Ian Townend
Chief Architect, Transformation Directorate, NHS England
Sharing information is vital to the functioning of the health and care service. This can include information for patient treatment, medications or at a population level to support risk stratification of patients and the management of care settings.
We need to have access to structured information that can be disassembled and used in different ways to support these activities. This could include creating a summary of someone’s care using a standard like the International Patient Summary, consuming a diabetic’s blood sugar readings to create a visual of their levels over time or ensuring that when a patient is admitted to a hospital, those providing care can maintain their medications.
Filling in gaps
To share information effectively, we need not just standards and specifications but consistent implementations. For some time, we have had this for administrative data like a patient’s demographics, but not across clinical data. There are several offerings in the market that provide some of this — but often to their own standard and not a shared one which everyone can use.
To share information effectively, we need
not just standards and specifications
but consistent implementations.
Clinical codes
A standard sets out the rules for a particular area such as SNOMED CT for conveying clinical codes (the semantic meaning), HL7 FHIR for messaging (the syntactic structure), NHS number for identifying the patient and a host of infrastructure standards to get the information from one point to another.
These need to be combined into a specification to set out how we will convey this information. For example, a FHIR patient resource to carry the NHS number and demographic details along with a condition resource with a SNOMED code such as 44054006 (the code for diabetes). Using this specification, a provider of data can be clear about how it should be exported from a system, and a consumer of this data can be sure about what they will receive from any number of providers.
This is harder than it may sound, but progress is being made with programmes like GPConnect (access to consistently structured data from general practice) and structured discharge summaries. Key to the success of this effort is working with key partners, including the Professional Record Standards Body supporting content standards and discovery and INTEROPen supporting technical specifications and hackathons.
Some great training resources are available across standards with further resources coming in the new year. The forthcoming Standards and Interoperability strategy from NHS England will set out the direction of travel for this area.