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0 Report from the Technical Committees Arlington, VA | June 23, 2008 Presented by Joyce Sensmeier MS, RN-BC, and the HITSP Technical Committee Co-Chairs.

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Presentation on theme: "0 Report from the Technical Committees Arlington, VA | June 23, 2008 Presented by Joyce Sensmeier MS, RN-BC, and the HITSP Technical Committee Co-Chairs."— Presentation transcript:

1 0 Report from the Technical Committees Arlington, VA | June 23, 2008 Presented by Joyce Sensmeier MS, RN-BC, and the HITSP Technical Committee Co-Chairs enabling healthcare interoperability

2 1 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

3 2 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

4 3 Use Cases Year 3 –Consultations and Transfers of Care -- The exchange of information between clinicians, particularly between requesting clinicians and consulting clinicians, to support consultations such as specialty services and second opinions. –Personalized Healthcare - The exchange of genomic/genetic test information, family health history and the use of analytical tools in the electronic health record (EHR) to support clinical decision-making. –Remote Monitoring – Focuses on the exchange of physiological and other measurements from remote monitoring devices in three candidate workflows: Measurement and Communication, Monitoring and Coordination, and Clinical Management.

5 4 Use Cases Year 3 –Patient-Provider Secure Messaging -- Patients consult with their healthcare clinicians remotely using common computer technologies readily available in home and other settings. –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.

6 5 Technical Committee Leadership  Provider Perspective – 203 members –Allen Hobbs, PhD, Kaiser Permanente –Steve Hufnagel, PhD, DoD/Medical Health System (MHS) –Mike Lincoln, MD, Department of Veterans Affairs  Consumer Perspective – 192 members –Mureen Allen, MD, FACP, ActiveHealth Management –Charles Parisot, EHR Vendor Association –Scott Robertson, PharmD, Kaiser Permanente

7 6 Technical Committee Leadership  Population Perspective members –Floyd Eisenberg, MD, MPH, Siemens Medical Solutions –Peter Elkin, MD, Mayo Clinic College of Medicine –Steve Steindel, PhD, Centers for Disease Control & Prevention  Administrative and Financial Domain – 42 members –Don Bechtel, Siemens Medical Solutions –Durwin Day, Health Care Service Corporation –Deborah Belcher, GE Healthcare

8 7 Technical Committee Leadership  Security, Privacy & Infrastructure Domain members –Glen Marshall, Siemens Medical Solutions –John Moehrke, GE Healthcare –Walter Suarez, MD, Institute for HIPAA/HIT Education and Research  Care Management and Health Records Domain - 31 members –Keith Boone, GE Healthcare –Corey Spears, McKesson Health Solutions Total Technical Committee Membership – 481 individuals

9 8 Report from the Population Perspective Technical Committee  Two Use Cases –Immunizations & Response Management –Public Health Case Reporting  Outline –Overview –Scope –Reuse Items –Identified new Constructs

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11 10 Report from the Population Perspective Technical Committee – Immunizations & Response Management  Release I: –Artifacts for communication of vaccination information between patients, providers, and immunization registries, including registry-to-registry communication –Allow for optionality of architectures supporting traditional legacy message-based communications, addition of support for patient identification services (TP22, T23), and the addition of support for document-centric sharing and point-to-point communications for PHR Interoperability –Include security and privacy constraints for implementation of the Immunization and Response Management Interoperability Specifications  Release II: –Identify specification and standard business workflows for supply chain and distribution management of vaccines and develop needed artifacts –Incorporation of the vaccine recall processes in the supply chain management. –Incorporation of pending constructs supporting Clinical Decision Support

12 11 Report from the Population Perspective Technical Committee – Immunizations & Response Management New Constructs Component: Identify communication recipients Transaction Package: Immunization Feed Component: Vaccination (VXU/VXR) Component: Unstructured document (communicate generic information to patient) Component: Generic alert to identified providers (communicate non-patient specific information) Transaction Package: Immunization Query & Response Referencing Public Health Case Reporting constructs (for reporting adverse reaction to Vaccination) Terminology Services (requirements driven by other use cases) Deferred Clinical Decision Support Content (immunization schedules, reminders) Vaccination Documents (including Consumer vaccination view) Medication Administration Supply Chain management (inventory management, vaccine recall)

