Digital Health and Electronic Medical Records: Aligning the EU

and UK Agendas

A UK VIEW

Prof. Martin Severs

Presentation

• A Clinician View

• Major Drivers [Globally, Regionally and Nationally]

• Equity and excellence: Liberating the NHS [some drivers made real in UK English setting]

• Some pointers for alignment

A CLINICIAN’S VIEW

INFORMATION FOR POLICY: {Months to Years}

INFORMATION FOR ACTION: {Days to Weeks}

INFORMATION FOR CARE: {Minutes to Hours}

CLINICAL PRACTICE: {Now}

THE CONSULTATION: {Pt & Dr}

PROFESSIONAL & ORG. REGULATION

THE LAW

CITIZEN

MAJOR DRIVERS

Major Drivers• Autonomy of citizens; dominant moral

force [choice, free movement, access etc]

• Plurality of providers; doctor to clinician to patient [expert patient]

• De-medicalisation of [mild] illness: self diagnosis, OTC meds, tele-help lines

• Reduce or curtail rises in costs: 70% costs are staffing, mechanise transactions

Major Drivers• De-centralisation of illness management:

home versus hospital

• Technology/computers as ‘actors’ in health care; decision support, medical devices

• Ageing Society: Multiple pathology and greater awareness of Imp – dis/func – hand/part continuum

• Chronic illness being the health challenge

INFORMATION FOR POLICY: {Months to Years}

INFORMATION FOR ACTION: {Days to Weeks}

INFORMATION FOR CARE: {Minutes to Hours}

CLINICAL PRACTICE: {Now}

THE CONSULTATION: {Pt & Dr}

PROFESSIONAL & ORG. REGULATION

THE LAW

CITIZEN

Equity and excellence: Liberating the NHS

Equity and excellence: Liberating the NHS• In 48 pages there are the following

references:

• 54 to information; 29 to standards; 22 to data and 13 to records

• Embodies in an English NHS instance of most of not all of the major drivers except free movement

Informatics Standards [1]

• Explicit in the Information Strategy Autumn 2010– Record Practice: Sharing Records with Patients [4b]– Information governance standards [2.11; 2.16; 2.13]– Standard interoperable format for records [2.12]– Record transfer [2.12]– Record Keeping standards [2.16] versus data collection

standards [2.15]– Data standards that are person condition and treatment specific

[2.16;5.7]

Informatics Standards [2]

– Data standards for secondary use eg 2nd Edition ICD 10 for PbR [3.19]: performance [2.8;2.9;2.10]

– Data standards for workforce [4.33], events [5.12], services [2.21],

– Standard for data compositions [2.16] – Business definitions eg definitions of use and recognition

including records eg PROMS [2.7] & reconciliation with data standards [NICE [3.12.-3.15] vs WHO vs national audit vs etc]

Informatics Standards [3]: section 2.16

‘Providers will be under clear contractual obligations, with sanctions, in relation to accuracy and timeliness of data. Along with commissioners, they will have to use agreed technical and data standards to promote compatibility between different systems. The NHS Commissioning Board will determine these standards but they will include, for example, record keeping, data sharing capabilities, efficiency of data transfer and data security’

Some Pointers to Alignment

Some Pointers to Alignment• The big picture is becoming clearer [final slide]• Pan-government strategy is to adopt non-proprietary

international standards• A new single authority for informatics standards in the NHS:

the NHS Commissioning Board• ISB could be become the governance link and formal

advisory body to Pan government, NHS CB, Europe and International bodies for all informatics standards in NHS England

• The technology office could become the data standards life cycle management lead for approved fundamental data standards in England and management link to International standards development organisations

Some Pointers to Alignment• Standards must interact; so must their organisations;

example IHTSDO which manages SNOMED CT• HL7: Terminfo work product: Initial guide on how to use SNOMED CT in HL7• OpenEHR: Initial agreement to begin working together is complete; Closer working

relationship is being developed• WHO : Nearing agreement on cooperative work plan encompassing all WHO classifications

(ICD-10, ICD-O, ICD-11, ICF, etc)• LOINC and IFCC-IUPAC (NPU); Nearing agreements on laboratory test terminology

cooperation• IHE: Work to date driven by individual IHTSDO Members e.g. Netherlands Nictiz,• GMDN Agency: Detailed discussions are underway re Linkage between SCT & GMDN• DICOM: Long-standing working relationship

• Professional leadership of record keeping informatics standards and clinical governance of other informatics standards at national, European and International level could be improved

Alignment: requires managed tension

Citizens & Patients

Information Technology

Health OrganisationsProfessions Successful Digital Health

CUI DISPLAY

OU

TP

UT

SP

EC

CU

I INP

UT

Com

positions

Mapping

Mapping

Messaging Schema

File transfer

Central

Collection /

Repository

Indicators and M

etrics

Algorithms / Calculations

Secure P

ortal

Policy D

rivers

Patient N

eed

Record Keeping Standards

Dashboards

Record Content StandardsStatistical Standards

Clinical Safety Testing

Organisational Safety Testing

Human Behavioural Guidance Organisational GuidanceTechnical Guidance

Algorithms / Queries

“QO

F –

like” m

easures

Term

inology & R

ecord Data S

tandards

Class G

roups

Citizen Patient & Clinician

INP

UT

SP

EC

Record Classification Standards

Decision Support & Patient Care Operational Management

Algorithms / Queries

Produced by John Varlow, & Martin SeversVersion 1.0114 July 2010 © Information Standards Board 2009

Binding