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Transforming Government using Open Standards

Jagdip Grewal

Chief Technical Architect

29th October 2007

Agenda

• Business Context

• Enterprise Architecture Context

• Services in an Enterprise Architecture

• Using standards to enable integrated

healthcare

• Integration challenges

• UK Government Enterprise Architecture

To deliver a 21st century health service through efficient use of technology to:

• Enable and improve Access and Choice

• Enable care pathways and patient focus

• Improve accuracy in treatment

• Create opportunities for improved efficiency

• Create opportunities for real NHS reform

Our Objectives

Ageing Population

2001 – over 60s > than under 18s

2050 – 4 times as many needing care

At 4 times the current cost

…while the number available as carers declines

Demographic Challenge

Life expectancy increased to 75 years 9 million people over 65 and increasingPopulation more mobileGreater long term chronic illnessPatients more educated on health and want greater involvement

1,200 Patients dying each year from medication errors

5,000 procedures cancelled each year

5% of patient safety incidents due to documentation errors

Has overburdened the system

The NHS in 2002• Patient records held on paper

• Highly variable usage of IT• Lots of home-grown specialist systems

• Continuing reliance on 1970s mainframes

A Changing Health Environment

1

The need for changeThe need for change

• Local procurement of IS/IT Systems by GPs, Trusts etc

• Disparate Technologies, 1000s of suppliers

• Limited data sharing

• Lack of standardisation

• Lots of paper

• Little leverage of NHS buying power

Challenges

National Programme for ITNational Programme for IT

• Launched Spring 2002 by “21st Century IT” policy document

• Mobilisation from Q1 2003

• Procurement completed Q1 2004• ‘Services’ based contracts

• Local and National Suppliers

• £6bn of IT services contracted over ten years

The answer…The answer…

• Largest civil IT project in the world

• 40,000 GPs• 80,000 other doctors• 350,000 nurses• 300+ hospitals• 10 year programme• 50m+ patients• 1.344m healthcare

workers

chooseandbookchooseandbook

Electronic Prescriptions Service

Electronic Prescriptions Service

NHSmailNHSmail

National & Local Care Record Services

HealthspaceHealthspace

Picture Archiving & Communications Service

Picture Archiving & Communications Service

Secure E-mail for all NHS workers

Web Access for Patients

Secondary Uses ServiceSecondary Uses Service

Analysing National Health Trends

New National Network

Patient Choice

Scope

N3N3

……and what does it look likeand what does it look like

Enterprise Services (NxSPs)

Electronic Booking Service

Transaction & Messaging Spine

Health System Users

GPNHS DirectPatient

ClinicianPharmacists Child ProtectionNational & Trust

ManagersHealth Care

Workers

N3 Network Services

Personal Demographics

Service

Electronic Transmission of

Prescriptions

Other Accredited Systems

Personal Spine Information System

Secondary Uses Service

Local Services LSPs

Spine Directory Service

Access Control Framework

Diagram file: VisioDocument

National and Legacy systems

120 Different Supplier

Accredited Systems to integrate

3 Suppliers with differing Architectures

Multiple and

Disparate Channels

Integration required with

set of common services

Programme Challenges

• Hundreds of different applications and suppliers• Large scale systems e.g. Prescriptions at 500tps• End Users with differing requirements and geographically

distributed• Diverse (often ‘legacy’) Supplier Technologies• Lack of Standards• Desire to Use COTS packages – avoid bespoke• Evolution in requirements and functionality • Data availability, quality and integrity is critical

• Enterprise Architecture required to define overall End to End approach

Agenda





healthcare



Business Services

IS Services

Technology Services

Enterprise Architecture

EA - Context

Policy

NASP

NHS CFH

MedicalAdvances

PatientDemand

LSP/ESP

We may all have different perspectives but we can make our lives much easier by ‘talking’ the same language.

