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Transforming Government using Open Standards

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Medical. Advances. Patient. Demand. LSP/ESP ... A drug database The Dictionary of Medication and Devices (dm d) ... dictionary. A standard drug dictionary ... – PowerPoint PPT presentation

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Title: Transforming Government using Open Standards


1
Transforming Government using Open Standards
Jagdip Grewal Chief Technical Architect 29th
October 2007
2
Agenda
  • Business Context
  • Enterprise Architecture Context
  • Services in an Enterprise Architecture
  • Using standards to enable integrated healthcare
  • Integration challenges
  • UK Government Enterprise Architecture

3
Our Objectives
  • To deliver a 21st century health service through
    efficient use of technology to
  • Enable and improve Access and Choice
  • Enable care pathways and patient focus
  • Improve accuracy in treatment
  • Create opportunities for improved efficiency
  • Create opportunities for real NHS reform

4
Demographic Challenge
  • Ageing Population
  • 2001 over 60s gt than under 18s
  • 2050 4 times as many needing care
  • At 4 times the current cost
  • while the number available as carers declines

5
The need for change
Has overburdened the system
A Changing Health Environment
  • 1,200 Patients dying each year from medication
    errors
  • 5,000 procedures cancelled each year
  • 5 of patient safety incidents due to
    documentation errors
  • Life expectancy increased to 75 years
  • 9 million people over 65 and increasing
  • Population more mobile
  • Greater long term chronic illness
  • Patients more educated on health and want greater
    involvement
  • The NHS in 2002
  • Patient records held on paper
  • Highly variable usage of IT
  • Lots of home-grown specialist systems
  • Continuing reliance on 1970s mainframes

1
6
Challenges
  • Local procurement of IS/IT Systems by GPs,
    Trusts etc
  • Disparate Technologies, 1000s of suppliers
  • Limited data sharing
  • Lack of standardisation
  • Lots of paper
  • Little leverage of NHS buying power

7
The answer
  • National Programme for IT
  • Launched Spring 2002 by 21st Century IT policy
    document
  • Mobilisation from Q1 2003
  • Procurement completed Q1 2004
  • Services based contracts
  • Local and National Suppliers
  • 6bn of IT services contracted over ten years

8
Scope
Secondary Uses Service
chooseandbook
Analysing National Health Trends
Patient Choice
  • Largest civil IT project in the world
  • 40,000 GPs
  • 80,000 other doctors
  • 350,000 nurses
  • 300 hospitals
  • 10 year programme
  • 50m patients
  • 1.344m healthcare workers

Electronic Prescriptions Service
N3
New National Network
Picture Archiving Communications Service
NHSmail
Healthspace
Secure E-mail for all NHS workers
Web Access for Patients
National Local Care Record Services
9
and what does it look like
Multiple and Disparate Channels
3 Suppliers with differing Architectures
120 Different Supplier Accredited Systems to
integrate
Integration required with set of common services
10
Programme Challenges
  • Hundreds of different applications and suppliers
  • Large scale systems e.g. Prescriptions at 500tps
  • End Users with differing requirements and
    geographically distributed
  • Diverse (often legacy) Supplier Technologies
  • Lack of Standards
  • Desire to Use COTS packages avoid bespoke
  • Evolution in requirements and functionality
  • Data availability, quality and integrity is
    critical
  • Enterprise Architecture required to define
    overall End to End approach

11
Agenda
  • Business Context
  • Enterprise Architecture Context
  • Services in an Enterprise Architecture
  • Using standards to enable integrated healthcare
  • Integration challenges
  • UK Government Enterprise Architecture

12
EA - Context
Medical Advances
NASP
NHS CFH
LSP/ESP
Policy
Outcomes Better Patient Care Reduced Cost Lower
waiting Times
Clinical Processes
Patient Demand
We may all have different perspectives but we can
make our lives much easier by talking the same
language.
13
The bigger picture - In support of traceability
(simplified view)
14
NHS relationship map
15
Agenda
  • Business Context
  • Enterprise Architecture Context
  • Services in an Enterprise Architecture
  • Using standards to enable integrated healthcare
  • Integration challenges
  • UK Government Enterprise Architecture

