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					Interoperability & Technical Embedding
introducing NHS Pathways into the wider technical
Pathways is…….

• A clinical triage system which embeds within a host
• Through questioning it reaches an end point – the
• The disposition can be sent to CMS DOS or handled by
  host system depending on local rules
Pathways is not…..

• A CRM tool – i.e. like a CAD or Adastra or CAS
• it does not hold patient information
• It does not duplicate the functionality of the host system
Work Flow - no transfer

           • Rings service (999, 111, OOH)

           • Collect demographics then launch Pathways

           • Triage then send information to DOS

           • DOS finds matching services and returns to pathways

           • Triage closes and returns to host system
Work Flow - with transfer

           • Rings service (999, 111, OOH)

 CRM 1
           • Collect demographics then launch Pathways

           • Triage, disposition requires transfer to another service

 CRM 1
           • Generates Pathways message and sends on

 CRM 2
           • Receives message and handles accordingly
But Pathways does…..

Have information useful to the host system
• System flags
• Symptom discriminators
• Disposition and rationale
Embedding - Resources

To support suppliers in embedding NHS Pathways suppliers
signs NHS Pathways License to Embed and gets:

•   NHS Pathways technical specification
•   Graphics for body maps
•   Test harness for look and feel
•   Source code of test harness
•   Sample clinical content
•   NHS Pathways Message specification
Embedding - options

• System supplier develops in own code from Tech Spec

• Supplier uses source code of test harness as a basis of
Embedding - rules

• Colour scheme can be adapted to suit host system….

• But don’t rearrange the furniture!

• Test harness provided meets the technical specification so is
a good guide to getting the interfaces and functionality right

• Code is not supported by NHS Pathways, it is for suppliers
convenience, the supplier has to deliver to their customers
and assure their development.
System Parameters

• Pathways can be configured to behave in different ways
  according to certain system parameters passed in to it.
• Host system needs to provide local administrators with
  ability to configure parameters
• These include flu pandemic/epidemic status, REAP
  status, triage cut off point
Starting Pathways

Host system can be launch Pathways in two ways depending
on what data the host system collects prior to Pathways.

There are specific entry Pathways based on the patient’s
•Age group
•Party (calling about self or other)
Starting Pathways with….
Call handler skill set and patient
postcode (e.g. for 999 calls)
Starting Pathways with….
Patient age, gender, party, postcode and call
handler skill set (e.g. for 111/GP OOH calls)
Listen for…..

•   System flags
•   Symptom discriminators
•   Disposition display text
•   Disposition codes

All these can provide information that you might want to use
   to trigger events in the host system
Triage complete

At the end of Pathways triage the host system needs to:

•Transfer Pathways triage record to reporting tables
• In some cases, forward message to another service

Report data is either written as you go to your own tables or
formed from xml output by dll code with extra information from
your tables.
Pathways team require data dump once per month

Message is xml combining host and Pathways data

At the end of a Pathways triage, several things can happen
• Call closed with no further action
• Call queued in local host system for another skill set
• Triage record forwarded to another service using NHS
   Pathways standard xml message
Receiving a Pathways message

The message contains a complete record of the triage
    completed by the sending service.
If the receiving service is a Pathways user then it can be
    queued for appropriate skill set to pick up and call
    reassembled and viewed in validation screen. Triage can
    be continued from end of previous or at any point within
    previous triage
If the receiving service does not use Pathways they can
    parse out the data – disposition, disposition rationale etc.
    that they need for their own system.
Any Questions?

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