Connected Care Standard for transfer of care and shared care applications
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Alastair Kenworthy Ministry of Health (Wednesday, Interoperability Workshop)
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Connected Care Standard for transfer of care and shared care applications
- 1. Connected Care Standard for transfer of care and shared care applications Alastair_Kenworthy@moh.govt.nz 7 November 2012 PREPARED BY
- 2. Connected Care Standard … … An unexpected(-ly long) journey! 2010 Midland ‘core clinical dataset’ GP2GP HISO 10040 HIEs HISO 10041 – 2013 Q1/2 2
- 3. Reference Architecture for Interoperability SAG review Vendor review 3
- 4. Requisite standards for 2014 4
- 5. The unstoppable march of CDA RSD (HISO 10011) and ePharms (10030) based on HL7 version 2.4 Counties Manukau & Taranaki pilot PDF + v2 transport for eDS Hutt Valley, Auckland and Canterbury referral solutions implement RSD, but in different ways … GP2GP goes live with CDA + v2 transport Counties eDS solution moves to CDA + v2 transport NZePS built on CDA and SOAP web services interRAI reports built on CDA and SOAP web services 5
- 6. CDA solar system 6
- 7. The changing world view 7
- 8. Right side up architecture PMS local Forms service interfaces are – environment CDA enabled both sides XDS enabled on one side HIE (outside world) 8
- 9. Connected Care Standard (HISO 10041) 10041.1 Referral Request 10041.2 Shared Health Summary 10041.3 Medications List 10041.4 Discharge Summary 10041.5 Health Event Summary 10041.6 GP2GP 10041.7 Ambulance ePRF 10043 CDA Common Templates (+ code sets) 10047 Comprehensive Clinical Assessment (interRAI) 9
- 10. Development timetable Release for consultation Specifications February 2013 Discharge Summary CDA Common Templates Common Code Sets March 2013 Shared Health Summary May 2013 Referral Request 10
- 11. ‘… a core set of personal health information …’ Required for 2014 OK if beyond 2014 Demographics Alerts and allergies Immunisations Screening results Encounters (admissions) Encounters of all kinds Medications (discharge) Medications (My List of Meds) Problems (conditions) Lifestyle risk factors Test results Vitals (eg BMI) Appointments Advance directives Enrolments Healthcare providers Support people 11
- 12. From: Bob Dolin Sent: Tuesday, November 29, 2011 12:55 PM To: Rishel,Wes; Pratt, Douglas (H USA); robert worden; Structured Documents WG Subject: RE: CDA or greenCDA Hi Wes, What is CCDA? Thanks, Bob 12
- 13. Consolidated CDA 13
- 14. Origins of CCDA 10040.3 10041 GP2GP 10040.2 14
- 15. Makeup of CCDA 15
- 16. CDA templates A process of design by constraint CDA clinical statements expressed within a fixed XML schema CDA templates refine the basic model – Reflecting business rules Limiting unnecessary choices (optionality, code sets) Often expressed as conformance statements – thou shalt … Usually implemented as Schematron rules 16
- 17. How NeHTA does templates NeHTA specifications include (per eDS etc) – 1. openEHR Archetypes (content model) 2. Core Information Components (data requirements) 3. Structured Documents Template (abstract document model) 4. CDA Implementation Guide (templates) 17
- 18. Our killer application Having a SNOMED CT coded eDS would be like Xmas to GPs Global general practice reference set has ~3500 concepts (July 2013) Locally, all clinical systems SNOMED enabled from x date – 2015? Typical ED reference set (NeHTA’s) comprises – Reason for presenting (71 concepts) Findings in presenting problem (222 concepts) Diagnosis in presenting problem (244 concepts) 18
- 19. Inside SNOMED Concepts each have one fully specified name and any number of preferred terms and synonyms Based on description logic alllowing reasoning about concepts and relationships Topology is ‘small world’ and ‘scale free’ (easily navigated and organic growth) 19
- 20. Problem 1: Makeup of our CDA document types Section eDS SHS HES eRef Alerts and allergies Immunisations Encounters Medications list Problems list Test results Appointments Enrolments Healthcare providers Support people 20
- 21. Problem 2: Adverse reactions dataset 21
- 22. Problem 3: Care plans dataset 22
- 23. 23
Notas del editor
- This presentation covers the development of the Connected Care Standard for e-referral, discharge and shared care applications, its origins in the Reference Architecture for Interoperability, and the approach we have taken of localising the international Consolidated CDA specification.
- How have things changed from a year ago? The Reference Architecture for Interoperability was ratified and an incremental update on what we are calling ‘connected care’ was added to the earlier foundations document. The absolute essentials were captured in the HISO 10040 standard for HIEs.Our philosophy on health information sharing remains based on –Structured informationCommon information modelStandardised exchange formatsShared out of repositories via web services Loosely coupled point of care systemsHISO 10040 (interim) standard for HIEs – CDA documents as a common currencyXDS-powered regional (and national) CDRsopenEHR archetypes for data models
- What standards do we need to reach the 2014 goal?Of these, HISO 10040 is an interim standard (awaiting trial implementation)Transfer of Care Standard is scheduled to be released for public comment before the end of 2012, ePharms (necessary for the NZePS) after thatThe Comprehensive Care Assessment Document will be a standardised interRAI extractWe will also have refreshed health identity standards
- The 1980s have called to ask for their messaging technology back
- The diagram shows the CDA solar system, with the blue planets representing sets of templates and document types we use locally, deriving from international specifications (green)We are strongly internationally influenced, reusing wherever the fit to requirements is better than we could hope to achieve by ourselvesThe Continuity of Care Record (CCR) – although not itself CDA – is the origin of our conceptual data model for information exchangeThe other document types shown are: Consolidated CDA (CCDA) developed by the US’s ONC for Health IT; Continuity of Care Document (CCD); local GP2GP; local e-discharge summary (eDS); local e-prescription document; local transfer of care – generic referral/discharge document
- The PMS centric view of the health sector is a bit like Ptolemy’s geocentric model of the universeThis is the world view that the Online Forms approach supportsOur new Copernican world view, centred on regional
- You might be wondering – as one of the founder
- Many different kinds of documents, a bucket of modular templatesThe CCD implementation guide is 100 pages, CCDA is 500 pages
- The templating process is an example of design by constraint