ClinicalProcesses

OutcomesBetter Patient Care

Reduced CostLower waiting Times

The bigger picture - In support of traceability (simplified view)

Contract

Schedule

Requirements

Non-functional requirement

Functional requirement

contains

Bundle

contains

Release

Are delivered by

Conceptual Services

Physical Application

Care Setting

Use Case

Which is supported by

Logical Applications

Are represented as

Service Provider

And is implemented by a

In a

Policy & Strategy, medical

advances, other factors

Creates additional

May be elaborated in a

From TA

This seems to be equivalent to the “project” concept from TA

Acceptance Status

“Strategic Tracking” on TA slides

Benefits

Artefacts

Test Cases

Whi

ch c

olle

ctiv

ly c

reat

e

Which may be used to validate

Implements

Have an

Are Structured in a

Are implemented in a

Has an

Implements

NHS – relationship map

NHS

OtherGovernment

DeptsExternal Support Services

Direct ServiceDelivery Links

Local Authority Services

DCAfMOD

DoH

LogisticsEstates Management

Audit Commission

Other NHS Organistiaons

Connecting for Health

PublicHealth

Education Departments

Housing

Social Services

HomeOffice

v

Courts

Police

Young Offenders

Teams

NPSA

Healthcare Commission

Schools

Higher / Further

Education

Education Psychology

DomicillaryCare

Mental Health & LD

Adult Services

Older People

Services

Children’s Services

PPA

Drug Companies

Prosthetics / Appliance Suppliers

Prison Service

DFES

ManagementServices

Non-StatutoryOrganisations

IndependentService

Providers

Charities

Patients

Relatives & Carers

SpecialEducation

Needs

Research

Private Hospitals

Forces Healthcare

NICE

NHS - includes:Primary Care

Acute CareMental Health& Ambulance

Services

TribunalsService

Dentists

Opticians

InformationCentre

Chiropodists

Physio-therapists

Other HealthServices

Pharmacies

DeFRA

Prison Healthcare

DWP

Home OfficeService

Contacts

NHS Service Contacts High-level Map

Agenda





healthcare



Enterprise Architecture – Domain View

Sec

uri

ty

Inte

gra

tio

n

Infrastructure

Enterprise Services

Channels and Presentation

Local Services

Views

Conceptual Services: what we do

Local Services

Enterprise Services

Inf rastructure

Channels and PresentationSecurity Integration

Care Management Services Manage User ServicesNSF Support Local ReportingManagement

Access Management

Audit and HistoryView Management

Digital ImagingSetting Specific

ServicesMedication

ManagementServices

Management Services

Reporting Services

Strategy

Integration ConstructionServices

Configuration andManagement Services

Demographics

Identity ServicesClinical NarrativeServices

Financial Services

Clinical SummaryAccess

Clinical SummaryRecords

Hosting Services Service Management

Integrity &Non Rep Services

Integration ProcessingServices

Message Level Security

Disaster Recovery

Local StructuredCare Mangement

Diagnostic & ResultsServices

Directory Services

Local ContentManagement

Knowledge ManagementServices

TerminologyServices

Decision Supportand Alerts

MedicationsManagement (EPS)

Platforms & Devices

eMail

EnvironmentalServices

NetworkServicesStorage

ScreeningManagement Manage Scheduled

Bookings

NHS Direct

DeploymentSchedulingServices

LegacyPatient Personal

Health Informationmanagement

Data QualityServices

Clinical MessagingServices

Governance

Requesting Services Manage Alert & EventNotifications

Strategy

Business ProcessManagement

Managee Booking

Local Workflow

Session &Context

ManagementVideo

ConferencingDevice and media

repurposingScanning User Interface

Services

Manage DecisionSupport Rules

(Active DecisionSupport)

