Background

Historically Clinical Systems have been supplied by a single supplier of both hardware and software.

This has lead to an inflexible situation that has meant that doctors that are dissatisfied with a particular aspect of a clinical system have had to replace the entire system or put up with the short comings of the system that they have.

As Medical practice becomes more sophisticated and government requires changes that are intended to alter working practices in order to increase cost effectiveness and target particular health problems, demands on General Practitioners and Clinical Systems Suppliers have increased, causing Clinical Systems Suppliers difficulty in providing excellent systems across all areas of General Practice at a cost that can be absorbed by the General Practice.

Specialist programs usually developed by doctors with particular interest and knowledge of the field of medicine involved are now available, and General Practitioners wish to use these programs, but would prefer to be able to make them behave as if they belonged with and were part of their Clinical System.

Clinical Systems Suppliers have been unable so far to satisfy this demand.

The general move towards Windows 95/98 operating systems and the use of standard networks within Clinical Systems has meant that new possibilities for developing an interface to enable specialist software to be linked to Clinical Systems is now a possibility.

Purpose

To establish a simple and commonly used standard agreed by all parties concerned.

To enable specialist software to be interfaced to clinical systems in General Practice.

To provide an interface that is reliable and easily tested.

To provide a flexible interface that can be developed and extended.

To enable General Practitioners to select extensions to their systems that will enhance their work.

To establish a plan and direction for changes in computing so that the interface does not fall into redundancy and disarray when new hardware or operating systems come into use.

To give doctors confidence when making difficult decisions with regard to selecting a Clinical Systems Supplier

e.g. Does the Clinical System Supplier support COSI ?

Yes - a positive indication

No - a negative indication

Method

The Clinical System shall be known as the HOST and any other software extending that system shall be known as a GUEST.

Both HOST and GUESTs shall not access or alter the software and files belonging to each other except in cases where permission is expressly given.

HOST and GUESTs shall maintain and publish an up to date record of their current levels of compliance to COSI, including the names and contact details of other software suppliers with which interworking is available. This should (where possible) be available on an internet web page with links to the relevant web pages of the supplier to which each reference relates (if such a web page exists).

COSI shall be implemented in numbered levels.

COSI Level 0

Level 0 is a written commitment to implement as a HOST or GUEST an agreed level of COSI in the near future, and should include an expected implementation date for each level and version for each HOST and GUEST (were applicable) that is to be implemented.

COSI Level 1 Version 1 - (Windows 95 & Windows 98)

The HOST software shall permit GUEST software and associated files within a folder called COSI1.1 on the C: drive of each computer in the network. (Where1.1 signifies the level of implementation of COSI).

Each GUEST shall occupy a directory with a name specific to that company within the COSI folder.

e.g. C:\COSI1.1\MEDCAL is the folder used by MEDCAL

A folder or folders will contain the files used for the interface. These folders will be located as designated by the GUEST within the GUEST's COSI Folder.

e.g. C:\COSI1.1\MEDCAL\RISK\IMPORT

and C:\COSI1.1\MEDCAL\RISK\REPLY are the folders

used by MEDCAL RISK CHD.

An ASCII text file (or files) designated by the GUEST will be used to receive data from the HOST and another file or files may be used to offer data to the HOST.

e.g. C:\COSI1.1\MEDCAL\RISK\IMPORT\RXPORT.txt

and C:\COSI1.1\MEDCAL\RISK\REPLY\RISKRPLY.txt are the files

used by MEDCAL RISK CHD.

The GUEST will be accept text files that conform to a prescribed format:-

Generally - Data will be identified by a descriptive text followed by

an equal sign and the data.

Specifically - In those cases where it is applicable a date followed by a colon sign will precede the identifying text.

Items of data will be separated by a comma sign and/or

be on a new line within the text file.

In those cases where the GUEST software maintains data relating to a patient they will be identified by Surname, Forenames, Sex, and DateOfBirth.

Patient data recorded by the GUEST shall be encrypted to avoid unauthorised access.

Example:-

Surname=Nicholson,Forenames=MatthewRigden,Sex=Male,

DateOfBirth=25/3/1950,Metres=1.73,13/7/1998:Kilos=63.5

The GUEST may be implemented as a DLL that has no parameters but returns a boolean value which is TRUE if the GUEST was implemented successfully or FALSE if there was a fatal error. Or the Guest may be implemented as an .EXE that is permanently available in which case files named ACTIVE and INACTIVE will indicated the presences of the GUEST.

The GUEST dll or exe and any dlls called by the GUEST may be copied to any area on the computer for use by the HOST. Responsiblility for maintaining the correct version of the GUEST software in these other locations is the responsibility of the HOST.

GUEST software may use other GUEST software by agreement and should do so as if calling as a HOST.

Implementation

The implementation of COSI and its expansion and future shall be governed by a management committee made up of General Practitioners that have no direct financial or beneficial interest in any software company.

Suppliers of HOST and GUEST software shall, having agreed with each other, submit proposals for each interface for inclusion in the COSI standard to the management committee.

The management committee will arbitrate in the case of a failure to implement an agreed interface.

The management committee, suppliers of HOST and GUEST software, and any association of General Practitioners formed for that purpose shall promote and encourage the expansion and implementation of the COSI interface, for the benefit of the health of patients within the NHS.