1. 0 Technical Committee on “Population Perspective” Atlanta, GA | August 25, 2008 Peter L. Elkin, MD, FACP, FACMI Professor of Medicine Mayo Clinic College of Medicine Vice-President, Translational and Biomedical Informatics Director, Center for Biomedical Informatics Vice-Chairman Department of Internal Medicine Mount Sinai School of Medicine Mark Tuttle, FACMI, Brett Trusko, PhD enabling healthcare interoperability

2. 1 New affiliation … peter.elkin@mssm.edu

3. 2 AHIC HITSP Secretary of HHS An example of what HITSP does … “Biosurveillance is … near real-time, nationwide public health event monitoring to support early detection, situational awareness and rapid response management across care delivery, public health, and other authorized government agencies.” “Mapping of Use Case requirements to Interoperability requirements, e.g., HL7, SQL, ….” “Approval for use”

4. 3 In order to better conduct its new work, HITSP has implemented a new Technical Committee structure  Three (3) Perspective Committees aligned with AHIC perspectives 1.Provider 2.Population 3.Consumer  Three (3) Domain Committees focused on healthcare domains 1.Care Management and Health Records 2.Security, Privacy and Infrastructure 3.Administrative and Financial

5. 4 New AHIC Use Cases (2008) Consultations and Transfers of Care Personalized Healthcare Immunizations and Response Management Public Health Case Reporting Remote Monitoring Patient – Provider Secure Messaging Provider ConsumerPopulation

6. 5 “Population” Use Cases Year 3 - Immunizations and Response Management – The ability to communicate a subset of relevant information about needs for medication and prophylaxis resources, about resource availability, about their administration and about the status of treated and immunized populations. –Public Health Case Reporting - Leveraging electronic clinical information to address population health data requirements.

7. 6 Technical Committee Leadership  Population Perspective - 166 members –Floyd Eisenberg, MD, MPH, Siemens Medical Solutions –Peter L. Elkin, MD, FACP, FACMI Director, Center for Biomedical Informatics, Vice-Chairman, Department of Internal Medicine, Mount Sinai School of Medicine, Vice-_President Mount Sinai Medical Center –Anna Orlova, PhD, Public Health Data Standards Consortium –Steve Steindel, PhD, Centers for Disease Control & Prevention

8. 7 Patient Discharge (Lab, EMR) HTISP- Surveillance Filter Terminology Service (Option) Anonymize/Pseudonymize Public Health Systems/ Case Workers: IHE-XDS (Document Consumers) IHE-XDS (Document Source) IHE-DSG Biosurveillance Document-based Data Submission Workflow IHE-NAV (Option) IHE-XDS-MS or IHE-Lab Report Doc Encode/Remove Free Text HITSP/IHE-XUA IHE-ATNAIHE-PIX HITSP/IHE- Manage Data Access HITSP/IHE- Authorization IHE-CT Verify Authenticity Manage Credentials

9. 8 Patient Discharge (Lab, EMR) HITSP-Lab Message HITSP-EMR Message HTISP- Surveillance Filter Encode/Remove Free Text Terminology Service (Option) Anonymize/Pseudonymize Public Health System: Data Recipient Biosurveillance Message-Based Data Submission Workflow HITSP-DSG HITSP/IHE-XUA HITSP-Audit HITSP- Secure Channel IHE-PIX HITSP/IHE- Manage Data Access HITSP/IHE- Authorization IHE-CT Manage Credentials ID Recipients Verify Authenticity

10. 9 Vendor/User of Healthcare Information System Performance Measure Development Organizations e.g., NCQA, PCPI, JCAHO Performance Measure Endorsers/ Approvers e.g., NQF, AQA/HQA Decision to Implement (by measure and by receiver) Related Codification Rules Local Decision Support (internal interaction and reporting) Transmission (implementer- specific data subset) Performance Measure Implementers/ Receivers F IL T E RF IL T E R Performance Benchmarking Clearinghouse/ Outsourced Measure Calculator/ Benchmarking Service Data quality, terminology, reliability results Specification Revisions Decision to Implement (by measure and by receiver) Incorporate into Healthcare Information System (Automated/Manual) F IL T E RF IL T E R Disseminate to Provider Organizations (customers/ health care providers) EntityActionFunctionData FileProcess Step Feedback Mechanism Related Process Step (if required by entity) K E Y Data quality, terminology, reliability results Quality Interoperability Specification

11. 10 Measurement Rules CIS Clearinghouse Payor Regulator Measurement System Report Card Consumer System Aggregate Raw data Push / Pull Raw / Aggregate Analyzer Raw data Vocabulary Mapping Quality Interoperability Specification

12. 11 Sharing/Interchanging and Transacting Health Information Exchange Publish Pull Structured objects Pull Send to Write Read Switch InterchangeMedia Transactions WorkflowMgrWorkflowMgr Query / Response Info Requestor DataRepository