ManageAdministrationof Acts giving

Compulsory Powers

Profiling &personalisation

Manage Consent toShare General &Specif ic Record

Information

Virtual Visiting

CertificateManagement

Homemonitoring

Manage Patient RecordCoding, Grouping and

Terming

Manage Incidentsand

Complaint Recording

Manage Local(pseudo)

anonymised data

Manage Local SUSdata review prior to

submission

Manage Whiteboardsand

Patient Tracking

Manage SUS datareview prior tosubmission

Manage ClinicalDocumentation

Templates

Manage Screeningand PreventionProgrammes

Non-repudiation

BusinessOrchestration

Encryption Authentication

LRS

RBAC

Sealing

Access Validation

Evidence Collation

User Directory

Service Directory

Record Audit Event

System Identification

Record Retrieval

Event SecurityAssessment

Scenario Recreation

Request Assessment

Ambulance

Ambulatory Care Mgmt

Assessment services

Cancer NSF

Chronic ObstructivePilmonary Disease NSF

Coronary NSF

Children's NSF

Long Term Care NSF

Mental Health NSF

Older People's NSF

Create and ManageLocal Reports

Dental

Image Archive

Image Retrieval

Image Viewing

Hardcopy Production

Domiciliary Care Mgmt

NSF InformationServices

Emergency Services Image Acquisition

Diabetes NSF

Renal NSF

ManageDigital Signatures

Manage Interventions

Manage LegalRequirements

Manage MaterialsManage Mobile

Working

Manage PatientRecord Presentation

Manage PatientRegisters

Manage PatientRegistration

Manage Patient Stays

Paediatric IntensiveCare NSF

Address lookup& validation

Prescribing Alerts

Prescription Transfer

Manage Blood

Privacy

Confidentiality

Authorisation

Integrity

Message Encryption

MessageAuthorisation

Message Integrity

MessageAuthentication

Interaction Patterns

Message ContractProperties

Message Channels

Adapters

Transport Protocols

InteroperabilityFramework

Execution

Validation

Transformation

TechnicalOrchestration

Configurationand Design

Platform Registration

Metadata andRepository

Service Managment

Quality of Service

Service Discovery

Imaging History

Image Export

Image Purge

Manage PatientRecord Presentation

Theatre management

Single Sign- on

Local Translation(Language)

Translation (Language)

Service RegistrationMaintenance

SAR Collation

Mental health

Manage ProfessionalCarer Relationships

Monitoring

Help desk Support

Incident & Problemmanagement

Backup Mgt

Change & ConfigMgmt

Systems MgtStorage Mgt

Network Mgt

Asset Mgt

Restore Services

Replacement IS andIT resources

Data BackupAssistive Technology

Service Hosting

Print Services

File Services

Data Management

Manage (pseudo)anonymised data

Manage Reports

Manage Reports Types

Manage ReportsGroups

External Interfaces

Registration &Maintenance

Patient trace & info

NHS No. Services

Update stored data types

Duplicate Record mgmt

Create event,workflow or alert

Store, maintain, retrievesummary etc data

Print prescription

View Spine data

Update Spine data

Manage Clinicaldocument tools

Manage Messages

List management

Local Authoring

Local Publishing

Major IncidentManagement

Manage care deliverybreach times

Manage Care period

Manage Care Spells

ManageCommissioning

Manage carepathways

Manage care plans

Manage CostingCare Delivery

Manage Death

Manage DuplicateRecords

Manage Expenses

Manage ExternalDocuments

Manage HealthIssues & types

Manage HealthcareOrganisation

Manage InternalSupport Tools

ManageKnowledge Bases

Manage Local ExternalReporting Tools

Manage LocalReports Groups

Manage LocalReports Types

Manage medicationadministration

Manage medicationcharts

Manage medicationrecord

Manage MedicalDevice Integration

Manage Multi-Resource Scheduling

Manage non-pharmacy dispensing

Manage Objects inClinical Documents

Manage PatientDemographic Details

Manage PatientDocumentation

Manage PatientEncounters

Manage PatientEpisodes

Manage PatientIdentif ication

Manage PatientProperty

Manage PharmacyDispensing

Manage prescribingmedications

Manage prescriptions

Manage PrivateFinance

Manage People

Manage Referral

Manage Resources

Manage Risks& Warnings

Manage services

Manage Third PartySupport Tools

Manage User Devices

Manage user interface

Manage WaitingLists

Manage Wards,Rooms and Beds

Maternity Services

Reimbursement

RequestManagement

Result Management

Manage User Sessions

E.g. DemographicsWithin local Services Domain

• Set of services required to be implemented by local systems

Within Enterprise Services Domain

• Set of services required to be implemented by national service provider for all 60m patients

