Common User Interface

ProgrammeTim Chearman – CUI lead

Lindsey Butler – Clinical Safety Advisor

Agenda today

• Context of Data Standards and Products department

• CUI current state

• CUI proof of concept implementations

• SNOMED Implementation review and subset

demonstrator

DS&P and where CUI CAPS fits

CUI CAPS

Data Standards & Products

Technology Office

Department of Health Informatics Directorate

Department of Health

DS&P Focus

Standards, Standards everywhere

but which ones should we choose

Standardisation is

important, not standards

A bogie exchange station exists at the Chinese border to Mongolia. Both the Moscow-Beijing passenger

train (Trans-Siberian) and freight trains get their bogies exchanged. Mongolia has Russian gauge 1,520

mm (4 ft 11 5⁄6 in), China has 1,435 mm (4 ft 8 1⁄2 in). © Shultz CC- BY-SA

International

UK

England

Local

• ISO, CEN

• HL7, SNOMED

• NHS Number System

• ISB approved

• Spine connections

• Bespoke

• Shared - ITK

Just some of our standards

• Messaging– HL7 V3 for Spine

– HL7 V2 for local

integration

– CDA + Templates

– Commissioning Data Sets

– Other data sets

• Content Modelling– Clinical Archetypes

(CEN13606)

– Content models for

suppliers

• Logical Record

Architecture

• Terminologies– Read

– CTV3

– SNOMED CT

– dm+d

– Cross maps

• Classifications– OPCS

– ICD10

– Cross maps

• Data Dictionary

• Common User

Interface

Read

The Standards Solar System

V3

openEHR

ICD10

IHE

UML

ISO Data

Types

EHR

WHO

ISO

SOA

SAIF

ISO13606

HL7

V2

Intellect

What does good

science need?

• Good data from good sample sizes of well chosen

individuals

• Controlled trials

• Long term view on outcomes

Resources

• Clinical Safety Management System

– Raising profile of safety issues

– Influencing national solutions, design through to deployment

– Accredited clinician training – increasing a safety culture within NHS CFH, wider NHS and Suppliers

http://www.connectingforhealth.nhs.uk/engagement/clinical/clinicaldivision/safety

• DSCN’s 14/2009 & 18/2009

– 14/2009 Patient Safety Risk Management System – Manufacture of Health Software

– 18/2009 Patient Safety Risk Management System – Deployment and Use of Health Software

– Further information via http://www.isb.nhs.uk/

• Safer Implementation – Key Clinical Safety Activities, A

Guide to Implementation

http://www.connectingforhealth.nhs.uk/engagement/clinical/

clinicaldivision/safety

• Clinical Deployment Guide

Deployment Guide for Clinicians (PDF 960Kb)

• Help clinicians who have been asked to get involved in

IT projects understand how they can contribute

effectively and what roles and responsibilities they may

be asked to undertake.

CUI CAPS

What is the CUI CAPS

Project?

An NHS CFH project for the NHS

Started in 2005 and is focused on helping the NHS:

increase patient safety

increase clinician effectiveness

make IT systems easier to use

enable improved personal and team efficiency and

productivity

Our Aim

“To provide a highly mobile workforce with a

degree of familiarity between different systems

sufficient for the safe and effective delivery of

care without extensive re-training”

How?

The scope of the CUI CAPS project is focused on patient

safety critical aspects of clinical systems such as

medications management and patient identification in

order to increase consistency and improve safety

integrity

Who are we, what do we do

and why?

• Clinicians, developers, safety experts, usability experts

The Team

• User centred design – user interface

• influence clinical applications to make them safer, more consistent and easier to use

• Develop guidance, software(prototypes) and standards to support the design of safe and effective clinical computer systems

What and why

Our Vision

Current clinical IT systems

Common User

Interface (CUI)

Standards can help enable safe and

effective delivery of care without

extensive re-training

Many different application user

interfaces mean that retraining is

necessary.

