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http://www.connectingforhealth.nhs.uk/lra

Semantic Interoperability I got your message I can understand it I know what you mean I believe you I know what I will do

I got your message

I understand it Syntax Content Rich Information Models Clear message specifications Understood by both parties Clinical statements Free text Images Sound

I know what you mean For computers, this is not easy Shared syntax Shared information models Shared language either interface terminology such as READ / LOINC or reference terminology such as SNOMED CT Maps / translations / transformations / functions into a classification terminology such as ICD10 Create new content, such as alert clinical statements

What does the LRA do It enables data and the uses of data to be described It enables the data required to inform patient care to be obtained as a by-product of the records used for patient care. It enables the data required to inform the design and management of healthcare systems to be obtained as a by-product of the records used for patient care.

What is the LRA It is Logical Architecture For Health and Social care records Driven by English National Health and Social Care requirements Based on EN13606 Exploiting the potential of SNOMED CT terminology It isn t The answer to life the universe and everything A physical model Designed to be implemented as a physical system Fully elaborated yet

The English Journey General Practitioner (family doctor) systems using MIQUEST for over 10 years Very simple model Pre-coordinated mono-axial terminology Patients Journals Encounters Journals Referrals Links

The future Mixed economy GP Data in READ with Miquest based queries GP Data using forms and templates Acute data from Millennium and Lorenzo using question/answer forms Acute data from note taking functionalities

Success and challenges Physician office READ interface terminology Journal of simple clinical statements Physicians generate content from terminology Hospitals Question and answer forms Creating enough forms is, at best, challenging Systems need the forms for deployment

Content is King A standard structure is important, but You need content to make it worthwhile

Note Taking

31 Octember 921 S: Sore throat 4 days temperature, taking fluids taking paracetamol. No better. O: Looks well, enlarged glands, pus - tonsils A: Folicular tonsilitis P: Penicillin V 250mg 2qds 40

31 Octember 921 S: Sore throat 4 days temperature, taking fluids taking paracetamol. No better. O: Looks well, enlarged glands, pus - tonsils A: Folicular tonsilitis P: Penicillin V 250mg 2qds 40 Composition

31 Octember 921 S: Sore throat 4 days temperature, taking fluids taking paracetamol. No better. O: Looks well, enlarged glands, pus - tonsils, Temp 38.1 A: Folicular tonsilitis P: Penicillin V 250mg 2qds 40 Composition Entry Element

Sore throat 4 days Meaning: The patient reported that the patient had a sore throat at the specified time Entry time: 31 Octember 921 Observation time: 28 Octember 921 to 31 Octember 921

Pus -Tonsils Meaning: The patient had pus - tonsils known to be present at the time Entry time: 31 Octember 921 Observation time: 31 Octember 921

Temp 38.1 Meaning: The patient had a temperature (observable) known to be present at the time Entry time: 31 Octember 921 Observation time: 31 Octember 921 Value: 38.1 Unit: degrees celsius

PDS SDS DM+D HL7 style actors and participations EN13606 SNOMED CT ISO 21090 datatypes (HL7 datatypes V2) UCUM Meaning: The patient had a temperature (observable) known to be present at the time Entry time: 31 Octember 921 Observation time: 31 Octember 921 Value: pq.value 38.1 pq.unit degrees celsius

The base elements Element Observation Activity Relationship Property Finding Investigation Substance Activity General Activity

An example constraint 243796009 situation with explicit context : { 363589002 associated procedure = <<14456009 measuring height of patient, 408730004 procedure context = <288532009 context values for actions, 408731000 temporal context = <410510008 temporal context value, 408732007 subject relationship context = <125676002 person }

An example Blood pressure

Haemodialysis Vascular Access

LRA Factory Machine (the next year s development) Requirements: Laws, guidelines, Frameworks, standards etc Archetypes/templates

More information http://www.connectingforhealth.nhs.uk/lra