Following E-Health Insider s XML in health feature two week s ago, Philip Firth, IM&T Strategy Implementation Manager at Wrightington, Wigan & Leigh NHS Trust, sets out how his trust has used XML to develop extremely low cost ‘best of breed’ solutions to integrate systems and improve clinical care.

Information Technology at Wrightington, Wigan & Leigh NHS Trust (WWL) is clinician led, and senior consultants and clinical support managers have consistently voiced a clear preference for a ‘best of breed’ approach.

Our current IM&T strategy is focused on maintaining legacy systems (systems which work and are not in immediate need of replacement) and building electronic patient records (EPR) through systems integration and developing web-based applications to meet strategic objectives, such as discharge letters and National Service Frameworks. The key to successfully implementing this ‘best of breed’ approach has been XML.

Case history: National Service Framework (NSF) for Coronary Heart Disease

An e-technology solution was required to monitor thrombolysis treatment (door-to-needle times) and improve the speed of access to electronic patient records. The use of XML enabled us to achieve this vital objective.

Coronary Heart Disease (CHD) electronic case notes are now viewable in seconds, cross-referenced with acute coronary care information held on other systems (such as the patient administration system (PAS) and pathology), and linked to evidence-based medicine via NHSnet and NeLH. This single integrated set of electronic patient records provides our clinicians with a very powerful NSF information resource.

The CHD e-technology solution has been a big hit with clinicians. For example, previously recorded ECGs are now stored in an XML repository, and are now used by clinicians to assess a patient’s eligibility for thrombolysis, providing a vital source of information for assessing patients for treatment within 20 minutes. Clinicians say that providing them with rapid access to ECG results has improved patient care.

Our XML-based approach is also providing significant value for money. This CHD e-technology solution was implemented at minimal cost using existing IT resources and £500 obtained from winning a Service Improvement Team (SIT) award.

Case history: Health Records Infrastructure pilot project

The NHSIA recently completed a ‘proof of concept’ pilot for Health Records Infrastructure (HRI) based around linking together existing computer systems to achieve virtual Electronic Health Records (EHR).

The HRI pilot programme utilised web service technology (again based on XML) to authenticate user access requests, manage patient consent, and ensure patient confidential information remained secure in transit.

The NHSIA approached WWL to take part the national HRI pilot programme because it had already implemented a web-based EPR system and was in a position to rapidly deploy a solution. The pilot was successful and demonstrated that patient records can be shared between NHS organisations securely and confidentially.

Interoperability standards

An NHSIA HL7 impact assessment report published in 2001 suggested that HL7 Version 3 was the only viable option for adopting a set of standards to support system interoperability. It is worth noting that HL7 Version 3 will be implemented in the NHS using XML schemas. WWL is in the process of developing a radiology results reporting interface, and will be using HL7 Version 3 messaging to transfer reports into our EPR XML data repository.

Overall feedback from clinicians

This XML based system development approach has been well received by clinicians at WWL. Feedback from consultants, SHOs, junior doctors and nurses points to the fact that presenting electronic notes in a web-based system provides a user-friendly way of navigating electronic patient records.

Another bi-product of the XML approach is the ease of configuring systems to meet local needs. A recent example of this was the implementation of a system for sending paediatric discharge letters to GPs.

The core system was designed by the lead paediatric consultant with significant inputs from clinical coding and pharmacy. The resulting system (developed using XML and ASP.NET) has provided SHOs a user-friendly way of compiling letters, and recording diagnoses and medications. The speed of sending letters to GPs has been reduced from up to 6 weeks to, in many cases, the same day.

Philip Firth
IM&T Strategy Implementation Manager
Wrightington, Wigan & Leigh NHS Trust