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The role of the CfH Interoperability Toolkit (ITK)

in information sharing13th October 2009

Keith Naylor

Head of DS&P Implementation

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CfH Interoperability Toolkit (ITK)

• Overview and Positioning• Principles• Selected Standards• Profiling• IHE-UK and HL7-UK involvement

• ‘Unifying the Belts’

• Pilots• Questions

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Overview and Positioning

Christine Connelly made a public commitment to the development of a toolkit for interoperability.  The objectives of this work are as follows:

• The publication of a set of standards and frameworks for interoperability covering transactional and analytical services – by end Sept 09

• The implementation of the services for use by third party – by end March 2010

• The development of guidance for the use of the standards – by end March 2010

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Overview and Positioning

• Publication of specifications will be driven by pilot (proof of concept) use cases.

• September publication is ‘draft - for consultation’ inviting comment and opportunity for refinement

• Specification development will continue beyond September in association with:• Vendors associated with pilots• HL7-UK• IHE-UK

• Note: On completion, Technology Office will seek ISB approval for the standards referenced in the specification

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Overview and PositioningO

per

atin

g M

od

el

(Pro

cess

es a

nd G

over

nanc

e)National Profiles (standards)

Applications (use of data)

• Standards are defined appropriate to the business scenario (e.g. HL7v2, HL7v2 XML, HL7v3) with focus on simplified XML to reduce barriers for new suppliers.

• Messaging Infrastructure exposes interfaces (based upon the standards) and provides technical services e.g. adapters, audit, routing, security

• Applications use adaptors (or standards directly) to execute business processes

• Operating Model provides enabling processes and governance

• Standards are defined appropriate to the business scenario (e.g. HL7v2, HL7v2 XML, HL7v3) with focus on simplified XML to reduce barriers for new suppliers.

• Messaging Infrastructure exposes interfaces (based upon the standards) and provides technical services e.g. adapters, audit, routing, security

• Applications use adaptors (or standards directly) to execute business processes

• Operating Model provides enabling processes and governance

ApplicationSuppliers

Messaging Infrastructure (connectivity)Middleware

Suppliers

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Comparison to Spine

Spine Toolkit

Interfaces are defined by CFH in

MIM / EIS New ITK specifications

Interfaces primarily describe

National Services (e.g. PDS)

Local Services (e.g. PAS)

Interfaces are exposed via

TMS New ITK middleware solutions

Number of instances

One (National)

Many (Based around Local Health Communities)

Middleware supplier(s)

NASP Multiple middleware vendors

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PrinciplesEstablished standards (Best-of-Breed)

Proven and established standards will be used wherever relevant. A flexible, best-of-breed approach will be used to select the standards most appropriate to the integration task in hand.

Practical approach

The Toolkit is not an academic exercise. All Toolkit development will be based on genuine business problems and pilot implementations in a Live Trust environment.

Lean but extensible

The Toolkit will contain only the features necessary for concrete practical scenarios, with no unneeded theoretical “baggage”. On the other hand, there is a balance to be struck – and the lean approach means that it is important to plan in extensibility for future needs.

Low barriers to entry

Clear standards will explain clearly what is required to participate in the market. Standards definitions will be kept simple and based on widely understood technologies (e.g. Web Services, XML)

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Principles

Toolkit (ITK)

The initial tranche of message payloads identified for the pilot deal with the Administrative domain. Therefore HL7v2.4 XML has been selected as the most appropriate standard.

PID|||1234567891||EXAMPLE^DAVID^S||19590520|M|||23MAINSTREET^^ANYTOWN^

PID|||1234567891||EXAMPLE^DAVID^S||19590520|M|||23MAINSTREET^^ANYTOWN^

PID|||1234567891||EXAMPLE^DAVID^S||19590520|M|||23MAINSTREET^^ANYTOWN^

HL7 v3 (Lite)

National HL7v2.XML

Web Services

HL7 v3 (Lite)

National HL7v2.XML

HL7 v2 (Lorenzo)

HL7 v2 (Cerner)

HL7 v2 (Kiosk)

New Toolkit App (external)