13 12 Report from the 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 Encounter Document Using IHE Medical Summary C32 Summary Documents Using HL7 CCD 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 Transfer of Documents on Media

14 13 Report from the Population Perspective Technical Committee – Immunizations & Response Management

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16 15 Report from the 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

17 16 Report from the 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 Alerts: Reuse from IRM: Generic Alert to Identified Providers and Unstructured Document Components –2009 – Release 1 Content Standardization in Progress Reporting Criteria Content – Common / basic (Structured content) Refined Transport

18 17 Report from the 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

19 18 Report from the Population Perspective Technical Committee – Public Health Case Reporting Use Case  New Constructs (Introduction timing not indicated) –Case Reporting Terminology Component –Standard Case Report Construct Adverse Event Reports: (CDC- HAI, AHRQ, FDA, PH Cases) –Reporting Criteria Content: Basic and Case-specific –Clinical Decision Support Content (Trigger Events: PH, AE, AHRQ) –Identify Communication Recipients –Generic Alert to Identified Providers –Unstructured Document Components

20 19 Report from the Population Perspective Technical Committee – Public Health Case Reporting Use Case Reuse of Existing Constructs TP50: Retrieve Form for Data Capture TP21: Query for Existing Data TP13: Manage Sharing of Documents C48: Encounter Document Using IHE Medical Summary C32: Summary Documents Using HL7 CCD C25: Anonymize C35: Lab Report Terminology C36: Lab Result Message C37: Lab Report Document T24: Pseudonymize T23: Patient Demographic 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: Transfer of Documents on Media

21 20 Report from the Consumer Perspective Technical Committee  Work items year-to-date –RDSS57 Patient-Provider Secure Messaging –RDSS56 Remote Monitoring –SOW Items  Advance Directives  Provider Lists  Consumer-Friendly Clinical Information

22 21 Report from the Consumer Perspective Technical Committee  Patient-Provider Secure Messaging -PPSM – Coordinated work with all three Domain TCs – RDSS57 complete, sent to IRT/project team – Public Comment in July – Will begin IS development early July. Target is IS submission to panel for December 2008.

23 22 Report from the Consumer Perspective Technical Committee  PPSM Architectural Variants The most generic variant selected as foundation. First two variants are supported as simplified implementations  Selected

24 23 Report from the Consumer Perspective Technical Committee  C62 Unstructured Document Component (new) –Support for a wide variety of content (PPSM and advanced directives-SOW)  Simple/unstructured text  Scanned Documents  PDFs –New component. References IHE XDS-SD & CDA r2 –Coordination between CPTC, SPI, Admin & Finance –Minimal document header (compatible with other HITSP CDA docs) to support wide applicability  Secured Messaging  Advance Directives

25 24 Report from the Consumer Perspective Technical Committee  Remote Monitoring – Coordinated work with all three Domain TCs – RDSS56 complete, sent to IRT/project team – Public Comment in July – Will begin IS development early July. IS submission to panel for Dec 2008 may be at risk:  Requires HL7 Personal Health Monitoring (PHM) document IG. First ballot Sept  Consistency with ongoing work in Continua and IHE PCD. Active partnership but completion expected Dec  RDSS feedback will be used to confirm schedule.

26 25 Report from the Consumer Perspective Technical Committee  Remote Monitoring - Business Actors Business Actors may be combined: e.g. RM Mgt Syst & EHR or RM Mgt Syst & PHR Significant reuse of existing constructs in Interfaces 3, 4, 5, 6 and 7.

27 26 Report from the Consumer Perspective Technical Committee  Statement of Work Items –A number of items identified last year (as gaps in use cases) prioritized for possible completion this year –IS03 / IS gap items:  Advance Directives  Consumer-Friendly Clinical Information  Provider Lists –Planning underway for an update IS03 / IS05 with advance directives and consumer-friendly clinical info. –Need to schedule reviews with the appropriate TCs

28 27 Report from the Consumer Perspective Technical Committee  Advance Directives (partial in 2008) –Unstructured document component  Consumer-Friendly Clinical Information –Defined the key actors and interactions  Provider Lists –Identified scope of work  Generating provider lists – current efforts  Setting permissions - TBD  Other uses- TBD –Working on identifying the key actors and interactions –Given complexity, work may extend in 2009

