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0 Report from the Technical Committees Arlington, VA | October 6, 2008 Presented by: Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS HITSP Technical Committee.

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Presentation on theme: "0 Report from the Technical Committees Arlington, VA | October 6, 2008 Presented by: Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS HITSP Technical Committee."— Presentation transcript:

1 0 Report from the Technical Committees Arlington, VA | October 6, 2008 Presented by: Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS HITSP Technical Committee Co-Chairs enabling healthcare interoperability

2 1 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

3 2 Technical Committee Leadership Provider Perspective – 210 members –Allen Hobbs, PhD, Kaiser Permanente –Steve Hufnagel, PhD, DoD/Medical Health System (MHS) –Mike Lincoln, MD, Department of Veterans Affairs Consumer Perspective – 191 members –Mureen Allen, MD, FACP, ActiveHealth Management –Charles Parisot, EHR Association –Scott Robertson, PharmD, Kaiser Permanente

4 3 Technical Committee Leadership Population Perspective members –Floyd Eisenberg, MD, MPH, Siemens Medical Solutions –Peter Elkin, MD, Mayo Clinic College of Medicine –Anna Orlova, PhD, Public Health Data Standards Consortium Administrative and Financial Domain – 48 members –Don Bechtel, Siemens Medical Solutions –Durwin Day, Health Care Service Corporation –Deborah Belcher, GE Healthcare

5 4 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 - 47 members –Keith Boone, GE Healthcare –Corey Spears, McKesson Health Solutions Total Technical Committee Membership – 505 individuals

6 5 Trending in Technical Committee Membership

7 6 Trending for Technical Committee Meeting Attendance

8 7 Report from the Population Perspective Technical Committee

9 8 Report from the Consumer Perspective Technical Committee IS 12 Patient-Provider Secure Messaging (PPSM) IS 77 Remote Monitoring (RMON) IS 03 & 05 Consumer Access to Clinical Information (extensions) –Advance Directives –Access to Consumer-Friendly Clinical Information

10 9 Report from the Consumer Perspective Technical Committee IS 12: PPSM – Completed and submitted to IRT for review – Public Comment Period –Target: IS submission to panel for December 2008

11 10 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

12 11 Report from the Consumer Perspective Technical Committee C62 Unstructured Document Component (new) –Support for a wide variety of content (PPSM and advance directives-SOW) Simple/unstructured text Scanned Documents PDFs –New component References: IHE XDS-SD, PDF/A ISO b Coordination between CPTC, SPI, Admin & Finance –Minimal document header (compatible with other HITSP CDA docs) to support wide applicability Secured Messaging Advance Directives

13 12 Report from the Consumer Perspective Technical Committee IS 77: Remote Monitoring – Completed and submitted to IRT for review – Public Comment Period Note: Access to the Continua (draft) guidelines requires to sign an NDA. Contact John Donnelly. –Target: IS submission to panel for December 2008 –Two main challenges: Convergence to a single interface between Device Intermediaries and Remote Monitoring Mgmt Systems (used either in Homes or in Care Delivery Organizations) Request to IHE and Continua for harmonization Tight schedule synchronization between completion of IEEE standards, Continua Implementation Guidelines, and IS completion for panel approval in December.

14 13 Report from the Consumer Perspective Technical Committee Remote Monitoring Business Actors may be combined: e.g. RM Mgt Syst & EHR or RM Mgt Syst & PHR Significant reuse of existing & new constructs in Interfaces 3, 4, 5, 6 and 7 Device Device Intermediary EHR System Remote Monitoring Mgmt System PHR System Health Info Exchange Interface #1 Interface #2 Interface #3 Interface #4 Interface #5 Interface #6 Interface #7

15 14 Report from the Consumer Perspective Technical Committee Devices that are being considered this cycle include: –Blood pressure monitor –Glucometer –Pulse oximeter –Thermometer –Weighing scale

16 15 C74 - Remote Monitoring Observation Document Concept –Specifies the medical information collected by remote health monitoring devices, based upon HL7 CDA –Measurements captured by devices; notes, summaries, and other kinds of narrative information that may be added by caregivers or by the users –Graphs that may be added by intermediary devices that represent trends of users health –Example systems include PHRs, EHRs, Practice Management Applications and other stakeholders Selected Standard –Implementation Guide for CDA Release 2.0 Personal Health Monitoring Report (PHMR)