16
Enterprise Architecture Domain View
17
Conceptual Services what we do
18
E.g. Demographics
  • Within local Services Domain
  • Set of services required to be implemented by
    local systems
  • Within Enterprise Services Domain
  • Set of services required to be implemented by
    national service provider for all 60m patients
  • Set of compliance docs from NHS CFH
  • Covering requirements to be met by systems
    implementing those services
  • MIM for message definitions and example process
    flows
  • Principles - loose coupling, search local first,
    update local first
  • What is to be tested and verified during
    integration testing

19
Logical Applications
20
Agenda
  • Business Context
  • Enterprise Architecture Context
  • Services in an Enterprise Architecture
  • Using standards to enable integrated healthcare
  • Integration challenges
  • UK Government Enterprise Architecture

21
The role for standards
  • Explicit from the outset.
  • The standards base evolves and grows
  • Standards chosen to maximise interoperability and
    to meet different integration requirements
  • Use of ebXML, (https, SOAP, XML) - reliable
    asynchronous messaging for patient demographic
    updates
  • Web Services and WS standards e.g. WS-A
    lightweight synchronous messaging for patient
    demographic queries
  • Use of SNOMED CT
  • Use of HL7 v3 (ETP, CB, PDS) and CDA v2
    (Clinical Documents)
  • Lots more.
  • Objective is to federate the design
    responsibility to the systems providers, working
    within a framework of standards and
    specifications

22
Not just technical standards
  • Common User Interface (CUI) - Microsoft and NHS
    CFH (http//www.mscui.org/)
  • Knowledge authorship to allow Knowledge Support
    (KBS) and Decision Support into all aspects of
    the implementation
  • The International Health Terminology Standards
    Development Organisation
  • SNOMED CT
  • Charter Members (Australia, Canada, Denmark,
    Lithuania, New Zealand, United Kingdom United
    States)
  • A drug database The Dictionary of Medication
    and Devices (dmd)
  • Standards by which we accredit systems as safe to
    implement and exchange information

23
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24
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25
Elective / Passive Decision Support same
component in all local solutions
26
Standard drug dictionary
  • A standard drug dictionary for all systems
  • We (and Australia) have chosen to make and
    maintain a new one called dmd (The dictionary of
    medications and devices)
  • NB. This is NOT decision support but a standard
    way of naming and structuring medication and
    devices so that decision support and complex
    rules based content can be added with predictable
    results.

27
Dmd and SNOMED CT (300,000 terms)
  • Both dmd and SNOMED have a central core with
    local additions

28
Standards enable supplier expansion
  • The use of Open Standards for integration (ebXML,
    HL7) has enabled an expansion in number of
    suppliers to the programme
  • Leverages existing knowledge capital and
    established standards
  • Allows suppliers to build COTS packages based
    upon industry standards. Move away of bespoke
    development
  • Allows plug and play of new services
  • Standardisation reduces overall testing
    complexity
  • To meet business objectives we have integrated
  • 100s of supplier applications
  • Access from private corporate WAN (N3) as well as
    internet aggregators for high street access

29
What have we achieved so far? - some numbers
(at 08/10/07)
  • 17,454 instances of systems connected into the
    national services which allows in a typical day
  • 190,000 prescription messages issued
    electronically (18 of all prescriptions)
  • 19,000 Choose and Book electronic bookings
  • 1,400,000 queries to be recorded on the patient
    demographic system enabling letters to be posted
    to the correct address and patient information to
    be handled more efficiently
  • These are deployed via the 20,662 connections to
    N3 (the national NHS WAN)
  • 380,350,622 images have been stored using PACS
    from NHS CFH
  • There are 394,367 Smartcard holders who are
    registered and approved for access to systems

30
Whats next - more clinical Information flows
between systems
Emergency Dept Discharge
Patient info
GP System
Patient visits GP
Acute System
Patient visits Emergency Dept
Update GP Summary
Emergency Dept Discharge
Patient info
Acute System
Patient visits hospital
Discharge
Enabled by standards (HL7v3 and HL7 CDA v2 over
ebXML (https/SOAP/XML) and central messaging
services (TMS)
Discharge
31
Agenda
  • Business Context
  • Enterprise Architecture Context
  • Services in an Enterprise Architecture
  • Using standards to enable integrated healthcare
  • Integration challenges
  • UK Government Enterprise Architecture