29 28 Report from the Provider Perspective Technical Committee: Consultations and Transfers of Care  Consultations and Transfers of Care (CTC) focuses upon: –“…the electronic exchange of information between clinicians…to support consultations, including specialty services and second opinions… (and) the exchange of clinical information needed during transfers of care.”  Status: –RDSS has been completed and submitted to IRT, following extensive feedback from other perspective and domain tech committees  Gaps: –For some standards (e.g., electrocardiogram) HITSP does not have a defined construct for all data types. Resolution anticipated: CTC Tech Committee (TC) to monitor emerging standards and include when available.  Future work: –Submit RDSS document to HITSP Panel and Public for comment –Dispose of received comments: use persuasive comments to inform the Interoperability Specification; log non-persuasive comments for information –TC will begin to develop the CTC Interoperability Specification

30 29 Report from the Provider Perspective Technical Committee: Personalized Health Care Personalized Healthcare: The exchange of genomic/genetic test information, family health history and the use of analytical tools in the electronic health record (EHR) to support clinical decision-making  Status: Completed RDSS and submitted to IRT Noted Gaps: 1. There is an inability to receive a report of risk to consumer based on analysis and interpretation of genetic test results. 2. There is a need verify eligibility for payer and provide authorization of service.  Next Steps: 1. Submit to the HITSP Panel and interested Public for Comment 2. Disposition the comments 3. Begin construction of Interoperability Specifications

31 30 Report from the Provider Perspective Technical Committee Emergency Responder EHR Use Case  Status: IS04 Version 1.0 was issued Dec 07 –10 GAP/Overlap closure projects (see next slide)  NEXT STEPS: –2008 HITSP Transaction (Package) for OASIS-HL7 header, container and payload harmonization –2009 HITSP Constructs for  NEMSIS and DEEDS harmonized vocabulary  pre-hospital EMS document content (e.g., field and run reports)  OASIS CAP, HAVE and RM (available now)  SITREP and Patient Tracking (in progress)  RECOMMENDATIONS: –IS04 updates as new HITSP constructs are ready (Dec 2008 and Dec 2009) 22 page ER-EHR Status Report, dated 11-Jun-08 is available at

32 31 Report from Provider TC: ER-EHR Projects’ Status  HITSP Nursing Terminology - done  NEMSIS chaired work group: 1.Finding a method of assigning and adopting unique identifiers for both incidents and patients so data from heterogeneous systems can be linked - pending 2.Common approaches of delivering third party incident information such as telematics data to the Emergency Communications System (ECS) and emergency responders - actively working 3.Reaching agreement between healthcare and other emergency responders on a common terminology (“Managed List”) for incident types - pending 4.Harmonizing the data taxonomies of hospital (DEEDS), EMS (NEMSES), and other emergency responders to the extent necessary to implement the ER- EHR – pending October funding start of work  Additional gap area projects are: 1.Decision Support Tool interoperability – monitoring external progress 2.Core Services - monitoring external progress 3.Situation Awareness Messaging - monitoring external progress 4.Emergency Contact Registry (ECON) – in-progress 5.Life Critical Remote Monitoring - monitoring HITSP RMON use case progress

33 32 Report from the Security, Privacy and Infrastructure Domain Technical Committee Current Work Items:  Minor/Editorial changes to existing constructs and TN900 (Due 11 July)  Development of 6 new constructs (for Public Comment in September)  Modification of 5 existing constructs to meet 2008 Use Case requirements (for Public Comment in September)  Longer term maintenance updates to constructs and TN900 (e.g. revisions to TP30: Manage Consent Directives – to incorporate additional coding/base standards which are now available)  Continue to work with TC-Leadership to address NHIN issues related to the use of SPI constructs in the NHIN Trial Implementations (ongoing)

34 33 New SPI Constructs Under Development New ConstructConstruct DescriptionCandidate Standards C62 - Unstructured Document Component Document that contains simple text such as a note to the patient or a note from the patient. This document could include an unstructured, presentation preserved format, such as pdf. This construct relates to patient identifiable transactions and will be transported by TP13, T31, or T33. IHE XDS-SD T63 - Non Patient Notification Alert/Text Message Multicast notification message to identified population.OASIS HAVE standards (edxl-DE) and CAP (i.e. CAP over DE) T64 - Identify Communication Recipients (service) Identification of communication recipients for the delivery of alerts and bi-directional communications from public health services. ISO Directory Standard TS21091, also IHE PWP C65 - Generic Alert to Identified Providers Component Requires support for communication of non IIHI data to: Population Groups, Consumers, Providers etc. Will not be used to send to a pool of patients based on treatment/condition, but OK if sending to a zip code etc. /MIME T66 - Terminology Service Infrastructure service – not content.IHE Sharing Value Sets T67 - Referral Request Transaction Authorization request and response for benefit coverage determination for a specific service. IHE ITI TF ’ 08- ’ 09 Referral Requests: (MRR; SRR; RRC)

