Systems Integration in an NHS Hospital

Trust using HL7 V2 and XML

Andrew Sergeant

ICT Development Manager

Island and Portsmouth Health ICT Service (IPHIS)

Introduction

IPHIS provides ICT services to:• Portsmouth Hospitals NHS Trust• Portsmouth City PCT• Hampshire PCT• Hampshire Partnership Trust• Approx 96 GP Practices

In total nearly 10,000 users.

Portsmouth Hospitals NHS Trust

One of the largest Acute Trusts in England

serving 1 million people in SE Hampshire, Isle

of Wight and the Channel islands.

Current Projects• EPR and CHR (South Central SHA EPR System)• Multiple system interfacing projects (e.g. PAS ADT to

Renal, Pathology to EPR)• Electronic forms and electronic workflow • Clinical correspondence system • EDM• Business Intelligence• New Intranet, Extranet, WWW site • Virtualisation (including storage and application)

Integration Issues

• More than 41 existing interfaces between systems• Interfaces written using different technologies• Lack of skilled staff to maintain existing interfaces

and write new ones• Inability to meet new challenges posed by national

objectives, e.g. CRS

Solution• Adopt a new Integration Engine• Specify new standards and adhere to them rigorously• Use object oriented principles to encourage code re-use• Simplify interface development • Train developers to support one and not multiple

technologies • Solution must be flexible and adaptable to meet new

requirements as many uncertainties, e.g. CRS• Needs to be feature rich• Must be affordable!

BizTalk Server 2006

Chosen as Trust Integration Engine:• Supports current Microsoft skills in

development team• XML based• HL7 Accelerator for creation of HL7 2.x

messages• Other BPM features supported (e.g. RFID

Manager in 2006 R2 and 2008 releases).

BizTalk Overview

Orchestration Designer

BAM & Rule Engine

BAM Reporting & KPIs

Challenges

• Document existing interfaces• Develop standard methods of implementing message

exchange between systems (orchestrations)• Other coding standards (e.g. common exception

handling for error messages)• Upgrading to latest releases of software (currently a 2

year cycle)• Uncertainties, e.g. CRS revised timetable (therefore

PAS Gap analysis delayed).

POC Interface

• Blood Gas Analyser – Department of Critical Care to Trust EPR and CIS systems.

• HL7 to HL7 (2 different versions of HL7 v2)• HL7 to XML (EPR) via Web Service

Outcome

• Rapid development within timescales• Minor issues regarding deployment and support• Further interfaces commissioned

New Interfaces

• IoW PAS to Fujitsu CRIS• PAS to EDM• PAS ADT to Renal (Proton)

In all of the above cases SQL Server database to

XML to HL7 V2.x

Issues

• Developer Training and support• Initial development work outsourced• Disaster recovery (DR) • Cost of upgrade as licensing costs have

changed (BizTalk Server cost has essentially doubled since we bought our licences!)

Future

• CRS Issues• New interface development• Support for new technologies, e.g. RFID and

mobility solutions (e.g. alerts)• Workflow and BI support.

Technical Challenges

• Developer Training, recruitment and retention• Upgrade path to support new releases• A large number of legacy interfaces to migrate

(approximately 41)• Many other projects competing for resource,

e.g. EDM, Web Technologies, eForms and workflow.

Conclusions

• Integration issues typical for an NHS Acute Trust

• Slow, but gradual move to a new standard (Gartner estimate major BPM initiatives can take up to 10 years to implement!)

• CRS and other Connecting for Health initiatives are a moving target

• Support for XML Web Services useful for maintaining future flexibility.

Any Questions..?

• andrew.sergeant@ports.nhs.uk• www.porthosp.nhs.uk• www.microsoft.com/uk/nhs/

(search under Portsmouth for BPM Article)• BizTalk whitepaper:

http://www.microsoft.com/biztalk/techinfo/whitepapers/

2006R2/Understanding.mspx