32
Integration The Challenges
  • Large number of suppliers and growing
  • Each supplier footprint is different can
    consume different services
  • Suppliers in different phases of development
  • Business critical services cannot be stopped
    for more than a few hours
  • We cannot lose data
  • Data must only flow from accredited applications
    running from authorised endpoints originating
    from users with the relevant roles
  • Large numbers of endpoints, systems and users
  • Strict Information Governance Rules

33
Challenges Service Definition
  • Right Granularity ? To high and they are subject
    to constant change. To Low and it can result in
    significant increases in message flow.
  • Generic or Specific business process ? The level
    of business logic can impact the re-usability of
    the service.
  • What SLAs ? Services that are used for many
    business functions may have varying SLA needs
    these must be balanced against cost
  • Trade off between performance and extensibility
  • What security model ? Whilst some aspects of
    information security can be centralised others
    must be federated

34
Challenges Compatibility
  • FORWARD and BACKWARD
  • A change to a service can impact many
    applications and suppliers
  • Each system needs to be fully tested before it is
    accredited for deployment !!!
  • The more versions we support the less scope we
    have to add new capabilities
  • Translation services are required to accommodate
    supplier applications running at different
    versions

35
Services usage can be different to expectation
  • All local systems will integrate with Summary
    Care Record
  • SCR provides a set of services to enable this in
    different ways

Summary Care Record
36
Agenda
  • Business Context
  • Enterprise Architecture Context
  • Services in an Enterprise Architecture
  • Using standards to enable integrated healthcare
  • Integration challenges
  • UK Government Enterprise Architecture

37
Cross Government Enterprise Architecture
  • CTO Council formed in Sept 2005. The aim is to
    support the CIO Council through the optimisation
    of the use of IT resources across the public
    sector.
  • Strategic value of xGEA is to identify
    opportunities for collaboration and reuse across
    government.
  • Without a business and IT Blueprint for
    Government an Enterprise Architecture
    avoidable cost would be incurred as IT is
    developed in islands.

38
So where do the CTO Council sit?
39
xGOV EA Domains and Leads
STRATEGY Andrew Stott (Cabinet Office)
CHANNEL DOMAIN Terry Hawes (HMRC)
PROCESS DOMAIN John Wailing (Home Office)
INFORMATION DOMAIN Pete Desmond (DWP)
INFORMATION ASSURANCE DOMAIN Marc Hocking
(Cabinet Office)
INTEGRATION DOMAIN Inderjit Singh (NHS CfH)
SERVICES MANAGEMENT DOMAIN Paul McAvoy (DWP)
APPLICATION DOMAIN TBD
INFRASTRUCTURE DOMAIN Andrew Bull (HMRC)
40
xGov EA Context
  • The majority of the work of the CTO council is
    structured around the xGov EA through the Domain
    Teams.
  • The Domain Team leads collectively form the
    Architecture Review Board (ARB) whose purpose is
    to
  • Oversee the development of cross-Government
    Enterprise Architecture xGEA
  • Oversee the development and operation of the
    clearing house process for exemplars
  • Assesses the fitness for purpose of proposed
    exemplars (managed services and solutions) for
    reuse across the public sector
  • Resolves overlaps between domains
  • Provides a forum for peer reviews

41
Capturing EXEMPLARS at various levels
  • A hosted service that is offered to others
  • A packaged service including code, design that
    can be rebuilt
  • The approach to providing the service
  • Experiences gained implementing the service

42
Clearing House Process and Domain ToR Detailed
Process Flow
Business Idea X Architecture Priority 1 CIO
Gate Status Viability Primary Domain
Infrastructure Secondary Domain Channels
Business Idea X
Business Idea X Architecture Priority 1 CIO
Gate Status Viability Primary Domain
Infrastructure Secondary Domain Channels
Re-used Business artefact
eRoom
43
Summary
  • Use a service based Enterprise Architecture to
    enable a common language
  • Set standards and frameworks that permit
    increasing levels of interoperability and
    interaction across multiple suppliers
  • Be aware of the challenges of integrating
    multiple suppliers
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