Transforming Government using Open Standards

Transforming Government using Open Standards JagdipGrewal Chief Technical Architect 29th October 2007

Agenda • Business Context • Enterprise Architecture Context • Services in an Enterprise Architecture • Using standards to enable integrated healthcare • Integration challenges • UK Government Enterprise Architecture

Our Objectives • To deliver a 21st century health service through efficient use of technology to: • Enable and improve Access and Choice • Enable care pathways and patient focus • Improve accuracy in treatment • Create opportunities for improved efficiency • Create opportunities for real NHS reform

DemographicChallenge Ageing Population 2001 – over 60s > than under 18s 2050 – 4 times as many needing care At 4 times the current cost …while the number available as carers declines

The need for change Has overburdened the system A Changing Health Environment • 1,200 Patients dying each year from medication errors • 5,000 procedures cancelled each year • 5% of patient safety incidents due to documentation errors • Life expectancy increased to 75 years • 9 million people over 65 and increasing • Population more mobile • Greater long term chronic illness • Patients more educated on health and want greater involvement • The NHS in 2002 • Patient records held on paper • Highly variable usage of IT • Lots of home-grown specialist systems • Continuing reliance on 1970s mainframes 1

Challenges • Local procurement of IS/IT Systems by GPs, Trusts etc • Disparate Technologies, 1000s of suppliers • Limited data sharing • Lack of standardisation • Lots of paper • Little leverage of NHS buying power

The answer… • National Programme for IT • Launched Spring 2002 by “21st Century IT” policy document • Mobilisation from Q1 2003 • Procurement completed Q1 2004 • ‘Services’ based contracts • Local and National Suppliers • £6bn of IT services contracted over ten years

Scope Secondary Uses Service chooseandbook Analysing National Health Trends Patient Choice • Largest civil IT project in the world • 40,000 GPs • 80,000 other doctors • 350,000 nurses • 300+ hospitals • 10 year programme • 50m+ patients • 1.344m healthcare workers Electronic Prescriptions Service N3 New National Network Picture Archiving & Communications Service NHSmail Healthspace Secure E-mail for all NHS workers Web Access for Patients National & Local Care Record Services

…and what does it look like Multiple and Disparate Channels 3 Suppliers with differing Architectures 120 Different Supplier Accredited Systems to integrate Integration required with set of common services

Programme Challenges • Hundreds of different applications and suppliers • Large scale systems e.g. Prescriptions at 500tps • End Users with differing requirements and geographically distributed • Diverse (often ‘legacy’) Supplier Technologies • Lack of Standards • Desire to Use COTS packages – avoid bespoke • Evolution in requirements and functionality • Data availability, quality and integrity is critical • Enterprise Architecture required to define overall End to End approach

Business Services IS Services Technology Services Enterprise Architecture EA - Context Medical Advances LSP/ESP NHS CFH NASP Policy Outcomes Better Patient Care Reduced Cost Lower waiting Times Clinical Processes Patient Demand We may all have different perspectives but we can make our lives much easier by ‘talking’ the same language.

The bigger picture - In support of traceability (simplified view)

NHS – relationship map

Enterprise Architecture – Domain View

Conceptual Services: what we do

E.g. Demographics Within local Services Domain • Set of services required to be implemented by local systems Within Enterprise Services Domain • Set of services required to be implemented by national service provider for all 60m patients Set of compliance docs from NHS CFH • Covering requirements to be met by systems implementing those services • MIM for message definitions and example process flows • Principles - loose coupling, search local first, update local first • What is to be tested and verified during integration testing

Logical Applications…

The role for standards • Explicit from the outset. • The standards base evolves and grows • Standards chosen to maximise interoperability and to meet different integration requirements • Use of ebXML, (https, SOAP, XML) - reliable asynchronous messaging for patient demographic updates • Web Services and WS standards e.g. WS-A – lightweight synchronous messaging for patient demographic queries • Use of SNOMED CT • Use of HL7 v3 (ETP, C&B, PDS) and CDA v2 (Clinical Documents) • Lots more…. • Objective is to federate the design responsibility to the systems providers, working within a framework of standards and specifications

Not just technical standards • Common User Interface (CUI) - Microsoft and NHS CFH (http://www.mscui.org/) • Knowledge authorship to allow Knowledge Support (KBS) and Decision Support into all aspects of the implementation • The International Health Terminology Standards Development Organisation • SNOMED CT • Charter Members (Australia, Canada, Denmark, Lithuania, New Zealand, United Kingdom United States) • A drug database – The Dictionary of Medication and Devices (dm+d) • Standards by which we accredit systems as safe to implement and exchange information

Elective / Passive Decision Support – same component in all local solutions

Standard drug dictionary A standard drug dictionary for all systems We (and Australia) have chosen to make and maintain a new one called dm+d (The dictionary of medications and devices) NB. This is NOT decision support but a standard way of naming and structuring medication and devices so that decision support and complex rules based content can be added with predictable results.

