Part IV — Building the Infrastructure

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Part IV turns principles into architecture. It reviews the standards ecosystem—terminologies, classifications, information models, and exchange specs—and explains why success depends less on picking a winner and more on profiling, governance and tooling that keep meaning intact across vendors and regions.

At the centre is the case for metadata registries. A registry is not a passive catalogue; it’s an operational service that holds canonical definitions, value sets, constraints, mappings, ownership, and version history—then drives validation, integration and analytics. With a registry, teams resolve meaning questions once and reuse everywhere; without it, every project re-discovers the same ambiguities.

The part also restores a neglected competency: process documentation. Data inherits meaning from workflow. If we can’t describe the process that created the data—actors, steps, controls, and intent—secondary use becomes hazardous. Healthcare-adapted BPM, clinical concept frameworks, and lightweight catalogs make processes inspectable by people and machines, enabling safer automation and AI.

The architectural posture that emerges is modular and federated: local autonomy with shared semantics; profiles over pure theory; registries and process catalogs as the connective tissue; and implementation guides that specify “just enough” to be achievable by real NHS teams. It’s infrastructure you can actually build.