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GP to GP Transfer

PRIMIS. GP to GP Transfer. Dr John Williams PRIMIS Clinical Adviser. Fifth Annual Conference 11 – 12 May 2005 Pieci ng Together the Future. GP to GP record transfer. John Williams (Lead Clinician for GP 2 GP messaging project). Areas we could cover. The GP to GP business process

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GP to GP Transfer

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  1. PRIMIS GP to GP Transfer Dr John Williams PRIMIS Clinical Adviser National PRIMIS Conference Fifth Annual Conference 11 – 12 May 2005 Piecing Together the Future

  2. GP to GP record transfer John Williams (Lead Clinician for GP 2 GP messaging project) National PRIMIS Conference

  3. Areas we could cover • The GP to GP business process • How the ‘payload’ is transferred • What the system suppliers need to do • The safety testing process • Steps to implementation • What can PRIMIS contribute? National PRIMIS Conference

  4. The GP to GP business process (1) • Relates to patients changing practice • Needs to be tied in with • Registration and deduction processes • Role based access controls • Legitimate relationships (eventually) • Augments existing paper process National PRIMIS Conference

  5. The GP to GP business process (2) • Driven from the point where patient registers with new practice • Uses the Spine • As a ‘store and forward’ relay • To authenticate • User – using SDS (Spine Directory Service) • GP system – using SSB (Spine Security Broker) • Patient’s identity and current registration details – using PDS (Patient Demographic Service) and SDS National PRIMIS Conference

  6. The GP to GP business process (3) • Request for patient’s electronic health record (EHR) • Triggered as patient registers with ‘new’ practice • Automatically sent • Various authentication processes occur including check that ‘old’ practice is GP 2 GP enabled National PRIMIS Conference

  7. The GP to GP business process (4) • ‘Old’ practice acknowledges request and confirms that patient’s EHR will be sent as soon as possible • Will become automatic in phase II • ‘Old’ practice later sends the EHR ‘payload’ • Likely to become automatic in phase II • ‘New’ practice sends acknowledgement that EHR has been received and successfully imported • To be added in phase II National PRIMIS Conference

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  9. How the ‘payload’ is transferred (1) • GP to GP message • Part of the ‘Connecting for Health’ Message Implementation Manual (MiM) • XML based • HL7 (Health Level 7) version 3 compliant schemas • Point to point • Spine as ‘store and forward’ relay National PRIMIS Conference

  10. GP 2 GP – the HL7 R-MIM National PRIMIS Conference

  11. A small sample of XML… - <component> - <CompoundStatement classCode="CATEGORY"> <id root="DD4F8DC2-F565-4D12-960E-2A8FB1C3288B" /> - <code code="394841004“ codeSystem="2.16.840.1.113883.6.96" displayName="Other"> <originalText>Result</originalText> </code> <statusCode code="COMPLETE" /> <effectiveTime value="20040913" /> <availabilityTime value="20050318083158" /> - <component> - <NarrativeStatement> <id root="459B2D6F-723B-40E3-A0E2-86CE933701C6" /> <text>Micro, culture & sensitivities, Normal</text> <statusCode code="COMPLETE" /> <availabilityTime value="20050318083158" /> </NarrativeStatement> </component> </CompoundStatement> </component> National PRIMIS Conference

  12. How the ‘payload’ is transferred (2) • Sending practice system transforms EPR into XML ‘extract’ • XML extract is sent in appropriate ‘wrappers’ across a TLS link • Spine provides Store and forward relay • XML extract forwarded to receiving practice system • Receiving practice system • Imports XML extract • XML extract previewed by user • XML extract filed by user National PRIMIS Conference

  13. How the ‘payload’ is transferred (3) • Filing process adheres to rules for transforming XML extract back to EPR • Where meaning can be preserved uses receiving system structured formats • Degraded to text where meaning cannot be preserved in receiving system structured format • May generate and store tasks to be worked on later by appropriately authorised users where it is not safe to rely on automatic translation National PRIMIS Conference

