1.

2. 3. 4. 5. 6. cataract 7. cataract 8. 9. Referral GP or Optometrist TIMARU EYE CLINIC Appt Book Mirror Surgical List FU appts DHB Mirror Appt Book Booking Office Surgical List Operating Theatre Prioritize FSA Pre Assessment Clinic report CPAC Prioritize 10. 11. 12. Coloured Lens Implant 13. Phaco emulsification 14. 15. London Bills of Mortality every Thursday from 1603 until the 1830s 16. The Catastrophe Theory Metaphor for the Process of Text Generation: The Predator Prey Cycle The Process of Human Interaction 17. process meeting parting The Record Meeting Process Parting Applied to EHR, the building, process and record are one! 18. The basic medical input template

SOAP: subjective, objective, assessment, plan from Lawerence Weed

Would the aggregation of attested SOAPs be enough for an EHR?

19. 20. The long and winding road . 21. Disease Course Assessment Objects Management Objects Conceptual Model for Standards NZ work group 1997: Encounters in Two Episodes, One Disease Course Episode of Care Episode of Care 22. The Health Event Summary (HES) and the CDA

The HES solution in search of a format

CDA was a no brainer for this

A container rather than a document

CDA format has wide global acceptance

The CDA is an attested unit, an independent data resource

Later proposed to ISOTC215 in the immunological model for access control

23. SSL SOAP security SOAP Envelope Digital signature Public key certificate SOAP encryption Role-base access control SSL SSL Regional (SOAP) Server Data store Regional (SOAP) Server Data store Requestor Data store Provider (originating Organization) Secure SocketLayer (SSL) Security Cleint/Server authentication Supporting SOAP encryption 2CDA request in SOAP envelope 3Route request toneigbour if necessary 3Get complete CDA fromProvider if request and access role matched 1Request to neighbour server CDA Document in SOAP Envelop SOAP Security 24. THE IMMUNOLOGICAL MODEL FOR ACCESS CONTROL TO CDA Mike Mair and Stephen Chu New ZealandAcupulco 22.10.2004 25. The CDA and the HL7 RIM

Vs 3 data type

26. CDA Advanced Tutorial Version 3 Data Types

Data types are the building blocks for both messaging and documents.

27. CDA Release 2.0 Data Types

CNE & CWE

ANY Base type

NullNull Values

BLBoolean

ST Character String

INT Integer Number

REALReal Number

PQ Physical Quantity

II Instance Identifier

ED Encapsulated Data

SC String w/ Code

CS Code Value

CE Coded Equivalent

CD Concept Descriptor

EN Entity Name

PN Person Name

ON Organization Name

TEL Telecom Address

AD Postal Address

TS Point in Time

28. CDA Release 2.0 Data Types

IVL_INT Integer Interval

IVL_TS Time Interval

IVL_PQPQ Interval

RTO_PQ_PQ Ratios

GTS General Time Specification

• SXCM_TS Set Component TS

• PIVL_TS Periodic Time Interval

• EVIL_TS Event Related Time Interval

• SXPR_TS Parenthetic Set Expression of Time

List_Int List of Integers

29. Concept Descriptor 30. Alternatives to the RIM

OpenEHR

Semantic Web

SDMX

SNOWMED

-and the Web2 challenge

31. Draft for Discussion April 2010 32. 33. 34.

TIMARU EYE CLINIC CATARACT AUDIT 1

Cataract Operations from 01/01/00 31/12/00

Total Number of Cataract Operations:178

• Left Eye: 73

Right Eye:105

Average Pre-op Acuity:Snellen 6/30

Logmar 0.21(6/6 = 1.00)

Average Post-op Acuity:Snellen 6/9

Logmar 0.60(6/6 = 1.00)

Average improvement in Acuity 190.28%

Change in Corneal H Shape 0.67%

Change in Corneal V Shape 1.4%

Capsule Ruptures 2.25%(4)

35.

TIMARU EYE CLINIC CATARACT AUDIT 2

Percentage of incidence ofearly complications: 15.17% (27 cases)

Percentage of incidence of Endophthalitis: 0.56% (1 case)

Ratio of ECCE:Phaco 1:81(2/182)incomplete data

Percentage of ECCEs done: 1.23% incomplete data

Pre-operative Iris Prolapse: 3.4%

Significant Immediate Post-operative Corneal

Oedema: 5.6%

Significant long term complications eg

Iris damage (excluding Capsule Rupture): 3.4%

36. UK National Data Set 37. 38. 39. 40. 01/01/09 15/08/09 41. 01/01/09 15/08/09 42. Thanks for listening