Scottish NHS Developments using XML

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• Scottish NHS Developments using XML

Paul Woolman
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• Scottish Immediate Discharge Letter Project 1998
  2000
• XML Dictionary for Scottish Healthcare
• Scottish Health XML Steering Group

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Motivation

• NHS network
• Electronic Patient Record
• Ministerial statement
• . the introduction of an instant electronic
  appointments system by 2002.

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Discharge letter projectstarted mid-1998
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• Glasgow Hospitals
• NHSiS ME
• NHSiS Information and Statistics Division
• Scottish Intercollegiate Guideline Network
• GPASS (main GP supplier NHS owned)
• Selected GPs

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EDI and Clinical Data- three views
GP Clinical View
IT View
Dont let GP mess with my letter
Dont let them get at my patient data
Computer- computer, dont let people interfere
Hospital Clinical View
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Immediate Discharge Documents and XML/EDI -
Advantages
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Pilot project
May 1999 fixed DTD Sept 1999 working XML
creation systems Oct 1999 working GP letter
manager Nov 1999 started GP practice
pilots March 2000 - finished
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Victoria Java Client
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GP letter manager
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Adding data to patient record
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GP Trials

• 4 trials
• 8 GPs, practice managers, clerical staff
• questionnaire and discussions
• 3 facets to results
• processing emails
• managing letters in practice
• processing individual patient records

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XML Dictionaryfor Scottish Healthcare

• Repository of standard XML tags reusable
  fragments and Schema
• Started early 1999

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Scope of Dictionary

• To support creation of Schema used in NHS
• Enable interoperability with clear definitions of
  elements matched to standard dictionary of terms.

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Use W3C XSDL as the Schema Language

• For the moment, we will work to the April draft
  of the W3C XML Schema Definition Language. We
  will move to the full standard when applicable.
• As implemented. Currently validating using XML
  Spy v. 3.0 and XML Authority

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Develop a meta model

• UML tool/skillset not currently available to us.
• Using SSADM case tools
• Creating user friendly diagrams

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Model Data, not Forms

• Where possible, XML schemas should model the
  underlying data needed for an application, rather
  than existing forms. This provides a more robust
  solution.

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Dont Duplicate Data

• Duplication of data, for example the use of both
  codes and descriptions, should be avoided. This
  prevents ambiguities where codes and descriptions
  do not agree.

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Method to date ..

• Starting with data items ( sample DTD)
• design a data hierarchy
• identify basic building blocks
• develop a prototype schema
• reverse engineer a specification language
• develop a way of bending existing case tool to
  express the specification

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Priorities

• Discharge
• Referral
• Outpatient booking
• Clinic letter
• Lab results?
• Test results?
• CHD referral
• Other referral
• Summary

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Use Standards as a Reference

• We have used European Prestandard DD ENV 13606,
  13607, 13608,13609.
• Health informatics - Electronic healthcare record
  communications
• Uses UML (Unified Modeling Language notation)
• Covers general health record concepts, labs,
  medication etc.
• 100 relevant to current work
• Is a reasonable match with existing NHSiS ISD
  standards
• Where possible, in future use the DSS/ES/HMCE/IR
  Data Standards Catalogue (DSC) as a reference
  document for element definitions. We are
  currently using Version 02, 29 February 2000.

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Naming Conventions

• 4.7.1 Use DSC Names
• Where possible, base element names on those on
  the DSC. See below for how they will be modified
  for XML Schemas.
• 4.7.2 Identification of Elements and Data Types
• The names of complex data types should end with
  the text string Structure. The name of simple
  data types should end with the text string
  Type.
• 4.7.3 Limit Abbreviations
• In general, do not abbreviate. Well known
  abbreviations, including the use of initial
  letters only, can be used when this significantly
  shortens an element name.
• 4.7.4 Use UpperCamelCase for Names
• Names should start with an initial capital, then
  each new word will start with an initial capital.
  Where an all uppercase abbreviation (such as
  NINO) is used, the following word should start
  with a lower case letter.

• Closer to the ENV 13606
• Different. Complex data types end with the text
  string Type. Have not defined any simple data
  types.
• As Implemented
• As Implemented

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Scottish Health XML Steering Group

• Founded May 2000
• Web site http//scotland-xml.uk.eu.org/

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Organisational Structure

• Scottish Health XML Steering Group
• chair Paul Woolman
• propose work programs, establish working
  groups.....
• Create XML standard Schema for the NHSiS
• IMT Program Board
• parent/sponsor, approves work programme
• ISD
• custodian of standards, builds, publishes

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Motivation

• Scottish Care Information initiative (SCI)
• Electronic Clinical Communications Implementation
  (ECCI)
• Two initiatives Million

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IMT supporting the patients journey

• assessment
• referral
• appt booking
• GPASS and other

Reception
GP practice
Treatment
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membership

• involve all NHSiS XML community
• Clinicians (8)
• NHS IM T (9)
• Suppliers technical (5)
• Academic (3)
• GP systems (4)
• Royal Colleges, Clinical Standards Board,
  external XML expertise (eg H.T. , PA)
• size of steering group 30 in 2 working groups

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liaison

• working groups clinical/technical liaise with
  colleagues wider groups
• liaison with external groups-
• Clinical Standards Board (England Scotland),
• Scottish Intercollegiate Guideline Network,
• UK NHS XML Group
• UK Govtalk
• W3C XML standards

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Working Methods(1)

• For specified area of work eg referral
• gather together and analyse basic material
• propose draft standard dataset
• get approval from clinical group for general data
  content under broad headings

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Working Methods(2)

• prototype a specification and schema
• distribute to sites for testing and evaluation
• sites check if spec meets local requirement
• analyse and incorporate feedback
• publish on WEB, inc. unresolved conflicts for
  consultation,with deadline for comments
• analyse comments

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Working Methods(3)

• resolve issues and sanction standard
• publish standard
• change control/version control
• periodic review 1-3 years
• change requests will wait for review

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Schema Development

• WORKING WITH
• GovTalk and the
• Portal Data Schema Project

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Schema layering

• Build Models
• Use NHSiS Data Dictionary
• Create Schema Spec.
• Use Govtalk methods simple schema