NHS Scotland Clinical Models
description
Transcript of NHS Scotland Clinical Models
NHS Scotland Clinical Models
Dr Paul Miller – [email protected]
Current designs• HSCIC Messaging –
GP2GP• NHS Scotland SCI XML• NHS Wales IHR• dm+d• RCP Core Clinical
Headings• RCP Standards for
structure & content
• Emergency Care Summary
• EMIS• Vision• OpenHR – MIG• Adastra• Gemscript• FDBE• HL7v3
Models!
Computable Clinical Model
• The representation of a clinical concept in a structured format in computer software
If…
My Model Your Model=My Model Your Model
MessagesMy Model Your Model≠
Common Model
My Model Your Model
Maps to & from Maps to & from
≠
?70, 80, 90 years??!!
Our Data
Application 1 Application 2
Application 3 Application 4
Archetype
SystolicDiastolic
Korotkoff
Laterality
Site
PositionDevice
Cuff Size
Date
Templates
Date
Systolic
Diastolic
Date
Systolic Diastolic Korotkoff
Position Laterality
Clinical Knowledge Manager
Adverse Reactions
Lessons
• Usability• eHealth / Informatics knowledge
Community• Leadership• Administrative Support
Outputs
IngredientsDrug Groups
Dose Syntax?
Other models?
GP
GP
GP
ECS
OOH
Pharmacies
Community
Core Medication
Record
Plans
• Publicity• Engagement• Education• Support• Timetable• Implementation
‘Clinical Archetype’
• Is a ‘clinical model’• Has all the items (elements)• Fully defined• More than most clinicians require
CKM is:
Structured Data
• Not just view!– Your computer is not a projector
• Computable, machine process-able data– Reduce or eliminate re-keying– Decision support
• Data rich records = Better Medicine– = Happy, healthy people
One Record?
• Always runs into boundaries• Unable to adapt to multiple care contexts• Reliant on the interface– The data should be separate from the interface
• Proprietary lock in• Instead– Multiple front ends– Common data models
For Example
Clinical Term
Value
Unit of Measure
Date
What is a Model?
• A representation of a real world object or phenomenon
Process and Progress
Lessons
Next Steps
Objectives
The big picture
Become involved
Clinical Template
• Just the bits you need– Systolic / Diastolic– Not Cuff, position, laterality
• Allows for context• Can use elements from other Archetypes• Flexible, complex, adaptable models
Proc
• Hand written prescriptions
• Computer printed prescription
• Transmitted Prescriptions
• New models of prescribing
• New uses for prescribing data
• New
• Clinical Requirements• Developer Requirements• Rapid, repsoni
What is this about?
• Medication Messages– Safe– Easy– Reliable– Computable
• Objectives– Save work– Save money– Reduce harm– Save lives
Provide a 21st century solution to medication
To last till the 22nd Century?
What needs to happen?
• Every system needs to be able to– Express– Store– Exhange– Clinical data in the same
way.
Medication Messages
ECS / KIS
SAS
NHS24
OOH - Adastra
Portals
SCI Gateway Hospitals
ePharmacy Community Pharmacies PSD
So what’s the problem?
• It’s complicated• The words used• The concepts• The culture• The requirements• The solutions• The political will
What’s the solution
• Models• What is a model anyway?• Eiffel Tower• Pretty people• CAD• In health care this means:
What’s out there?• SCI XML• EMIS• Vision• Adastra• SCI GW• ECS / KIS• HEPMA• ePharmacy
And yet:
• Atenolol is Atenolol wherever you put it IRL• We have dm+d– This does the medicine– But not the ‘order’ or ‘prescription’
• We need clinical input.• We need developer input• How do we get this?
CKM
• The story so far• What we get out the box• Tricky things:– Learning– Navigation– Concepts– Core knowledge
Community
The Difficutly with Allergies
The dose / product conudnrum
Next Steps
Solutions and outputs
Become involved
Medication Models
• Ah the problem
What does this do
How we fix this
What is a computer model?
• The representation of a real world concept, object or phenomenon in computer software
NHS Scotland Clinical Models
• We need models!• Bring together clinical and technical• Simple, agile, iterative• Open Source• Join in:– http://www.clinicalmodels.org.uk/ckm/