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Digital Health and Electronic Medical Records: Aligning the EU
and UK Agendas
A UK VIEW
Prof. Martin Severs
Presentation
• A Clinician View
• Major Drivers [Globally, Regionally and Nationally]
• Equity and excellence: Liberating the NHS [some drivers made real in UK English setting]
• Some pointers for alignment
INFORMATION FOR POLICY: {Months to Years}
INFORMATION FOR ACTION: {Days to Weeks}
INFORMATION FOR CARE: {Minutes to Hours}
CLINICAL PRACTICE: {Now}
THE CONSULTATION: {Pt & Dr}
PROFESSIONAL & ORG. REGULATION
THE LAW
CITIZEN
Major Drivers• Autonomy of citizens; dominant moral
force [choice, free movement, access etc]
• Plurality of providers; doctor to clinician to patient [expert patient]
• De-medicalisation of [mild] illness: self diagnosis, OTC meds, tele-help lines
• Reduce or curtail rises in costs: 70% costs are staffing, mechanise transactions
Major Drivers• De-centralisation of illness management:
home versus hospital
• Technology/computers as ‘actors’ in health care; decision support, medical devices
• Ageing Society: Multiple pathology and greater awareness of Imp – dis/func – hand/part continuum
• Chronic illness being the health challenge
INFORMATION FOR POLICY: {Months to Years}
INFORMATION FOR ACTION: {Days to Weeks}
INFORMATION FOR CARE: {Minutes to Hours}
CLINICAL PRACTICE: {Now}
THE CONSULTATION: {Pt & Dr}
PROFESSIONAL & ORG. REGULATION
THE LAW
CITIZEN
Equity and excellence: Liberating the NHS• In 48 pages there are the following
references:
• 54 to information; 29 to standards; 22 to data and 13 to records
• Embodies in an English NHS instance of most of not all of the major drivers except free movement
Informatics Standards [1]
• Explicit in the Information Strategy Autumn 2010– Record Practice: Sharing Records with Patients [4b]– Information governance standards [2.11; 2.16; 2.13]– Standard interoperable format for records [2.12]– Record transfer [2.12]– Record Keeping standards [2.16] versus data collection
standards [2.15]– Data standards that are person condition and treatment specific
[2.16;5.7]
Informatics Standards [2]
– Data standards for secondary use eg 2nd Edition ICD 10 for PbR [3.19]: performance [2.8;2.9;2.10]
– Data standards for workforce [4.33], events [5.12], services [2.21],
– Standard for data compositions [2.16] – Business definitions eg definitions of use and recognition
including records eg PROMS [2.7] & reconciliation with data standards [NICE [3.12.-3.15] vs WHO vs national audit vs etc]
Informatics Standards [3]: section 2.16
‘Providers will be under clear contractual obligations, with sanctions, in relation to accuracy and timeliness of data. Along with commissioners, they will have to use agreed technical and data standards to promote compatibility between different systems. The NHS Commissioning Board will determine these standards but they will include, for example, record keeping, data sharing capabilities, efficiency of data transfer and data security’
Some Pointers to Alignment• The big picture is becoming clearer [final slide]• Pan-government strategy is to adopt non-proprietary
international standards• A new single authority for informatics standards in the NHS:
the NHS Commissioning Board• ISB could be become the governance link and formal
advisory body to Pan government, NHS CB, Europe and International bodies for all informatics standards in NHS England
• The technology office could become the data standards life cycle management lead for approved fundamental data standards in England and management link to International standards development organisations
Some Pointers to Alignment• Standards must interact; so must their organisations;
example IHTSDO which manages SNOMED CT• HL7: Terminfo work product: Initial guide on how to use SNOMED CT in HL7• OpenEHR: Initial agreement to begin working together is complete; Closer working
relationship is being developed• WHO : Nearing agreement on cooperative work plan encompassing all WHO classifications
(ICD-10, ICD-O, ICD-11, ICF, etc)• LOINC and IFCC-IUPAC (NPU); Nearing agreements on laboratory test terminology
cooperation• IHE: Work to date driven by individual IHTSDO Members e.g. Netherlands Nictiz,• GMDN Agency: Detailed discussions are underway re Linkage between SCT & GMDN• DICOM: Long-standing working relationship
• Professional leadership of record keeping informatics standards and clinical governance of other informatics standards at national, European and International level could be improved
Alignment: requires managed tension
Citizens & Patients
Information Technology
Health OrganisationsProfessions Successful Digital Health
CUI DISPLAY
OU
TP
UT
SP
EC
CU
I INP
UT
Com
positions
Mapping
Mapping
Messaging Schema
File transfer
Central
Collection /
Repository
Indicators and M
etrics
Algorithms / Calculations
Secure P
ortal
Policy D
rivers
Patient N
eed
Record Keeping Standards
Dashboards
Record Content StandardsStatistical Standards
Clinical Safety Testing
Organisational Safety Testing
Human Behavioural Guidance Organisational GuidanceTechnical Guidance
Algorithms / Queries
“QO
F –
like” m
easures
Term
inology & R
ecord Data S
tandards
Class G
roups
Citizen Patient & Clinician
INP
UT
SP
EC
Record Classification Standards
Decision Support & Patient Care Operational Management
Algorithms / Queries
Produced by John Varlow, & Martin SeversVersion 1.0114 July 2010 © Information Standards Board 2009
Binding