17 16 T73 - Aggregate Device Information Communication Concept –Allows a system (such as a home hub, a cell phone, a set top box, a monitoring station) to report device observations through a local or remote connection to an information management system Selected Standard –The Tier 2 analysis has resulted in two alternatives: One approach is based on the use of the IHE DEC Integration Profile (HL7 V2.x). This approach is widely used today within Hospitals to connect clusters of devices to EHRs The other approach is based on the use of IEEE Device Specialization conveyed as a document (ASN1 encoded with MDER or XER)) by HITSP T31 (IHE-XDR). This approach is primarily targeted at home monitoring –Public Comment is expected on the selection that should be made between these alternatives. IHE and Continua Health Alliance are currently working collaboratively to analyze the approaches and propose their recommendation to HITSP.

18 17 Report from the Consumer Perspective Technical Committee IS 03 & IS 05 Updates 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 (2009)

19 18 Report from the Consumer Perspective Technical Committee Advance Directives (partial in 2008) –C62: Unstructured document Consumer-Friendly Clinical Information / translations –T81: Retrieval of Medical Knowledge 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 extended to 2009

20 19 Report from the Consumer Perspective Technical Committee T81: Retrieval of Medical Knowledge Transaction (new) –Supports the retrieval of medical knowledge –References: HL7 v 3.0 Context-Aware Information Retrieval Specification: URL Implementation Guide –Based on the Infobutton concept

21 20 Report from the Provider Perspective Technical Committee ISO-8 Personalized Health Care Use case Scenario's Clinical Assessment. A family health history is gathered from or by the consumer in an interoperable form to be used by consumers and clinicians. This information is accessed by clinicians and used in conjunction with personal medical history, current health status, and personal preferences to develop a diagnostic plan. Genetic Testing, Reporting, and Clinical Management. A medical testing laboratory performs genetic or genomic testing after it receives genetic/genomic test orders and any accompanying information necessary for the testing in an interoperable form. The testing laboratory performs the tests, develops the patient report, and transmits this information back to authorized providers. Clinicians utilize this new diagnostic information for the management of their patients. Both clinicians and consumers have access to this information via the PHR.

22 21 Report from the Provider Perspective Technical Committee: PHC Roadmap

23 22 Report from the Provider Perspective Technical Committee: Identified Constructs HITSP/C19 - Entity Identity Assertion HITSP/C32 - Summary Documents Using HL7 Continuity of Care Document (CCD) HITSP/C36 - Lab Result Message Component HITSP/C37 - Lab Report Document HITSP/C48 - Encounter Document Using IHE Medical Summary (XDS-MS)

24 23 Report from the Provider Perspective Technical Committee : Identified Constructs HITSP/C62 Unstructured Document Component HITSP/C69 - Generic Order Component HITSP/C80 - Clinical Document and Message Terminology Component HITSP/C84 - Consult and History and Physical Note Component HITSP/C90 – Clinical Genomic Decision Support Component

25 24 Report from the Provider Perspective Technical Committee : Identified Constructs HITSP/T15 - Collect and Communicate Security Audit Trail HITSP/T16 - Consistent Time HITSP/T17 - Secured Communication Channel HITSP/T23 - Patient Demographics Query HITSP/T29 - Notification of Document Availability HITSP/T31 - Document Reliable Interchange HITSP/T33 - Transfer of Documents on Media HITSP/T40 - Patient Generic Health Plan Eligibility Verification Transaction

26 25 Report from the Provider Perspective Technical Committee :Identified Constructs HITSP/T68 - Health Plan Authorization/Referral Request and Response HITSP/T85 – Administrative Transport to Health Plan HITSP/TP13 - Manage Sharing of Documents HITSP/TP20 - Access Control HITSP/TP22 - Patient ID Cross-Referencing HITSP/TP30 - Manage Consent Directives HITSP/TP89 – Sharing Imaging Results

27 26 Report from the Provider Perspective Technical Committee: Framework for Personalized Healthcare Intervention Development and Review Integration into Clinical Practice Expansion of the Science Base Health Information Technology Personalized Health Care Adapted from DHHS PHC, Opportunities, Pathways, Resources 2007

