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This project aims to establish a grounded framework for a federated information service within NHS England, specifically targeting the integration of clinical records by September 2002 in the Durham and Darlington areas. Key aspects include creating an ethical and legal foundation for shared information, engaging clinicians through ethnographic studies, and providing educational tools for user engagement. By emphasizing open, flexible, scalable, and federable characteristics, the project seeks to facilitate a coherent understanding of electronic health records and drive clinical innovation and collaborative care.
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Aims of the project • Create a grounded framework for a federated information service for the NHS in England • Create an environment in Durham and Darlington ready to procure an integrated clinical record service by the end of the project in September 2002
Customers of the project • NHS in England (national reference architecture) • Health Community in Durham and Tees Valley Strategic Health Authority area (1.2 million people)
Principles of the project • Ethical and Legal foundation for a shared information service • Based on informed patient consent • Prime inter-organisational clinical information source • Grounding in real clinical work • Engage clinicians in coherent design understanding (using ethnography)
Project themes • Ethical Framework • Security Framework • Ethnography • Educational tools to facilitate user engagement and informing the architecture (ANIMATORS) • Simulated commercial product reflecting the architecture (SIMULATOR) • Governance framework
Enterprise architecture • Projections of enterprise architecture cover: • Organisation • Resources • Functions • Technologies • Governance
Characteristics of the information service • Open • Flexible • Scaleable • Federable • Cope with legacy
Record architecture Terminology Classification Messaging ENV 13606 prENV 13940 Read, SNOMED, Drug dictionary HL7 Framework for other standards
Conceptualising problems in Architecture • Abstraction and Parsimony • Computing science • Exemplification and specificity • Medicine and surgery • To move toward shared understanding we exemplify concepts in animators
Location of work • Primary care • General practice / Multidisciplinary care teams • Transitional care • NHS Direct • Out of hours services • Paramedic /ambulance • Hospitals (Acute services) • A+E ; CCU; Acute medical wards
Context of work • Interdisciplinary Care pathways • Coronary heart disease • National Service framework • Co-ordinated care within and between health care organisations • Cultural issues of trust related to information sharing
From discourse to understanding • Coherence of vision of EHR • System vendors • NHS informaticians, clinicians, managers • Local and national policy • Academics
Facilitate cultural change • Clinically led innovation • Dynamic local reconfiguration • Informatics services as facilitators not leaders of the change process