Royal Bolton Hospital NHS

The Trust’s IT team prepares for NPfIT by using InterSystems Ensemble to build new interfaces

Royal Bolton Hospital NHS Foundation Trust integrates its healthcare systems seamlesslRoyal Bolton Hospital NHS Foundation Trust integrates its healthcare systems seamlesslyRoyal Bolton Hospital. At the end of its last IT procurement/implementation cycle‚ Royal Bolton Hospital NHS Foundation Trust decided that to gain the full benefits provided under the National Programme for IT (NPfIT) it would be required to migrate away from its locally hosted Patient Administration System (PAS). It was determined that to save money and improve patient services the Trust would take a progressive approach and switch to a centrally hosted reference solution from regional provider‚ CSC.

However‚ Bolton‚ like all other NHS Trusts within the North‚ Midlands and East (NME) Local Service Provider regions‚ had to meet one very strict criterion: it had to ensure that the centrally hosted CSC applications could communicate properly with all its existing legacy systems using HL7 v2. Without this the Trust would be unable to link with CSC’s reference PAS and Emergency applications.

Within CSC’s NPfIT service solution there is a clear dividing line between the responsibilities of the Trust and CSC. Individual Trusts are responsible for the IT services within their hospitals‚ whilst CSC manages information and connections beyond these boundaries. Therefore they need to cooperate closely in order to ensure that the links between these two “domains” meet the demanding levels of rigour and quality that are at the heart of the National Programme. However‚ during the period when Bolton was preparing to take the CSC reference solution‚ each Trust had responsibility for procuring its own integration software solution.

We needed a modern integration engine that could evolve with us as our needs changed [and would] work with HL7 v2 ‘straight out of the box’.

Ken Bradshaw, Head of IT Strategy and Implementation
Royal Bolton Hospital NHS Foundation Trust

Although Bolton already had a Trust integration engine in place‚ Ken Bradshaw‚ the Head of IT Strategy and Implementation‚ wanted to ensure the Trust benefited from tackling this latest task using the best available technology. “We needed a modern integration engine that could evolve with us as our needs changed‚ work with HL7 v2 ‘straight out of the box’ and give us additional‚ in-built functionality‚ such as scope to apply intelligent rules-based routing‚ business intelligence‚ and the ability to build composite applications.”

Key Benefits

  • Fast development
  • High performance
  • Advanced integration technology

InterSystems Ensemble® is a seamless platform for integration and the development of connectable applications that provides complete support for all HL7 v2.x messages‚ with full comprehensive parsing and transformation capabilities. The provision of standard HL7 v2 schema is an integral part of Ensemble‚ as is the ability to define and store custom schema and to drill down to the underlying schema documentation directly from message traces. Ensemble also provides the components that minimise the programming involved in creating interfaces.

Bradshaw continues‚ “After running a rapid‚ but extensive‚ procurement process‚ the choice was clear. We selected Ensemble as we saw it as being robust and easy to use‚ and it came with its own HL7 adapters. This gave me confidence that my own IT staff would be able to create the interfaces we required within the demanding and tight deadline that faced them‚ standardise our approach to interfacing and reduce our dependence on third-party suppliers.”

The Trust’s decision was endorsed as CSC subsequently selected Ensemble as the integration platform for their new Trust Integration Engine (TIE) programme. Underthe programme every Trust within its NME regions can be provided with Ensemble as part of CSC’s implementation of NPfIT applications.In addition‚ since Bolton were working with the same integration engine as CSC‚ they were able to work closely with them to prepare for the migration from the locally to the centrally hosted PAS.

Implementing the Trust’s vision

In phase one of the integration project‚ the Trust needed to prepare 12 new interfaces between its own local applications and the new hosted application in a very short period of time.

Rather than ask each individual supplier to develop the necessary interfaces – which would have been the case with their previous interface engine – Bradshaw was keen for the Trust’s IT team to build them internally using Ensemble‚ as this would give them far greater control over the IT system and save money.

We selected Ensemble as we saw it as being robust andeasy to use‚ and it came withits own HL7 adapters.

Ken Bradshaw, Head of IT Strategy and Implementation
Royal Bolton Hospital NHS Foundation Trust

“Unfortunately‚” said Bradshaw‚ “although they were steeped in healthcare IT‚ because we had invested heavily in managed services‚ no one within the IM&T Department had a great deal of hands-on experience with integration. Another complicating factor was the fact that some of the older interfaces were very poorly documented. However‚ we assembled a small team comprising of staff who had excellent knowledge of how the Trust worked‚ would get on well with the heads of department affected by the project and were keen to learn about integration under the tutelage of InterSystems’ support staff.”

With the help of the InterSystems support staff‚ the Trust’s team developed the first eight integration interfaces. The most straightforward interfaces involved the transformation of data from one HL7 message format to another. In other cases‚ the information was extracted from the HL7 message and inserted into InterSystems Caché® (a high performance object database) using the SQL adapter‚ so that the application could retrieve the patient data via industry standard ODBC. Only one interface required a new custom adapter to be built within Ensemble. Having gained this experience they were then able to specify‚ design‚ test and implement a further four interfaces on their own in just three months. The speed of the project was a consequence of the team being able to work with Ensemble’s graphical data transformation and test environment.

As ‘Go Live’ with the new integration platform approached‚ the team’s determination to ensure everything went as smoothly as possible was epitomised by the relentless testing and re-testing of the new interfaces to verify their performance.

“But‚” according to Bradshaw‚ “the effort was well worth it. In the end ‘nobody saw the join’ between the old and the new PAS‚ as it all went so smoothly.” As to how Bradshaw can be so certain as to the high level of his team’s success‚ “If there had been problems‚” he adds‚ “my phone would haverung immediately!”

In the end ‘nobody saw the join‘between the old and the new PAS‚it all went so smoothly.

Ken Bradshaw, Head of IT Strategy and Implementation
Royal Bolton Hospital NHS Foundation Trust

With the new interface engine in place‚ the Trust can now distribute definitive patient demographics from the reference solution to multiple in-house applications‚ saving time for clinicians and patients. For example‚ screens within the maternity‚ broncoscopy and endoscopy departments‚ plus others‚ are now pre-populated with accurate patient information‚ reducing scope for typing errors.

The additional benefits also extend to the technical quality of the solution. Not only is the Royal Bolton Hospital NHS Foundation Trust using the same integration platform as CSC‚ but its implementation is consistent with rigorous standards and specifications that CSC is defining at LSP level.

The good work continues with additional interfaces being written internally to support orthopaedics‚ GP Order Communications and Radiology Reporting. With Ensemble now ensconced within the Trust‚ and staff fully trained‚ Bolton has the agility and flexibility to adapt with the changing nature of healthcare and its own individual needs.