28 27 Report from the Provider Perspective Technical Committee Emergency Responder Use Case SITUATION: IS04 Version 1.0 was issued Dec 07 –10 GAP/Overlap closure projects NEXT STEP: IS04 Version for public review –2008 ER-EHR New Constructs for for OASIS EDXL DE and CAP Other New Constructs developed by other TCs –2009 and beyond HITSP Constructs for NEMSIS and DEEDS harmonized vocabulary pre-hospital EMS document content (e.g., field and run reports) SITREP and Patient Tracking

29 28 Report from the Provider Perspective Technical Committee: Emergency Responder Use Case ConstructNew/Repurposed 2008 construct HITSP/T40Insurance Coverage and Eligibility HITSP/T63Emergency Message Distribution Element Transaction HITSP/T64Identify Communication Recipients (service) HITSP/T66Terminology Service HITSP/T67Clinical Referral Request Transport Transaction HITSP/T68Patient Health Plan Authorization Request and Response HITSP/T85Administrative transport to health plan HITSP/C48 Encounter/ Discharge Doc. Using IHE Medical Summary (XDS-MS) HITSP/C62Unstructured Document Component HITSP/C82Emergency Common Alerting Protocol (CAP)

30 29 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 – October funding start of work at Univ. of Utah 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) – done 5.Life Critical Remote Monitoring - pending

31 30 Report from the Provider Perspective Technical Committee: Emergency Responder Use Case Information Exchange Requirement - Data RequirementComponentTransactionTransaction Package IER01 Emergency ContactNA TP22 IER02 Clinical SummaryC32NATP13 IER03 Run ReportGAP PDFGAP T63, T64NA IER04 Present Episode of CareC28, C48GAP T63, T64TP13 IER05 Discharge SummaryC48NATP13 IER06 Situation ReportGAP PDFGAP T63, T64TP13 IER07 Medical Device DataGAPGAP T63, T64NA IER08 Info Provider Data (e.g., telematics)GAP PDFGAP T63, T64NA IER09 Decision SupportGAPGAP T63, T64NA IER10 Patient IdentificationNAT23TP22 IER11 Public Health DataGAPNATP13 IER12 Public Health ProtocolGAPGAP T63, T64NA IER13 Ins. Coverage & EligibilityNAT40NA IER14 Ins. Care Authorization/DenialNA T68 IER15 Alert (patient en route)NA C82 IER16 Transfer-of-care informationC28T63TP13

32 31 Report from the Provider Perspective Technical Committee : Consultations and Transfers of Care IS09 was completed September 22, 2008 –Produced by Provider Perspective TC –Input from Admin and Finance, Care Management, Security TCs Work based upon –Consultation and Transfers of Care Detailed Use Case, March 21, 2008 –TN900, Security and Privacy Technical Note –TN901, Technical Note for Clinical Documents

33 32 What it covers: –Consultations: information exchange supporting consult request, performance, and resulting –Transfers of care: information exchange for request and actual transfer For both consults and transfers –Supports information exchange to verify eligibility and authorization for services Report from the Provider Perspective Technical Committee : Consultations and Transfers of Care

34 33 Summary of IS09 constructs used –Lab-related (C35, C36, C37, T14) –Document-related (C32, C48, C62, C84, T29, T31, T33, TP13, TP22) –Radiology-related (C41, TP89) –Security/infrastructure-related (T15, T16, T17, T85, TP20) –Eligibility/referral-related (T40, T67, T68, T79) –Entity/identity-related (C19, T23, TP22) Report from the Provider Perspective Technical Committee : Consultations and Transfers of Care

35 34 IS09 gaps Some clinical data without a HITSP construct –Example-ECG Functional status instruments poorly supported –We need a CDA implementation guide for assessment instruments including functional status Nursing documentation –Highly variable, no good standard for nursing summaries, notes, etc. CDA probably applicable here but needs development Report from the Provider Perspective Technical Committee : Consultations and Transfers of Care

36 35 IS09 gaps Identifying consultant and transfer setting –Few tools to identify providers and facilities meeting a complex set of preferences Patient and referring/transferring provider preferences are multi-faceted Prefs include specialty, network, location, co-pay preferences… –Needs Cross TC work and SDO engagement Report from the Provider Perspective Technical Committee : Consultations and Transfers of Care

37 36 IS09 gaps Decision support (IER 5) –No current HITSP-defined DSS interoperability –Needs cross-TC work and possibly SDO engagement (e.g., HL7) Report from the Provider Perspective Technical Committee : Consultations and Transfers of Care

38 37 IS09 Lessons Learned Tables relating constructs, actors, IER, and ER were very helpful to clarify/speed the work Tight timelines met by able help of the entire TC team! –Particular thanks to Steve Hufnagle, Mike Glickman, & Allen Hobbs –Huge debt to Suzi Hines and Gila Pyke Report from the Provider Perspective Technical Committee : Consultations and Transfers of Care

39 38 Questions?