Snomed CT drug core etc etc IS_A Beta-blocker drug IS_A Cardioselective beta-blocker IS_A Atenolol (drug product) (VTM) NHS dm+d Atenolol 50mg Tablet (VMP) Atenolol 50mg Tablet x28 (VMPP) Atenolol 50mg Tablet (COX) (AMP) Atenolol 50mg Tablet (Cox) X28 (AMPP) Dm+d and SNOMED CT (300,000 terms) • Both dm+d and SNOMED have a central core with local additions

Standards enable supplier expansion • The use of Open Standards for integration (ebXML, HL7) has enabled an expansion in number of suppliers to the programme • Leverages existing knowledge capital and established standards • Allows suppliers to build COTS packages based upon industry standards. Move away of bespoke development • Allows plug and play of new services • Standardisation reduces overall testing complexity • To meet business objectives we have integrated • 100s of supplier applications • Access from private corporate WAN (N3) as well as internet aggregators for high street access

What have we achieved so far? … - some “numbers” (at 08/10/07) • 17,454 instances of systems connected into the national services which allows in a typical day • 190,000 prescription messages issued electronically (18% of all prescriptions) • 19,000 Choose and Book electronic bookings • 1,400,000 queries to be recorded on the patient demographic system enabling letters to be posted to the correct address and patient information to be handled more efficiently • These are deployed via the 20,662 connections to N3 (the national NHS WAN) • 380,350,622 images have been stored using PACS from NHS CFH • There are 394,367 Smartcard holders who are registered and approved for access to systems

Broken Leg Back Pain Chest infection Summary Care Record What’s next - more clinical Information flows between systems Emergency Dept Discharge Patient info GP System Patient visits GP Acute System Patient visits Emergency Dept Update GP Summary Emergency Dept Discharge Patient info Acute System Patient visits hospital Discharge Enabled by standards (HL7v3 and HL7 CDA v2 over ebXML (https/SOAP/XML) and central messaging services (TMS) Discharge

Integration – The Challenges • Large number of suppliers – and growing • Each supplier footprint is different & can consume different services • Suppliers in different phases of development • Business critical services – cannot be stopped for more than a few hours • We cannot ‘lose’ data • Data must only flow from accredited applications running from authorised endpoints originating from users with the relevant roles • Large numbers of endpoints, systems and users • Strict Information Governance Rules

Challenges – Service Definition • Right Granularity ? To high and they are subject to constant change. To Low and it can result in significant increases in message flow. • Generic or Specific business process ? The level of business logic can impact the re-usability of the service. • What SLAs ? Services that are used for many business functions may have varying SLA needs – these must be balanced against cost • Trade off between performance and extensibility • What security model ? Whilst some aspects of information security can be centralised – others must be federated

Challenges – Compatibility • FORWARD and BACKWARD • A change to a service can impact many applications and suppliers • Each system needs to be fully tested before it is accredited for deployment !!! • The more ‘versions’ we support the less scope we have to add new capabilities • Translation services are required to accommodate supplier applications running at different versions

CSA LSP Pre-fetch ESP On-demand … Response Response Response Request Request Request Services usage can be different to expectation • All local systems will integrate with Summary Care Record • SCR provides a set of services to enable this in different ways Summary Care Record

Cross Government Enterprise Architecture • CTO Council formed in Sept 2005. The aim is to support the CIO Council through the optimisation of the use of IT resources across the public sector. • Strategic value of xGEA is to identify opportunities for collaboration and reuse across government. • Without a business and IT Blueprint for Government – an Enterprise Architecture – avoidable cost would be incurred as IT is developed in ‘islands.’

So where do the CTO Council sit?

xGOV EA Domains and Leads STRATEGY Andrew Stott (Cabinet Office) CHANNEL DOMAIN Terry Hawes (HMRC) PROCESS DOMAIN John Wailing (Home Office) INFORMATION DOMAIN Pete Desmond (DWP) INFORMATION ASSURANCE DOMAIN Marc Hocking (Cabinet Office) INTEGRATION DOMAIN Inderjit Singh (NHS CfH) SERVICES MANAGEMENT DOMAIN Paul McAvoy (DWP) APPLICATION DOMAIN TBD INFRASTRUCTURE DOMAIN Andrew Bull (HMRC)

xGov EA Context • The majority of the work of the CTO council is structured around the xGov EA through the Domain Teams. • The Domain Team leads collectively form the Architecture Review Board (ARB) whose purpose is to: • Oversee the development of cross-Government Enterprise Architecture – xGEA • Oversee the development and operation of the clearing house process for exemplars • Assesses the fitness for purpose of proposed exemplars (managed services and solutions) for reuse across the public sector • Resolves overlaps between domains • Provides a forum for peer reviews

Capturing EXEMPLARS at various levels • A hosted service that is offered to others • A packaged service including: code, design that can be rebuilt • The approach to providing the service • Experiences gained implementing the service

Generate Idea Delivery and Transformation Group Organisations’ Architecture Team Interface Process Entry CTO Council Organisation Organisation Organisation Organisation Organisation Organisation Organisation Test Feasibility Viability Define Idea ARB Define Proposition Check keywords against ‘Metadata’ Definition Domain Teams Organisations’ (Technical) Architecture Team Organisations’ (Technical) Architecture Team Organisations’ (Technical) Architecture Team Organisations’ (Technical) Architecture Team Organisations’ (Technical) Architecture Team Organisations’ (Technical) Architecture Team Organisations’ (Technical) Architecture Team Match Reqs Design Service Design Exemplar Exist Complete business case Business Justification Build Service Re-use as-is Record as WIP Enhance and re-use Reuse & Identify New Build Clearing House Test Service Go Live Harvest to Exemplar Live Running Future / WIP Existing Benefits Live Running Clearing House Process and Domain ToR Detailed Process Flow Business Idea X Architecture Priority : 1 CIO Gate Status : Viability Primary Domain : Infrastructure Secondary Domain : Channels Business Idea X Business Idea X Architecture Priority : 1 CIO Gate Status: Viability Primary Domain : Infrastructure Secondary Domain : Channels Re-used Business ‘artefact’ eRoom

Summary • Use a service based Enterprise Architecture to enable a common language • Set standards and frameworks that permit increasing levels of interoperability and interaction across multiple suppliers • Be aware of the challenges of integrating multiple suppliers

Transforming Government using Open Standards