Interoperability at Great Ormond Street Hospital
description
Transcript of Interoperability at Great Ormond Street Hospital
Interoperability at Great Ormond Street Hospital
What HL7 Made Possible
Ken Smith – [email protected]
www.bridgeforwardsoftware.net
Ken Smith Senior Integration Specialist –
BridgeForward Integration Specialist – GOSH (formerly)
Great Ormond Street Hospital Specialty Children’s Hospital Tertiary Referral Complex cases (multiple specialties) Long term cases (seen over long
periods of time) Critical cases Large international and private patient
service
GOSH Ambitions Establish integrity of patient data across
departmental systems Exchange and make use of clinical
information Automate processing of billable costs
for private patient billing
Patient Data Requirements Patient data has to be kept current
across multiple systems Has to be kept current over time Updates have to be instantaneous Updates have to account for different
patient populations (NHS and private)
Patient Data – PAS Centric PAS (iPM from iSOFT) the source of all
patient data PAS not accept patient data from other
systems Drip-feed (publish/subscribe) Query/response
Patient Data – Phase 1 Initially, no HL7 messages from PAS Make do:
Poll extracts tables (simulate drip-feed) Query of PAS database Construct non-HL7 messages
Mitigated by few interfaces built at this stage
Patient Data – Phase 2 Upgrade of PAS Full set of HL7 messages, drip-feed and
query/response More interfaces, more quickly Discovered variability in interpretations and
requirements of HL7 Placement of NHS ID in drip feed and q/r Formatting of data Differences in coded value lists Confidentiality
Clinical Information Notification systems
Pathology results notification Radiology results notification Patient death notification
2 out of the 3 were failures Failed to engage the clinicians
Difficulties Sharing Clinical Information Sharing clinical information much more difficult
Building a clinical application, not an integration Clinical practices and applications highly localized
(specialty and context) Informatics (analysis) is as or more important than
technology HL7 2.x vs. HL7 3
Clinician involvement necessary (do it for them, not to them)
Greater challenge holds promise of greater rewards
Private Patients Billing Recoverable/billable costs:
Pathology tests Radiology tests Pharmacy prescriptions
Route from source departments into Private Patient system
Billing Messages – non HL7 Each department created spreadsheets of
costs for each patient for specific time Naturally, each spreadsheet in different
format Integration engine processed spreadsheets,
and shoehorned different column formats into a proprietary, non HL7 message format
It was a pain from start to finish If only…
ClearSpanServer
Kintrak Clinical Genetics
InfoflexPulmonary Hypertension
ADT / PAS
JACPharmacy
ISSPATHOLOGY
Radiology Results
TomcatCARDIOLOGY
iIE
iSofti.PM
AD
T / PAS
AD
T / P
AS
ADT / PAS
MedicalIllustration
AD
T / PA
S
iSoftRADIOLOGY
Rad
iolo
gy R
esul
ts
AD
T / PA
S
Pathology Results
Email Server
Deceased Notification
Results Notification
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ClinicalLetters
ADT / QRY
ADT / QRY
AD
T / Q
RY
AD
T / Q
RY
ADT / QRY
ADT / QRY
Radiology R
esults
AD
T / QR
Y
SentillionSSO
AD
T / Q
RY
CompucareBILLING
ADT / PAS
Pathology Costs
Billable Costs
Radio
logy
Costs
Pha
rmac
y C
osts
Conclusions Starts and ends with HL7 HL7 2.x almost universal, but variable HL7 transport neutral No use of HL7 3.0 HL7 needs tools Success with patient data easier to achieve Goal is not to deliver healthcare IT
integrations, but integration solutions that improve delivery of clinical care