Development process

Design

PrototypingUser

Research

PSAs

Requirements

ISB

Requirements

Standard

ISB

Draft

Standard

Guidance &

Technology

Pilot &

Feedback

ISB

Full

Standard

Updates

User

TestingUser

Testing

Updates

Patient Safety Risk Mitigation

Healthcare Professionals, NHS CFH, ISVs, ISB

PSAs

PSAs

Development process

Design

PrototypingUser

Research

PSAs

Requirements

ISB

Requirements

Standard

ISB

Draft

Standard

Guidance &

Technology

Pilot &

Feedback

ISB

Full

Standard

Updates

User

TestingUser

Testing

Updates

Patient Safety Risk Mitigation

PSAs

PSAs

PlanningHazard

identification

& analysis

Risk

management

Risk level

review

Safety

case

& closure

User interface

guidance

Guidance Catalogue

• Key Information• Telephone Number Display and

Input

• Patient ID Display and Input

• Sex / Gender Display and Input

• Address Display and Input

• Date Display and Input

• Time Display and Input

• Patient Name Display and Input

• Email Display and Input

• Accessibility• Accessibility Principles

• Accessibility Checklists

• Terminology (SNOMED CT)• Terminology Matching

• Terminology Elaboration

• Terminology Display

• Allergy/ADR display and entry

• SNOMED CT entry

• Admissions clerking

• Truncation of Clinical Terms

• Display of Clinical Statements

• Patient Administration• Patient Banner

• Find a Patient

• Patient List View

• Medications Management• Medications Views

• Drug Administration

• Search and Prescribe

• Medication Lines

• Abbreviations• Abbreviations in Free Text

• Abbreviations in Fixed Text

• Consistent Navigation• Alert Symbols

• Icons and Symbology

• Sorting filtering and grouping

• Decision Support• Decision Support Notification

• Decision Support Alerts

• Clinical Noting• Noting Using Templates

• Noting with Graphics

www.cui.nhs.uk

POC

POC

POC

Context

Mandated standards

Background

• The CUI project aims to reduce the risk of

misinterpretation of information and documentation input

options by users of different clinical systems. See

www.cui.nhs.uk

The common user interface programme has

produced a set of standards that address this

problem

Context

Clinical safety themes

Clinical safety hazard themes

Incorrect identification of the patient

Wrong record, wrong patient

Delayed, missed or inappropriate healthcare

•As the CUI CAPS project discovered during

the research phase, there are many causes of

safety hazards in relation the user interface

display.

•There are a limited set of safety themes that

this set of information standards seek to

address:

Context

The Information Standards Board

The ISB is the Board responsible for setting information

standards for the NHS and adult social care in England.

Please see the ISB website for more detailed information

www.isb.nhs.uk

Context

The information standards board has

mandated CUI demographics standards

has Data Set Change Notices (DSCN’s)

Standards and DSCN’s

IT systems must conform to the following standards by 1 December 2015

Address Input and Display

Date and Time Input

Date Display

NHS Number Input and Display

Patient Banner

Patient Name Input and Display

Sex and Current Gender Input and Display

Telephone Number Input and Display

Time Display

Further detail for each standard can be accessed at

www.isb.nhs.uk/use/baselines/cui . We are currently reviewing

the compliance process.

Context

Documents

Guidance examples

diltiazem – RETALZEM –

modified-release tablet –

DOSE 60 mg – oral – three times a day

Diltiazem – retalzem –

modified-release tablet –

DOSE 60 mg – oral – three times a day

paracetamol – 120 mg in 5 mL – suspension –

DOSE 80 mg – oral – every 4 hours

cefotaxime – powder for solution for

injection – intravenous – DOSE 400 mg –

every 8 hours

• All UI guidance is platform

agnostic and available free of

charge

• Rationale and evidence provided

within each guidance document

Patient banner

Medication line

Patient

name

Date

display

Address display

Patient banner

Leeds Teaching Hospitals

NHS Trust – Secondary

Care

Patient banner

Medication

line

Date

bluewire Technologies –

Secondary Care

Recording adverse

drug reaction

Date

CUI Standards Compliance

The Trust Clinical Safety

Officer and Compliance

CSO

External supplier

compliance

NHS CFH CSG

In-house and legacy

systems

SHA CSO

Request evidence of compliance

Prioritise and

assess

Key

Relationships Activities

Compliance overview

The Aims

• To enable healthcare IT suppliers to demonstrate they are

meeting the requirements of the CUI CAPS patient safety

standards (the DSCN’s)

