prepared by connected care standard for transfer of care and shared care applications...
TRANSCRIPT
PREPARED BY
Connected Care Standardfor transfer of care
and shared care applications
7 November 2012
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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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Reference Architecture for Interoperability
SAG review
Vendor review
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Requisite standards for 2014
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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
NZePS built on CDA and SOAP web services
interRAI reports built on CDA and SOAP web services
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CDA solar system
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The changing world view
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Right side up architecture
PMS local environment
HIE (outside world)
Forms service interfaces are – CDA enabled both sidesXDS enabled on one side
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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)
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Development timetable
Release for consultation SpecificationsFebruary 2013 Discharge Summary
CDA Common TemplatesCommon Code Sets
March 2013 Shared Health SummaryMay 2013 Referral Request
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‘… a core set of personal health information …’
Required for 2014 OK if beyond 2014DemographicsAlerts and allergiesImmunisationsEncounters (admissions)Medications (discharge)Problems (conditions)Test resultsAppointmentsEnrolmentsHealthcare providersSupport people
Screening resultsEncounters of all kindsMedications (My List of Meds)Lifestyle risk factorsVitals (eg BMI)Advance directives
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From: Bob DolinSent: Tuesday, November 29, 2011 12:55 PMTo: Rishel,Wes; Pratt, Douglas (H USA); robert worden; Structured Documents WGSubject: RE: CDA or greenCDA
Hi Wes,
What is CCDA?
Thanks,
Bob
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Consolidated CDA
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Origins of CCDA
10040.3
GP2GP
10040.2
10041
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Makeup of CCDA
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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
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How NeHTA does templates
NeHTA specifications include (per eDS etc) –
1. openEHR Archetypes (content model)
2. Core Information Components (data requirements)
3. Structured Documents Template (abstract document model)
4. CDA Implementation Guide (templates)
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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)
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Inside SNOMED
Concepts each have one fully specified name and any number of preferred terms and synonyms
Based on description logic alllowing reasoning about concepts and relationships
Topology is ‘small world’ and ‘scale free’ (easily navigated and organic growth)
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Problem 1: Makeup of our CDA document types
Section eDS SHS HES eRef
Alerts and allergies
Immunisations
Encounters
Medications list
Problems list
Test results
Appointments
Enrolments
Healthcare providers
Support people
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Problem 2: Adverse reactions dataset
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Problem 3: Care plans dataset