Interoperability at Great Ormond Street Hospital

What HL7 Made Possible

Ken Smith – ken.smith@bridgeforward.net

www.bridgeforwardsoftware.net

Ken Smith Senior Integration Specialist –

BridgeForward Integration Specialist – GOSH (formerly)

Great Ormond Street Hospital Specialty Children’s Hospital Tertiary Referral Complex cases (multiple specialties) Long term cases (seen over long

periods of time) Critical cases Large international and private patient

service

GOSH Ambitions Establish integrity of patient data across

departmental systems Exchange and make use of clinical

information Automate processing of billable costs

for private patient billing

Patient Data Requirements Patient data has to be kept current

across multiple systems Has to be kept current over time Updates have to be instantaneous Updates have to account for different

patient populations (NHS and private)

Patient Data – PAS Centric PAS (iPM from iSOFT) the source of all

patient data PAS not accept patient data from other

systems Drip-feed (publish/subscribe) Query/response

Patient Data – Phase 1 Initially, no HL7 messages from PAS Make do:

Poll extracts tables (simulate drip-feed) Query of PAS database Construct non-HL7 messages

Mitigated by few interfaces built at this stage

Patient Data – Phase 2 Upgrade of PAS Full set of HL7 messages, drip-feed and

query/response More interfaces, more quickly Discovered variability in interpretations and

requirements of HL7 Placement of NHS ID in drip feed and q/r Formatting of data Differences in coded value lists Confidentiality

Clinical Information Notification systems

Pathology results notification Radiology results notification Patient death notification

2 out of the 3 were failures Failed to engage the clinicians

Difficulties Sharing Clinical Information Sharing clinical information much more difficult

Building a clinical application, not an integration Clinical practices and applications highly localized

(specialty and context) Informatics (analysis) is as or more important than

technology HL7 2.x vs. HL7 3

Clinician involvement necessary (do it for them, not to them)

Greater challenge holds promise of greater rewards

Private Patients Billing Recoverable/billable costs:

Pathology tests Radiology tests Pharmacy prescriptions

Route from source departments into Private Patient system

Billing Messages – non HL7 Each department created spreadsheets of

costs for each patient for specific time Naturally, each spreadsheet in different

format Integration engine processed spreadsheets,

and shoehorned different column formats into a proprietary, non HL7 message format

It was a pain from start to finish If only…

ClearSpanServer

Kintrak Clinical Genetics

InfoflexPulmonary Hypertension

ADT / PAS

JACPharmacy

ISSPATHOLOGY

Radiology Results

TomcatCARDIOLOGY

iIE

iSofti.PM

AD

T / PAS

AD

T / P

AS

ADT / PAS

MedicalIllustration

AD

T / PA

S

iSoftRADIOLOGY

Rad

iolo

gy R

esul

ts

AD

T / PA

S

Pathology Results

Email Server

Deceased Notification

Results Notification

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ClinicalLetters

ADT / QRY

ADT / QRY

AD

T / Q

RY

AD

T / Q

RY

ADT / QRY

ADT / QRY

Radiology R

esults

AD

T / QR

Y

SentillionSSO

AD

T / Q

RY

CompucareBILLING

ADT / PAS

Pathology Costs

Billable Costs

Radio

logy

Costs

Pha

rmac

y C

osts

Conclusions Starts and ends with HL7 HL7 2.x almost universal, but variable HL7 transport neutral No use of HL7 3.0 HL7 needs tools Success with patient data easier to achieve Goal is not to deliver healthcare IT

integrations, but integration solutions that improve delivery of clinical care