Set of compliance docs from NHS CFH

• Covering requirements to be met by systems implementing those services

• MIM for message definitions and example process flows • Principles - loose coupling, search local first, update local first• What is to be tested and verified during integration testing

Logical Applications…

Enterprise Services

Local Services

Channels and Presentation

Infrastructure

IntegrationSecurity

Legacy Services

Demographics Clinical Summary

Information,Knowledge and

Research Services

LocalApplicationIntegration

EnterpriseApplicationIntegration

Assessmentsand Clinical

Documentation

NWCS

NSTS

NN4B

CHRIS

NHAIS

Blood

HealthSpace

QMAS

Access ControlFramework Demographics

DataClinical

Summary Data

Gazetteer

ElectronicPrescriptions

Choose andBook

DemographicBack Office

Clinical SummaryApplication

Data Feeds

Workflowand Rules

Terminology

SecondaryData Uses

DocumentManagement Prescribing Emergency

Requesting &Results

Maternity

DentalRadiologyPatient

Administration Pathology GP Systems Reporting

CommunityServices Legacy Systems Pharmacy Theatres Ambulance Data Warehouse

ImageManagement

LocalInfrastructure Devices Networks Hosting

SystemManagement

Client IdentityAgent (IA)

SecurityServices

DirectoryServices

LegacyChannels

Web

ChannelManagement Phone SMS(text) Paper DTV

Web Service AssistiveTechnology

Local Services

Assessmentsand Clinical

Documentation

Theatres

Information,Knowledge and

Research Services

PatientAdministration

Requesting &Results

ImageManagement GP Systems

Emergency

Maternity

CommunityServices

Prescribing

Ambulance

Radiology

Data Warehouse

DocumentManagement

Map of Medicine

Pathology

Blood

Dental Reporting

Legacy Systems

i.CM

i.CM

SAP

Lorenzo R1

Lorenzo R1

Lifenet ECS

CRIS

Child Health(HSW)

i.PM

Lorenzo R4Lorenzo R2

Lorenzo R2

Lorenzo R2

SystmOnePACS (GE)

Pharmacy

Evolution[Maternity]

PACS (Agfa)

Lifenet ECSScantrack

ORMIS

Lorenzo R3

TMS

Agenda





healthcare



The role for standards

• Explicit from the outset. • The standards base evolves and grows• Standards chosen to maximise interoperability and to meet different

integration requirements

• Use of ebXML, (https, SOAP, XML) - reliable asynchronous messaging for patient demographic updates

• Web Services and WS standards e.g. WS-A – lightweight synchronous messaging for patient demographic queries

• Use of SNOMED CT• Use of HL7 v3 (ETP, C&B, PDS) and CDA v2 (Clinical Documents)• Lots more….

• Objective is to federate the design responsibility to the systems providers, working within a framework of standards and specifications

Not just technical standards

• Common User Interface (CUI) - Microsoft and NHS CFH (http://www.mscui.org/)

• Knowledge authorship to allow Knowledge Support (KBS) and Decision Support into all aspects of the implementation

• The International Health Terminology Standards Development Organisation• SNOMED CT

• Charter Members (Australia, Canada, Denmark, Lithuania, New Zealand, United Kingdom United States)

• A drug database – The Dictionary of Medication and Devices (dm+d)

• Standards by which we accredit systems as safe to implement and exchange information

Elective / Passive Decision Support – same component in all local solutions

Standard drug dictionary

A standard drug dictionary for all systems

We (and Australia) have chosen to make and maintain a new one called dm+d (The dictionary of medications and devices)

NB. This is NOT decision support but a standard way of naming and structuring medication and devices so that decision support and complex rules based content can be added with predictable results.