  14. How the ‘payload’ is transferred (4) • Such tasks / user involvement can be employed safely to retrieve information that otherwise would be degraded e.g.: • Authorising prescription of medications • Dealing with drug allergies • Business flow related information such as cervical cytology call / recall National PRIMIS Conference

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  16. What the system suppliers need to do • Develop modules that are usable and can handle • Extraction of EHR to XML • Import from XML to EHR • Technical issues of message transfer in NCRS environment • Successfully complete • Technical testing • Clinical safety assurance • Patient safety assurance National PRIMIS Conference

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  18. The safety testing process (1) • Role of the Clinical Safety Group of Connecting for Health • Clinical Safety Officer Dr Maureen Baker of National Patient Safety Agency • Clinical ‘Authority to deploy’ • Clinical testing on behalf of Joint GP IT Committee • Primarily concerned with safety in terms of preservation of meaning National PRIMIS Conference

  19. The safety testing process (2) • Clinical Safety Group prescribes a process which involves • Holding an ‘End to end hazard workshop’ to compile a ‘Hazard log’ • Deciding on measures to mitigate these hazards • Production of evidence that these measures have been effected • Generating a ‘Safety Closure Document’ • Clinical Safety Officer issuing ‘Clinical Authority to deploy’ if the whole process has been satisfactorily completed National PRIMIS Conference

  20. The safety testing process (3) • Clinical safety testing • Involves Clinical Lead with team of GP clinicians • If successful will lead to endorsement by Joint GP IT Committee • Endorsement by JGPITC is required before Safety Closure documents can be issued • Involves a sequence of tests National PRIMIS Conference

  21. The safety testing process (4) • Clinical safety testing involves a sequence of tests • With ‘artificial’ patient records • Checking the initial XML extracts • Doing A – A comparisons • Doing A – B comparisons • Doing A – B – C comparisons • With real patient records (involves patient consent) • Doing A – B comparisons • Doing A – B – C comparisons National PRIMIS Conference

  22. The safety testing process (5) • JGPITC endorsement will depend on • Satisfactory completion of clinical safety testing • As outlined, ensuring that key hazard log issues have been satisfactorily mitigated • Bearing in mind that it is neither possible nor necessary to test for every eventuality • Satisfactory completion of technical testing • Including demonstration that ‘artificial’ record with all attachments can be transmitted from end to end across the Spine without any loss National PRIMIS Conference

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  24. Steps to implementation (1) • Before implementation • Successful completion of testing of • Technical issues including • Patient identification • End to end transmission without loss • Clinical safety assurance • ‘Bench’ testing • Real patient record testing • Endorsement by JGPITC ….All leading up to ‘Clinical authority to deploy’ National PRIMIS Conference

  25. Steps to implementation (2) • Once ‘Clinical authority to deploy’ is obtained implementation at ‘Early adopter’ sites can start • Selected Primary Care Trusts (PCTs) • Limited to • Patient transfers within the PCT area • Practices that have been GP 2 GP enabled • Users will need to be trained • Will need to develop ‘Best practice’ guidelines National PRIMIS Conference

  26. Steps to implementation (3) • Experience at ‘Early adopter’ sites will be evaluated • Experience to date and ‘Early adopter’ site evaluations will influence future developments and plans for wider implementation National PRIMIS Conference

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  28. What can PRIMIS contribute (1)? • GP 2 GP safety assurance • Deals with transfer process only • ‘Rubbish in – rubbish out’ faithfully transmitted • Best practice and structuring of records • Communicating beyond local organisational bounds • CARAT matters more than ever National PRIMIS Conference

  29. What can PRIMIS contribute (2)? • Appropriate use of terminology to represent concepts • Consistent use of systems to structure information and to capture context • Think in terms of concepts rather than ‘codes’ • Meaning depends on concepts and context National PRIMIS Conference

  30. What can PRIMIS contribute (3)? • In the future may need to develop thinking about • “R” for ‘Relevance’ • Context • What is ‘Relevant’ depends on context • Harder to communicate effectively the less the shared understanding about context • Need to know what is relevant to the person(s) we are communicating with… National PRIMIS Conference

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