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Connected Care Standard for transfer of care and shared care applications

Connected Care Standard for transfer of care and shared care applications. Alastair_Kenworthy@moh.govt.nz 7 November 2012. Connected Care Standard …. … An unexpected(-ly long) journey! 2010 Midland ‘core clinical dataset’ GP2GP HISO 10040 HIEs HISO 10041 – 2013 Q1/2.

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Connected Care Standard for transfer of care and shared care applications

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  1. Connected Care Standardfor transfer of careand shared care applications Alastair_Kenworthy@moh.govt.nz 7 November 2012

  2. Connected Care Standard … • … An unexpected(-ly long) journey! • 2010 Midland ‘core clinical dataset’ • GP2GP • HISO 10040 HIEs • HISO 10041 – 2013 Q1/2

  3. Reference Architecture for Interoperability • SAG review • Vendor review

  4. Requisite standards for 2014

  5. The unstoppable march of CDA • RSD (HISO 10011) and ePharms (10030) based on HL7 version 2.4 • Counties Manukau & Taranaki pilot PDF + v2 transport for eDS • Hutt Valley, Auckland and Canterbury referral solutions implement RSD, but in different ways … • GP2GP goes live with CDA + v2 transport • Counties eDS solution moves to CDA + v2 transport • NZePSbuilt on CDA and SOAP web services • interRAI reports built on CDA and SOAP web services

  6. CDA solar system

  7. The changing world view

  8. Right side up architecture Forms service interfaces are – CDA enabled both sides XDS enabled on one side PMS local environment HIE (outside world)

  9. Connected Care Standard (HISO 10041) • 10041.1 Referral Request • 10041.2 Shared Health Summary • 10041.3 Medications List • 10041.4 Discharge Summary • 10041.5 Health Event Summary • 10041.6 GP2GP • 10041.7 Ambulance ePRF • 10043 CDA Common Templates(+ code sets) • 10047 Comprehensive Clinical Assessment (interRAI)

  10. Development timetable

  11. ‘… a core set of personal health information …’

  12. From:Bob DolinSent: Tuesday, November 29, 2011 12:55 PMTo:Rishel,Wes; Pratt, Douglas (H USA); robertworden; Structured Documents WGSubject: RE: CDA or greenCDA • Hi Wes, • What is CCDA? • Thanks, • Bob

  13. Consolidated CDA

  14. Origins of CCDA 10040.3 10041 GP2GP 10040.2

  15. Makeup of CCDA

  16. CDA templates • A process of design by constraint • CDA clinical statements expressed within a fixed XML schema • CDA templates refine the basic model – • Reflecting business rules • Limiting unnecessary choices (optionality, code sets) • Often expressed as conformance statements – thou shalt … • Usually implemented as Schematron rules

  17. How NeHTA does templates • NeHTA specifications include (per eDS etc) – • openEHR Archetypes (content model) • Core Information Components (data requirements) • Structured Documents Template (abstract document model) • CDA Implementation Guide (templates)

  18. Our killer application Having a SNOMED CT coded eDS would be like Xmas to GPs Global general practice reference set has ~3500 concepts (July 2013) Locally, all clinical systems SNOMED enabled from x date – 2015? Typical ED reference set (NeHTA’s) comprises – • Reason for presenting (71 concepts) • Findings in presenting problem (222 concepts) • Diagnosis in presenting problem (244 concepts)

  19. Inside SNOMED Concepts each have one fully specified name and any number of preferred termsand synonyms Based on description logicalllowing reasoning about concepts and relationships Topology is ‘small world’ and ‘scale free’ (easily navigated and organic growth)

  20. Problem 1: Makeup of our CDA document types

  21. Problem 2: Adverse reactions dataset

  22. Problem 3: Care plans dataset

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