Atenolol50mg

Tablet x28(VMPP)

Atenolol 50mgTablet(COX)(AMP)

Atenolol 50mgTablet(Cox)X28

(AMPP)

Atenolol 50mgTablet(VMP)

Atenolol(drug product)

(VTM)

Cardioselective beta-blocker

IS_A

Beta-blocker drug

IS_A

etc etc

IS_A

Snomed CT drug core

NHS dm+d

Dm+d and SNOMED CT (300,000 terms)

•Both dm+d and SNOMED have a

central core with local additions

Standards enable supplier expansion

• The use of Open Standards for integration (ebXML, HL7) has enabled an expansion in number of suppliers to the programme• Leverages existing knowledge capital and established

standards • Allows suppliers to build COTS packages based upon

industry standards. Move away of bespoke development• Allows plug and play of new services• Standardisation reduces overall testing complexity

• To meet business objectives we have integrated• 100s of supplier applications• Access from private corporate WAN (N3) as well as internet

aggregators for high street access

What have we achieved so far? … - some “numbers” (at 08/10/07)

• 17,454 instances of systems connected into the national services which allows in a typical day• 190,000 prescription messages issued electronically

(18% of all prescriptions)• 19,000 Choose and Book electronic bookings• 1,400,000 queries to be recorded on the patient

demographic system enabling letters to be posted to the correct address and patient information to be handled more efficiently

• These are deployed via the 20,662 connections to N3 (the national NHS WAN)

• 380,350,622 images have been stored using PACS from NHS CFH

• There are 394,367 Smartcard holders who are registered and approved for access to systems

Acute System

Patient info

Broken Leg

Patient visits Emergency Dept

Emergency Dept

Discharge

GP System

Back Pain

Patient visits GP

Acute System

Patient info

Chest infection

Patient visits hospital

Summary Care

Record

What’s next - more clinical Information flows between systems

Enabled by standards (HL7v3 and HL7 CDA v2 over ebXML (https/SOAP/XML) and central messaging services (TMS)

Update GP Summary

Emergency Dept

Discharge

Discharge

Discharge

Agenda





healthcare



Integration – The Challenges• Large number of suppliers – and growing• Each supplier footprint is different & can consume

different services• Suppliers in different phases of development• Business critical services – cannot be stopped for more

than a few hours• We cannot ‘lose’ data• Data must only flow from accredited applications running

from authorised endpoints originating from users with the relevant roles

• Large numbers of endpoints, systems and users• Strict Information Governance Rules

Challenges – Service Definition• Right Granularity ? To high and they are subject to constant

change. To Low and it can result in significant increases in message flow.

• Generic or Specific business process ? The level of business logic can impact the re-usability of the service.

• What SLAs ? Services that are used for many business functions may have varying SLA needs – these must be balanced against cost

• Trade off between performance and extensibility• What security model ? Whilst some aspects of information

security can be centralised – others must be federated

Challenges – Compatibility

• FORWARD and BACKWARD

• A change to a service can impact many applications and suppliers- Each system needs to be fully tested before it is

accredited for deployment !!!

• The more ‘versions’ we support the less scope we have to add new capabilities

• Translation services are required to accommodate supplier applications running at different versions

Services usage can be different to expectation• All local systems will integrate with Summary Care

Record• SCR provides a set of services to enable this in

different ways

Summary Care Record

CSA

Req

uest

Re

spo

nse

ESPOn-demand …

Req

uest

Re

spo

nse

LSPPre-fetch

Req

uest

Re

spo

nse

Agenda





healthcare



Cross Government Enterprise Architecture

• CTO Council formed in Sept 2005. The aim is to support the CIO Council through the optimisation of the use of IT resources across the public sector.