40 39 Completed editorial changes to existing construct documents (out for Public Comment in September) Developed 10 new constructs (out for Public Comment in September) Modified 3 existing constructs (out for Public Comment in September) Worked with PTCs to ensure new constructs meet the requirements of the use cases Report from the Security, Privacy & Infrastructure Domain Technical Committee

41 40 Continued to work with TC-Leadership to address NHIN issues related to the use of SPI constructs in the NHIN Trial Implementations (ongoing) Longer term plan of maintenance updates to constructs and TN900 (e.g. revisions to TP30: Manage Consent Directives – to incorporate additional coding/base standards which are now available) Report from the Security, Privacy & Infrastructure Domain Technical Committee

42 41 New & Updated SPI constructs use in Interoperability Specifications Doc # Document Name IS08 CTC IS09 PHC IS10 PHCR IS12 PPSM IS11 IRM IS77 RMON IS03 CE- Networks IS03 ER- EHR IS05 CE- Media C62 Unstructured Document C82 Emergency Common Alerting Protocol C87 Anonymize – Public Health C88 Anonymize - Immunization T23 Patient Demographics Query (*new option) T63 Emergency Message Distribution Element T64 Identify Communication Recipients T66 Terminology Services T67 Clinical Referral Request Transport T81 Retrieval of Medical Knowledge T85 Administrative Transport to Health Plans TP22 Patient ID Cross-Reference (*new option) New Interoperability Specifications Existing Interoperability Specifications

43 42 C62 Unstructured Document Concept –Capture and storage of patient identifiable, unstructured document content, such as text, PDF, images rendered in PDF Selected Standards –IHE XDS-SD –ISO PDF/A b

44 43 C82 Emergency Common Alerting Protocol Concept –Multicast notification message sent to an identified channel –Intended recipients are populations such as all emergency departments in XXX county, within a geographic area, etc –Construct can only be used to transport text message alerts Selected Standards –OASIS CAP v1.1

45 44 New Approach to Anonymize Construct Existing C25 construct contains anonymization requirements for two different use cases (Bio and Quality) –Adding new requirements to same construct (from new use Public Health Care Reporting and Immunization Management) would be inefficient and less effective –Would require constant updates to construct, and constant updates to ISs that use it New Approach –Dedicate separate anonymize construct to each use case –Modify current anonymize construct (C25) to focus only on the IS02 – Biosurveillance –Develop two new anonymize constructs, one for Public Health Case Reporting (C87) and one for Immunizations and Response Management (C88) –Create a new construct for the Quality IS

46 45 C87 Anonymize Public Health Case Reporting Data Concept –Provides specific instruction for anonymizing repurposed data created as part of routine clinical care delivery –Defines anonymization requirements specific to Public Health Case Reporting data Selected Standards –ISO Pseudonymisation TS# 25237

47 46 C88 Anonymize Immunizations and Response Management Data Concept –Provides specific instruction for anonymizing repurposed data created as part of routine clinical care delivery –Defines anonymization requirements specific to Immunizations and Response Management data Selected Standards –ISO Pseudonymisation TS# 25237

48 47 TP22 Patient ID Cross-Referencing Concept –Identifying and cross-referencing different attributes for the same patient. It contains following transactions: –Patient ID Cross-Referencing –Patient Identity Feed –Updated to include an optional transaction - Patient Identity Management transaction - for Pediatrics Demographics Selected Standards –IHE PIX –IHE Technical Framework Supplement, Pediatric Demographics –HL7 v2.5 –HL7 v2.3.1

49 48 T23 Patient Demographics Query Concept –Involves request for patient demographic information, and a response with a list of patient demographics for matching patients, if any were found –Updated to include Pediatric Demographics option which makes use of six additional demographic fields to aid record matching in databases with many pediatric records Selected Standards –IHE PDQ –IHE Technical Framework Supplement, Pediatric Demographics –HL7 v2.5/v2.5.1

