Hi Andrew,
1) at what level is the standardisation done with the GP
systems ie. is the XML that is sent to the SCI Store standardised
(and if so, can you give us a pointer to the standard) and the role
of the GP systems vendors is to get their clinical data into that
format -or-
Is some interface level standardised that the GP system vendors must
meet, and the ECS calls into this interface to extract the data it needs?
The XML is standardised and is based on a pre-existing set of XML
standard interchange formats also used for Referrals, Discharges and lab
test reporting. These are home-grown but are heavily based on CEN/ EnV
13606 models. There is a link to a document below that details the XML
schema.
For either of these approaches, is the terminology home grown
or an international (i.e. medication codes), or is the data
not coded?
Any coded data is also expressed as Text and in any case the XML file is
simply stored as a blob and used to display in a browser via an XSL
transform. i.e There is no current requirement to parse the XML or
enforce machine-level interoperability
Although terminologies are normally included,there is as yet no standard
medication code but the medication details are passed in a highly
structured format. All vendors in Scotland will be moving to the UK dm+d
medication database standard in the near future.
The only clinically coded aspect of data that is passed at present is
allergies and ADRs. This has proved a problem as each vendor has a
different way of recording these items and integrating with decision
support systems. There id work being done at a UK level to rationalise
this. It is not currently a major problem since the requirement is only
to display the ADR information correctly. Even if we had a standardised
ADR representation, there are currently no recipient systems that could
make use of this to trigger drug alert warnings.
I presume there are multiple GP system vendors?
There are 4 commercial vendors in Scotland + one publicly funded system
(GPASS) which currently has 70%+ of users.
2) How were the GP vendors convinced to do the work - was it
carrot or stick?
Good question!! Both - the carrot is that the market has been somewhat
liberalised in the last 2 years, so that GPASS (whicgh was free) has no
real economic advantage since practices will now receive 100%
reimbursement for any 'accredited' systems. GPASS is also seen as being
significantly deficient compared to the commercial alternatives and
there is now a fair amount of pressure from practices to switch. So
there is a real opportunity for the vendors at present but they must be
'accredited', one of the criteria being ECS compatibility
As I said before I am not directly involved in ECS but I found this
document via Google:
Name: ECS Solution Overview (GMS-013-06-004)
http://www.show.scot.nhs.uk/forums/g/gmsimt/_html/GMS%20IM&T%20Projects/ECS%20Solution%20Overview%20(GMS-013-06-004).doc
After a bit of management wibble, there is a fair amount of technical
detail.
Regards,
Ian
Andrew
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