• To inform NHS Trusts about the CUI CAPS patient safety

standards and empower NHS Trust representatives to request

this information from healthcare IT suppliers

• Give accreditation to suppliers for CUI CAPS compliance

What we want you to do

Work with suppliers to

• Undertake the compliance checks as per

defined process

• Evaluate the compliance process and

provide feedback on the process and tools

• Provide feedback on CUI design guidance if

identified

Supplier / developer

process

Have you

considered CUI

in your system

design

Plan/estimate

compliance

check

Assess effort and

plan into product

roadmap

Perform

Compliance

check

Inform CUI team

of compliance

results/queries

Feedback to CUI

team on planned

implementation

or issues

CUI

accreditation(plan)/

resolution of

feedback

Yes No

Feedback to cuistakeholder:

cuistakeholder.mailbox@nhs.net

Evaluating your systems

We realise that from a trusts perspective there will be a

need to prioritise systems to identify which ones should

be implementing the patient safety standards. Working

with Trusts we have found that it is best to consider:

– Type of system – assess the clinical risk and

potential clinical safety benefits

– System owners – you might have a strong influence

internally or be dependant on a supplier

– Roadmap/development opportunities e.g. There

may be opportunities to insert CUI CAPS

requirements in new procurements, upgrade requests

etc.

System review activities

• For systems that you prioritise the following activities

should be considered:

• Contact suppliers/internal teams to inform about CUI

CAPS DSCN’s and understand current status

• Assess the software for compliance

• Evaluate the effort of any updates

• Request activities to attain CUI CAPS compliance in

roadmap/plans

•Give feedback to the CUI CAPS Team on the

design guidance and compliance process

Compliance exampleGuidance

document

Compliance

checklist

Tools

Full CUI design guidance – includes supporting

information on the project, safety issues, references see our guidance catalogue www.cui.nhs.uk

QIG – Quick Implementation Guidance documents. See our guidance catalogue www.cui.nhs.uk

Check lists – The guidance check lists in Microsoft Excel will help you to assess the healthcare IT system and document the level of compliance the system demonstrates. See our compliance section www.cui.nhs.uk

What you will need

• Access to www.cui.nhs.uk

• Familiarity with the Full CUI design guidance, access to

the QIG’s

• The check list – downloaded from www.cui.nhs.uk

• The application/s you are assessing for compliance level

• Commitment from the suppliers/time to do the

assessment and time to complete the evaluation

questionnaire

Feedback

We welcome feedback on any aspect of this pack.

Please direct your feedback to the CUI team via

cuistakeholder.mailbox@nhs.net

General enquiries or feedback on a specific design

guidance area should be sent to

cuistakeholder.mailbox@nhs.net

In order to ensure this process is useful, realistic and

achievable the CUI Team request your feedback

An online questionnaire will be available to give you theopportunity to give detailed feedback on the process.Link to be inserted

Other CUI project areas

CUI Proof of concept

implementation

• CURIO was developed as a collaborative research

project by the Centre for Health Informatics and Multi

professional Education (CHIME) team from UCL and the

Common User Interface (CUI) team

• http://forge.tactix4.net/gf/project/curio/

The aims of the CURIO project are:

• To develop a technical environment and framework to

explore implementation of Common User Interface

components and SNOMED CT

• To make learnings shareable and leveraged by others to

implement UKTC standards and CUI specifications.

Other Projects –

SNOMED CT

Goal – how best to implement SNOMED CT in the

User Interface of an Electronic Patient Record

Draft

implementation

recommendations

Various

exploratory

prototypesSubset analysis

SNOMED CT in the UI SNOMED CT Demonstrator

SNOMED CT

Demonstrator

• Identify appropriate

user interface

elements

• Design various

exploratory

prototypes of a

Discharge Summary

• But...there is a

dependency on

subset size

SNOMED CT

Demonstrator

• Different User Interface

elements work well for

different subset sizes

• To get feel for number of

results returned we

investigated: No.

Characters typed-in

wanted result (in a small

list of results)

• Re-worked prototype as

testing-rig

SNOMED CT

Demonstrator

Demo of prototypehttp://snomeddatahandling.appspot.com/

SNOMED CT

Demonstrator

Number of search characters typed in

% T

erm

s in

sm

all lis

t

Single search token e.g. “pneum”, “diab”, “ecze”

SNOMED CT

Demonstrator

Number of search characters typed in

% T

erm

s in

sm

all lis

t

Double search token e.g. “ches cold”, “child ecze”

SNOMED CT

Demonstrator

% Terms in small list 50,000

terms

3000

terms

3 chars (“pne”) 3% 38%

6 chars (“actino”) 16% 71%

2 chars per token (“co pn”) 16% 94%

3 chars per token (“com acq”) 56% 99%

Thank you…..

Any questions?

www.cui.nhs.uk