulate drip-feed) Query of PAS database Construct non-HL7 messages Mitigated by few interfaces built at this stage

8. Patient Data – Phase 2 Upgrade of PAS Full set of HL7 messages, drip-feed and query/response More interfaces, more quickly Discovered variability in interpretations and requirements of HL7 Placement of NHS ID in drip feed and q/r Formatting of data Differences in coded value lists Confidentiality

9. Clinical Information Notification systems Pathology results notification Radiology results notification Patient death notification 2 out of the 3 were failures Failed to engage the clinicians

10. Difficulties Sharing Clinical Information Sharing clinical information much more difficult Building a clinical application, not an integration Clinical practices and applications highly localized (specialty and context) Informatics (analysis) is as or more important than technology HL7 2.x vs. HL7 3 Clinician involvement necessary (do it for them, not to them) Greater challenge holds promise of greater rewards

11. Private Patients Billing Recoverable/billable costs: Pathology tests Radiology tests Pharmacy prescriptions Route from source departments into Private Patient system

12. Billing Messages – non HL7 Each department created spreadsheets of costs for each patient for specific time Naturally, each spreadsheet in different format Integration engine processed spreadsheets, and shoehorned different column formats into a proprietary, non HL7 message format It was a pain from start to finish If only…

14. Conclusions Starts and ends with HL7 HL7 2.x almost universal, but variable HL7 transport neutral No use of HL7 3.0 HL7 needs tools Success with patient data easier to achieve Goal is not to deliver healthcare IT integrations, but integration solutions that improve delivery of clinical care