50 49 T29 Notification of Document Availability Concept –Defines mechanism for a healthcare stakeholder (e.g. provider, public health, etc) to notify providers or the patient about information that is available for retrieval pertaining to an identified patient –Updated to expand the use of this construct for notifications from other contexts such as public health, or other sources Selected Standards –IHE NAV

51 50 T63 Emergency Message Distribution Element Concept –Multicast notification message sent to an identified radio channel –Intended recipients are populations such as all emergency departments in XXX County Selected Standards –OASIS EDXL-DE

52 51 T64 Identify Communication Recipients Concept –Identification of communication recipients –Delivery of alerts and bi- directional communications (e.g., public health agencies notifying a specific group of service providers about an event) Selected Standards –IHE PWP

53 52 T66 Terminology Service Concept –Used to transform human or computer vocabularies. –Retrieve and resolve a value set with the appropriate terminology or code system –Retrieve a value set with an appropriate map from one terminology to another Selected Standards –IHE SVS –HL7 CTS Release 1

54 53 T67 Clinical Referral Request Transport Concept –Transport for provider-to- provider referral request interaction. –Bundle referral request document & other relevant clinical documents of interest, and optionally send a trigger message to receiving provider system Selected Standards –IHE Document-based Referral Request (DRR)

55 54 T81 Retrieval of Medical Knowledge Concept –Enables request and receipt of additional knowledge about medical concept based on specific context parameters –Does not prescribe knowledge content of message returned –Provides specifications for query/receipt of additional knowledge Selected Standards –HL7 v3.0 Context-Aware Information Retrieval

56 55 T85 Administrative Transport to Health Plan Concept –Transport for administrative transactions between provider and health plan –Example: pharmacy obtaining health plan eligibility, or physician requesting referral or authorization information from a health plan Selected Standards –CAQH CORE Phase II, #270 rule

57 56 Report from the Care Management & Health Records Domain Technical Committee

58 57 Report from the Administrative and Financial Domain Technical Committee Current Work Completed editorial changes –T40 - Patient Health Plan Generic Eligibility Verification Transaction Completed new construct –T68 - Patient Health Plan Authorization Request and Response Transaction –T79 - Pharmacy to Health Plan Authorization Request and Response Transaction Reviewing proposed 2009 Use Cases Long Term - Develop a Technical Note document for Administrative and Financial Domain TN902

59 58 Report from the Administrative and Financial Domain Technical Committee HITSP Doc # TITLE 2008 Use Cases 2007 Use Case RMON IS77 PPSM PHC IS08 CTC IS09 IRMPHCR E-EHR IS04 T40 Patient Health Plan Eligibility Verification Transaction x x xx T68 Patient Health Plan Authorization Request and Response Transaction xxxx T79 Pharmacy to Health Plan Authorization Request and Response xx Construct Work

60 59 Report from the Administrative and Financial Domain Technical Committee Existing Constructs Modified to Meet New Use Case Requirements Doc # ConstructChange Description T40 Patient Health Plan Eligibility Verification Transaction Updates to support service/procedure specific inquiry and response Replaced CORE Phase 1 rules with new CORE Phase 2 rules Renamed to remove word Generic in the name

61 60 Report from the Administrative and Financial Domain Technical Committee New ConstructConstruct DescriptionSelected Standards T68 – Patient Health Plan Authorization Request and Response Used by a healthcare provider (other than a retail pharmacy) to request approval from a health plan to authorize certain healthcare services, when required by the patient s health plan contract. The health plan responds to the healthcare provider authorization request. ASC X v4010A T79 – Pharmacy to Health Plan Authorization Request and Response Transaction Used by a retail pharmacy to request approval from a health plan to authorize certain healthcare services, when required by the patient s health plan contract. The health plan responds to the healthcare provider authorization request. NCPDP Telecommunication Standard Implementation Guide version 5.1 New Construct Development Work

62 61 Report from the Administrative and Financial Domain Technical Committee Current Work Plan Project/taskTarget date Support Prospective TC with 2008 Use Cases11/16/2008 Draft Administrative and Financial Technical Note 90212/15/2008 Review & Comment on Proposed 2009 Use Cases10/16/2008


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