New applications can build directly to the Toolkit standards. No adaptor needed

New applications can build directly to the Toolkit standards. No adaptor needed

Standard adaptors, provided with the Toolkit for common conversions

Standard adaptors, provided with the Toolkit for common conversions

Bespoke adaptor, developed by existing Kiosk vendor

Bespoke adaptor, developed by existing Kiosk vendor

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Standards ChoiceInitial Choice:

• HL7 version 2.4

• initially based on HL7-UK Version 2.4 A2

• Proposal to ‘profile’ this for use in the UK with HL7-UK and IHE-UK support

• Eventual submission to NHS Information Standards Board

National / International Standards

Exiting system capability

Timescales

Proof of Concept scenarios

Extensibility and future requirements (native pipe and hat over MLLP)

• Decision to natively support the XML format of HL7v2.4 over web services

• Provide native toolkit adapter to convert ‘|^’ (pipe and hat) over MLLP

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Examples

Traditional ‘^|’ form of HL7:MSH|^~\&|PAS|ORG1|LSP|ORG1 |20070927152752||ADT^A01^ADT_A01 …

XML form of HL7:<HL7>

    <ADT_A01>        <MSH>            <MSH.1>|</MSH.1>            <MSH.2>^~\&amp;</MSH.2>            <MSH.3>PAS</MSH.3>            <MSH.4>ORG1</MSH.4>            <MSH.5>LSP</MSH.5>            <MSH.6>ORG1 </MSH.6>            <MSH.7>20070927152752</MSH.7>            <MSH.9>                <MSH.9.1>ADT</MSH.9.1>                <MSH.9.2>A01</MSH.9.2>                <MSH.9.3>ADT_A01</MSH.9.3>            </MSH.9>

…..    </ADT_A01></HL7>

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ITK Reference Tables

• We have started a process of reviewing all the reference data tables in the HL7v2.4 specification in order to identify mismatches with PDS, SDS, NHS Data Dictionary etc.

• Part of the profiling process will be to agree a common set of nationally agreed reference values (where appropriate)

• Invitation to all stakeholders to engage in this review process

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HL7v2.4 XML

Benefits of choosing HL7v2.4, XML over Web Services:• Continue support for National Standards• Minimal change to current application capability• Provision of ‘toolkit adapters’ for standardised

transforms (Pipe and Hat -> XML)• Ability to cross enterprise boundary using existing

TMS/N3 protocols• ‘Black Box’ toolkit services, abstracted from vendor

services.• Ability to easily extend range of services provided

through toolkit

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The Pilots - background

•A key aspect of the current Toolkit work is that it is based on practical pilots

•The aim is not just to create documents and specifications, but also to demonstrate the Toolkit in use within real-world NHS Trusts

•By working closely with stakeholders to develop the Toolkit approach, the aim is to deliver business benefit from the very start

•Note that the initial pilots are based on iPM and Cerner.

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The Pilots

Clinical Domains?

Administrative Domains

Other?

Scope of pilot

Potential future directions

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Directions – Interoperability Coverage

Local Health Community

Acute TrustCross Health Community / National Services?

Initial pilot scenarios, based around

interoperability within an Acute Trust

Potential future directions – linking

Toolkits to the Spine and/or each other?

Further pilot scenarios to enable

Local Health Community

interoperability (e.g. GP)

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Pilot Scenarios

Scenarios identified include:

Scenario BenefitsSMS Reminders Reduction in DNA

Self-Service Outpatient Kiosks

Reduction in Resource/Improve Data Quality

Patient Ward/specialty transfer

Reduction in Resource/Improve Data Quality

NHS encounter summary

Cross-care exposure

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Summary

• Ease the local integration burden on trusts implementing LSP (or indeed any) solution

• De-risk the development of third party/departmental vendors

• De risk local procurements and their integration with the LSPs

• Timeline:

• September 2009 – Draft operating framework out for comment via Intellect UK

• March 2010 – Pilot implementations of example applications utilising ITK operating framework

• HL7v2.4 based messaging to support pilot scenarios, over XML and web services

• Invitation to engage and help develop the profile development

• Invitation to develop innovative applications based on the ITK (after March 2010)

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Questions