HL7 A.2 Messaging within Wales

HL7 A.2 Messaging within Wales

Karen WinderNorth Glamorgan NHS Trust

The need for standardisation of message exchange

1999 saw the formation of Cervical Screening Wales - CSW A National Service for managing the Cervical Screening

program in Wales requiring data in a standard format from all Welsh legacy pathology systems

Information requirement for smear takers and screeners opinions in conjunction with the patients results

Simple delimited flat file was suitable for basic data transfer but complex histology and cytology pathology results required a more structured message – HL7UK A.2

Repository synchronisation

Multiple National Services now utilise these messages for surveillance and screening purposes

Standardising on the HL7UK A.2 message allows: Pathology systems at all Welsh Trusts to transfer data in

the same message structure One interface engine to receive the messages and feed

several repositories Weekly downloads of authorised histology to:

Breast Screening Wales Cervical Screening Wales Welsh Cancer Intelligence Surveillance Unit

Progress to real time messages for database synchronisation

Use the functionality within the HL7 message for real time data base synchronisation from all pathology disciplines

This enables additional applications such as: Data repositories for access to pathology and radiology

results which supplies clinicians with up to date status information on requests and results

Transfer of pathology results to CANISC (the Cancer data repository for Wales) to provide continuity of care

Breast Screening results to GP using HL7 A.2 messages

Breast screening currently generates thousands of paper reports per GP surgery each cycle

These reports are then manually typed into the GP system This process is currently being replaced in Wales by HL7 A.2

messages generated from the National Breast Screening System and sent out via Middleware and DTS to the GP systems

The scope of the project currently includes normal results, DNAs and decliners

It will be extended to include Bowel Screening results later next year

Results to Requesting

2006 saw the development of an in-house electronic ordering solution for pathology

This extended the functionality of the legacy pathology systems to include HL7UK A.2 orders as well as results

It encompasses both primary and secondary care ordering

Disciplines currently in scope are Biochemistry, Haematology and Microbiology

Welsh Clinical Portal and Test Requesting and Results Reporting

Test Requesting and Results Reporting (TRRR) in the Welsh Clinical Portal is making use of the developments at Trust level using A.2 as the standard for orders and results.

A number of new components are also being developed, including the portal’s user interfaces and the National Pathology Handbook.

Messaging Fabric

Institution- based System (Hospital)Institution- based System (Hospital)

Pathology Service

Clinical PortalClinical PortalClinical Portal

Clinical Portal Services




Requests

Results

Orders

RequestMonitor

OrderMonitor

Laboratory System

Inbound message queue

BiochemistryMicrobiology Haematology

Outbound message queue

Print engine

PASdatabase

TraditionalPAS

interfaces

PAS

adapter

adapter

Nationalpathologyhandbook

NHS Wales Clinical Portal

Peter Nicklin

HL7 UK Annual Conference, November 2007

NHS Wales

Topics:

• NHS Wales National Architecture

• NHS Wales Clinical Portal

• Clinical Communications and CDA.

NHS Wales

Topics:




NHS Wales National Architecture

Objectives:• Provide a migration path for NHS Wales

health systems from “where we are now” to a common framework,

• enable communication between clinical services within an organisation (short term),

• enable communication between organisations (longer term),

• adapt to radical changes in organisation structures (mergers, specialisations etc.),

• protect privacy and confidentiality.

NHS Wales National Architecture

Infrastructure:• information design for what information will be

exchanged,• SOA: how information will be exchanged,• connectivity with existing systems,• identification of patients, users, and

organisations, • security and control of the use of information.

Institution- based System (Hospital)

PAS

Pharmacy

Pathology

Radiology

Other systems

5

Institutional Messaging Fabric

National Messaging

Fabric


Patient Record

Services 2

Patient Record

Services

Patient Record

Services

PAS

Pharmacy

Pathology

Radiology

Other systems

PASPAS

PharmacyPharmacy

PathologyPathology

RadiologyRadiology

Other systemsOther systems

Clinical Portal


Clinical Portal


Clinical Portal



Gateway Services

4

Gateway ServicesGateway Services

Authentication

Services

Authentication

Services

Authentication

Services

Demographics

Services

Demographics

Services

Demographics

Services

linked together by

the messaging

fabric.

the Welsh Clinical Portal,

Adapters to existing

departmental systems,







develop the local

patient record

NHS Wales National Architecture - LocalNHS Wales National Architecture - National

national services need a

national messaging

fabric

national

services

national

services

and gateways to

external systems

NHS Wales

Topics:





Objectives:

• clinical communications and correspondence,

• view an individual's records,

• request, prescribe, report, track,

• document care.


Phases:• foundation phase:

– lists and basic patient information,– pathology requests and results.

• further phases:– radiology requests and results,– referral and discharge comms. (+ clinic letter),– transcription of medicines,– etc..


Approach:• Requirements and design:

– User Centred Design sessions,– heavy emphasis on clinical needs,– captured in the Generic Information Framework

for the Individual Record (GenIFIR).

• Iterative. Services & phases based on:– user requirements as they are gathered,– feedback from clinical use of the Portal.

NHS Wales

Topics:





PAS

Pharmacy

Pathology

Radiology

Other systems

5

Institutional Messaging Fabric

National Messaging

Fabric


Patient Record

Services 2

Patient Record

Services

Patient Record

Services

PAS

Pharmacy

Pathology

Radiology

Other systems

PASPAS

PharmacyPharmacy

PathologyPathology

RadiologyRadiology

Other systemsOther systems

Clinical Portal


Clinical Portal


Clinical Portal



Gateway Services

4

Gateway ServicesGateway Services

Authentication

Services

Authentication

Services

Authentication

Services

Demographics

Services

Demographics

Services

Demographics

Services

NHS Wales Clinical Communications

access to external patient records

Clinical communications

Demands:• complex clinical info.: diagnoses, signs & symptoms,

medications, results etc.,• linked information,• identity: attribution, provenance, creator, the individual,• domains: identification, code sets,• flexibility, the capacity to reorganise information (into a

new document),• longevity; all information must have a human-readable

form,• usability,• stability.

CDA CharacteristicsHL7 CDA Release 2.0, 28th July 2003

• Persistence – A clinical document continues to exist in an unaltered state, for a time period defined by local and regulatory requirements.[1]

• Stewardship – A clinical document is maintained by an organization entrusted with its care. • Potential for authentication - A clinical document is an assemblage of information that is

intended to be legally authenticated.• Context - A clinical document establishes the default context for its contents.• Wholeness - Authentication of a clinical document applies to the whole and does not apply to

portions of the document without the full context of the document.• Human readability – A clinical document is human readable. ..from elsewhere…(Human

readability applies to the authenticated content. There may be additional information conveyed in the document that is there primarily for machine processing that is not authenticated and need not be rendered.)

• ……………….• Pre-formatting documents:

– section level templates– entry level templates

• …...............................• Provenance (paraphrased): authoriser, transcriber, doer, etc..

[1] There is a distinct scope of persistence for a clinical document, independent of the persistence of any XML-encoded CDA document instance.

Major components of a CDA document:

<ClinicalDocument> ... CDA Header ... <StructuredBody> <section> <text>...</text> <Observation>...</Observation> <Observation> <reference> <ExternalObservation>...</ExternalObservation> </reference> </Observation> </section> <section> <section>...</section> </section> </StructuredBody></ClinicalDocument>

Context

HL7 A.2 Messaging within Wales

Documents

cytology pathology results

bowel screening results

hl7 message

national pathology handbook

pathology disciplinesthis

messagesbreast screening

normal results

radiology results