13. 12 Community or sub-network Clinical Encounter Clinical IT System Index of patients records (Document-level) Aggregate Patient Info 4-Patient data presented to Physician Sharing System Clinic Record Specialist Record Hospital Record 2-Reference to Records for Inquiry Introduced at HIMSS in 2005 : IHE-XDS 3-RecordsReturned Reference to records Repository of Documents

14. 13 XDS Affinity Domain (NHIN sub-network) Community Clinic Lab Info. System PACS Teaching Hospital PACS ED Application EHR System Physician Office EHR System XDS Scenario + use of ATNA & CT Showcased at HIMSS PMS Retrieve Document Register Document Query Document XDS Document Registry ATNA Audit record repository CT Time server Record Audit Event MaintainTime MaintainTime Event Maintain Time Provide & Register Docs Record Audit Event XDS Document Repository Secured Messaging

15. 14 XDS Affinity Domain (NHIN sub-network) Community Clinic Lab Info. System PACS Teaching Hospital PACS ED Application EHR System Physician Office EHR System XDS Scenario + use of PIX & PDQ Showcased at HIMSS A87631 PACS L-716 Affinity Domain Patient Identity Source M8354673993 Retrieve Document Provide & Register Docs Register (using Pt ID) Query Document (using Pt Id) Patient Identity Feed Document Registry 14355 M8354673993 L-716 A87631 Patient Identity Feed PIX Query PIX Query Patient Identity Feed Patient Identity XRef Mgr Patient Identity Feed PDQ Query to Acquire Affinity Domain Patient ID M8354673993 A87631 L-716 M8354673993 XDS Document Repository XDS Document Repository ATNA Audit record repository CT Time server

16. 15 Population Perspective Technical Committee – Immunizations & Response Management Scenario 1 – Vaccine and Drug Administration and Reporting Scenario 2 – Vaccine and Drug Inventory Reporting (Supply Chain Mgmt) Deferred – Engage Subject Matter Experts to define workflow beyond Vaccine for Children’s program – Consider for 2009

17. 16 Population Perspective Technical Committee – Immunizations & Response Management New Constructs Component: Identify communication recipients Component: Vaccination message Component: Unstructured document (communicate generic information to patient) Component: Generic alert to identified providers (communicate non-patient specific information) Component: Consumer vaccination view Transaction Package: Immunization Query & Response Vaccination Component Deferred Clinical Decision Support Content (immunization schedules, reminders) Vaccination Document Component Medication Administration Terminology Services

18. 17 Population Perspective Technical Committee – Immunizations & Response Management Reuse of Existing Constructs Transaction Package: Immunization Feed Package (PIX/PDQ, TP13) TP 50 Retrieve Form for Data Capture TP 21 Query for Existing Data TP 13 Manage Sharing of Documents C48 HITSP Summary Document C32 HITSP Encounter Document C25 Anonymize T24 Pseudonymize T23 Patient Demographics Query T29 Notification of Document Availability T22 Patient ID Cross-Referencing T16 Consistent Time T17 Secured Communication Channel C26 Nonrepudiation of Origin C19 Entity Identity Assertion T15 Collect and Communicate Security Audit Trail TP30 Manage Consent Directives TP20 Access Control T31 Document Reliable Interchange T33 HITSP Transfer of Documents on Media Transaction

19. 18 Population Perspective Technical Committee – Immunizations & Response Management

20. 19 Population Perspective Technical Committee – Public Health Case Reporting Use Case –Public Health Case Reporting Content Standardization in Progress Ongoing Content Source: Council of State and Territorial Epidemiologists (CSTE) –Adverse Event Reporting Content Standardization in Progress Ongoing Content Sources: Adverse Drug Events – FDA Patient Safety – TBD AHRQ Patient Safety Data Set Public Comment 9 Aug 2008 CDC Healthcare Associated Infection definitions / reporting Patient Safety Organization (PSO) instantiation

21. 20 Population Perspective Technical Committee – Public Health Case Reporting Use Case –2008 – Trial Implementation Testing, Publication of Roadmap TP50 – Retrieve Form for Data Capture No determination regarding content structure within RFD Content can be mapped to HL7 message – CDA, C32, C48, message or other One construct for trial content component consideration HL7 Healthcare Associated Infection (HAI) report –2009 – Release 1 Content Standardization in Progress Reporting Criteria Content – Common / basic Alerts, Reporting Criteria, Transport Support Communication of non-PHI alerts and notifications

22. 21 Population Perspective Technical Committee – Public Health Case Reporting Use Case –2010 – Release 2 FDA MedWatch, Vaccine Adverse Event Reporting System (VAERS) – Pending successful ballot of Individual Case Safety Report (ICSR)v3 through HL7, ISO, CEN – Expected Dec 2009 AHRQ Sentinel Event / Adverse Reaction Reporting Public Health Case Reporting Reporting Criteria Content – Case-specific Communications from Public Health Clinical Decision Support content, triggers

23. 22 How YOU can get involved … Join the HITSP Population Perspective Technical Committee Participate in meetings and Conference Calls Review Draft Interoperability Specifications Move our Nation toward interoperable data for safer and more effective practice of medicine.