35 34 New SPI Constructs Under Development HITSP Doc # DRAFT TITLE RDSSs for 2008 Use CasesExisting ISs RMONPPSMPHCCTCIRMPHCR IS02: BIO IS04: ER-EHR IS06: Quality C62 Unstructured Document Component XXXXXX T63 Non Patient Notification Alert/Text Message Transaction X T64 Identify Communication Recipients (service) XX C65 Generic Alert to Identified Providers Component XX T66Terminology ServiceXXXX T67 Referral Request Transaction X

36 35 Existing Constructs to be Modified to Meet New Use Case Requirements Doc # ConstructChange Description TP22 Patient ID Cross-Referencing Transaction Package PIX/PDQ Update: Demographic Data T23 Patient Demographics Query Transaction PIX/PDQ Update: Demographic Data TP20 Access Control Transaction Package TP20/C19 Update for Policy Attribute Service: WS-XACML, WS-Trust C19 Entity Identity Assertion Component TP20/C19 Update for Policy Attribute Service: WS-XACML, WS-Trust C25 Anonymize Component Update C25 Anonymize for IRM purposes to include content considerations for immunizations TP50 Retrieve Form for Data Capture Transaction Package Needs to be able sign the information that is being submitted (AE). May now need to support electronic signature. Also looking at XForms Note that RFD goes beyond XForms

37 36 Report from the Care Management & Health Records Domain Technical Committee  12 New constructs identified – 2 technical notes on HITSP Care Management framework – 2 for restructuring of existing work for reuse – 5 for which there are significant gaps in standards – 5 in support of CTC, PHCR, PH, and ICRM use cases  Tier 2 evaluations underway  Significant work completed on one new construct  Coordination needed with SPI TC on a few constructs –Scanned/Text Documents –Order/Response Messages for Referrals

38 37 Care Management & Health Records Construct Reorganization for Reuse

39 38 Report from the Administrative and Financial Domain Technical Committee Current Work  Reviewed all RDSS documents and met with Provider and Consumer Perspective TCs  Minor Editorial changes T40 and TP46 (due July 11)  Develop 1 new construct (for public comment in September)  Modify 1 existing construct to meet 2008 use case requirements (for public comments in September)  Long Term - Develop a Technical Note document for Administrative and Financial Domain TNnnn

40 39 Report from the Administrative and Financial Domain Technical Committee New ConstructConstruct DescriptionCandidate Standards Txx – Authorization Request and Response When conditions require, this construct will be used to request authorization from or to notify a health plan for certain testing, consultations (referrals), treatment, therapies, and/or transfer of care. Will also support information exchanges between a provider and a health plan when addition patient information is required to make authorization decisions. ASC X HL7 V2.6 HL7 V3 New Construct Development Work

41 40 Report from the Administrative and Financial Domain Technical Committee Existing Constructs to be Modified to Meet New Use Case Requirements Doc # ConstructChange Description T40 Patient Generic/Specific Health Plan Eligibility Verification Transaction Update to support service/procedure specific inquiry and response

42 41 Report from the Administrative and Financial Domain Technical Committee HITSP Doc # TITLE (Draft TITLE) RDSSs for 2008 Use CasesExisting ISs RMO N PPSMPHCCTCIRMPHCR T40 Patient Generic Health Plan Eligibility Verification Transaction x x x Txx Authorization Request and Response xxx Construct Development/Modification Work

43 42 Report from the Administrative and Financial Domain Technical Committee Current Work Plan Project/taskTarget date Tier 2 Document for Txx Authorization Request and Response 6/24/2008 Review RDSS documents during public comment7/25/2008 Modify Construct: T409/10/2008 New Construct: Health Plan Authorization Request and Response 9/10/2008 Draft Administrative and Financial Technical Note9/10/2008


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