British Computer Society report calls for overhaul of NHS IT project

A new report from the British Computer Society calls for a fundamental rethink of the NHS IT programme. Several of its proposals relate to standards, including the assertion that much more needs to be done to ensure that systems achieve semantic interoperability. Among the key additional tasks in the area are:

a) an electronic health record/electronic patient record (EHR/EPR) architecture that suppliers can converge towards. The ENV13606/CDA v2 standards would be sensible starting points. [ENV 13606 is a European pre-standard for exchanging electronic patient records. It is due to become a full European and ISO standard in 2007. CDA (clinical document architecture) version 2 is an HL7 v3 generic standard for messaging clinical documents. Like ENV13606, it comprises a recursive hierarchy of components.]

b) representation of content, especially clinical content. Particularly important are items most relevant to patient safety, such as allergies, adverse drug reactions and medication statements of all sorts. Again ENV13606/OpenEHR archetypes would be a sound starting point ...

f) representation of knowledge in general, and the clinical knowledge associated with drugs and prescribing in particular, i.e. indications, cautions, contraindications, side-effects, drug to drug interactions and so on. The latter needs to be accessible via the NHS Dictionary of Medicines & Devices (DM+D). ...

m) continuing the work NHS CFH is already engaged in with others to make the HL7v3 messaging standard easier (and safer) to use, which is timely and important. The claims made for HL7 v3 to be a basis for standards other than messaging should however be investigated thoroughly when considering their adoption.

n) a need to openly pilot SnomedCT, the terminology adopted as standard by the NPfIT, disseminate the outcomes and to publicize current plans to cope with and tackle long-term challenges, such as equivalence and negation. There will inevitably be significant generic issues in the introduction of compositional terminology as novel as SnomedCT, especially in real-time use, and it would be sensible to explore these centrally on behalf of all future users.

o) a need to check that the set of standards chosen form a coherent whole – given the variety of standards that exist and their overlapping scopes, e.g. HL7 v3 / SnomedCT & record architectures – and decide the deployment scope of each. The expression of negation in clinical records is a case in point.

The apparent incompatibility of SnomedCT's 2-valued logic with HL7's 3-valued logic is another case in point.