• Strategic value of xGEA is to identify opportunities for collaboration and reuse across government.

• Without a business and IT Blueprint for Government – an Enterprise Architecture – avoidable cost would be incurred as IT is developed in ‘islands.’

So where do the CTO Council sit?

Ministerial Leadership

Business Leadership

Technical Leadership

Deep Business and technical knowledge

Ministerial Group

Leadership Groups

Technical Steering Group

Working Groups Working Groups

Working Groups

DA (PED)

CIO Council PGSSBDelivery Council

CTO Council

xGOV EA Domains and Leads

CHANNEL DOMAINTerry Hawes (HMRC)

INFRASTRUCTURE DOMAINAndrew Bull (HMRC)

APPLICATION DOMAINTBD

PROCESS DOMAINJohn Wailing (Home Office)

INFORMATION DOMAINPete Desmond (DWP)

STRATEGYAndrew Stott (Cabinet Office)

SE

RV

ICE

S M

AN

AG

EM

EN

T D

OM

AIN

Pau

l McA

voy

(DW

P)

INT

EG

RA

TIO

N D

OM

AIN

Inde

rjit

Sin

gh (

NH

S C

fH)

INF

OR

MA

TIO

N A

SS

UR

AN

CE

D

OM

AIN

Mar

c H

ocki

ng (

Ca

bine

t O

ffic

e)

xGov EA Context

• The majority of the work of the CTO council is structured around the xGov EA through the Domain Teams.

• The Domain Team leads collectively form the Architecture Review Board (ARB) whose purpose is to: • Oversee the development of cross-Government

Enterprise Architecture – xGEA• Oversee the development and operation of the clearing

house process for exemplars• Assesses the fitness for purpose of proposed exemplars

(managed services and solutions) for reuse across the public sector

• Resolves overlaps between domains• Provides a forum for peer reviews

Capturing EXEMPLARS at various levels

Managed Service

Solution

Pattern

Lessons Learned

Potential Value

Number of assets found

• A hosted service that is offered to others

• A packaged service including: code, design that can be rebuilt

• The approach to providing the service

• Experiences gained implementing the service

Clearing House Process and Domain ToR Detailed Process Flow

Organisation

Organisations’(Technical)ArchitectureTeam

Organisation


Organisation


Organisation


Organisation


Entry

Viability

Definition

Design

BusinessJustification

Build

Go Live

Benefits

Generate Idea

Test Feasibility

Define Proposition

Design Service

Complete business case

Build Service

Live Running

Live Running

Test Service

Define Idea

Match Reqs

Reuse & IdentifyNew

Harvest to Exemplar

Organisations’ Architecture TeamInterface Process

Domain Teams

Clearing House

ARB

CTO Council

CHANNEL DOMAIN

INFRASTRUCTURE DOMAIN

COMMON APPLICATION DOMAIN

PROCESS

DOMAIN

INFORMATION

DOMAIN

STRATEGY

SE

RV

ICE

S M

AN

AG

EM

EN

TD

OM

AIN

INT

EG

RA

TIO

N D

OM

AIN

SE

CU

RIT

Y D

OM

AIN

Future / WIP Existing

Delivery and Transformation Group

Business Idea X

Business Idea XArchitecture Priority : 1CIO Gate Status: ViabilityPrimary Domain : InfrastructureSecondary Domain : Channels

Business Idea XArchitecture Priority : 1CIO Gate Status : ViabilityPrimary Domain : InfrastructureSecondary Domain : Channels

Check keywordsagainst ‘Metadata’

ExemplarExist

Record as WIP

Re-useas-is

Enhanceand re-use

Organisation


Organisation


Re-usedBusiness ‘artefact’

eRoom

Summary

• Use a service based Enterprise Architecture to enable a common language

• Set standards and frameworks that permit increasing levels of interoperability and interaction across multiple suppliers

• Be aware of the challenges of integrating multiple suppliers