SDS & Harmonization HeD Leadership Agenda WG call presentations during Thursday WG meeting Update on progress & decisions made last week HeD Standards.

SDS & Harmonization HeD Leadership Agenda WG call presentations during Thursday WG meeting Update on progress & decisions made last week HeD Standards Selection Risks Timeline review Detailed Data Requirement Analysis Follow-up on discussion with Dave Shields IG Update –Conformance Verbs –Data Model Approach –Functional Interaction Types –Vocab & Codeset inclusion into HeD UC2 IG: update from HL7? 1

SDS & Harmonization HeD Leadership Agenda WG call presentations during Thursday WG meeting Update on progress & decisions made last week HeD Standards Selection Risks Timeline review Detailed Data Requirement Analysis Follow-up on discussion with Dave Shields IG Update –Conformance Verbs –Data Model Approach –Functional Interaction Types –Vocab & Codeset inclusion into HeD UC2 IG: update from HL7? 2

Discussion Points and Activities for Week of 5/13  WG call presentations during Thursday WG meeting o vMR: Claude Nanjo & David Shields presenting? 11:15-12pm EST o C-CDA: Calvin Beebe presenting 12pm-12:30pm EST o Can we extend meeting/webex past 12:30pm in case there are questions? 3

SDS & Harmonization HeD Leadership Agenda HeD WG Agenda for 5/16 Update on progress & decisions made last week HeD Standards Selection Risks Timeline review Detailed Data Requirement Analysis Follow-up on discussion with Dave Shields IG Update –Conformance Verbs –Data Model Approach –Functional Interaction Types –Vocab & Codeset inclusion into HeD UC2 IG: update from HL7? 4

Discussion Points and Activities for Week of 5/13  Update on progress & decisions made last week o Initial feedback of the Solution Plan and Gap Mitigation Plan due by COB on Tuesday, 5/14 o Solution Plan and Gap Mitigation plan will continue to be reviewed with the SWG on 5/15. FINAL feedback will be due COB 5/21 5

HeD Community Decisions: Viable Implementation Options 6 Implementation Option TransactionService Organizer/ Container PayloadTransport Notes/Rationale 3 II01 - Request DSSCCDA SOAP 1. Further discussion needed on utilization of vMR vs. CCDA and SOAP vs. REST 4 II01 - Request DSSCCDA REST 1.Further discussion needed on utilization of vMR vs. CCDA and SOAP vs. REST 2.There is currently implementation guidance on DSS to be used with SOAP, not REST 5 II01 - Request DSSVMR SOAP 1. Further discussion needed on utilization of vMR vs. CCDA and SOAP vs. REST 6 II01 - Request DSSVMR REST 1.Further discussion needed on utilization of vMR vs. CCDA and SOAP vs. REST 2.There is currently implementation guidance on DSS to be used with SOAP, not REST 9 II02 - Response DSSHeD UC1 IGVMRSOAP 1. Consistent with UC1 10 II02 - Response DSSHeD UC1 IGVMRREST 1.Consistent with UC1 2.There is currently implementation guidance on DSS to be used with SOAP, not REST

HeD Community Decisions: Non Viable Implementation Options  For the request transaction, vMR or CCDA should be used for both the Organizer/Container and Payload, instead of a combination of both. They are not meant to be separated in this manner. All implementation options that combined vMR and CCDA were eliminated  CCDA is not a commonly used standard for the response transaction, therefore any implementation option that had CCDA as the Item Payload standard was eliminated  Adoptability of HL7 Version 3 Order Set Standard for the response transaction was decided to be low, therefore any implementation option that had HL7 Version 3 Order Set Item Payload standard was eliminated 7

Discussion Points and Activities for Week of 5/13  HeD Standards Selection Risks o vMR vs. CCDA o SOAP vs. REST Update from Pilots Call on SOAP/REST Information on use of SOAP today? 9

Health eDecisions (HeD) Standards Risk vMR vs. C-CDA Background vMR and C-CDA could both potentially support the payload of the request for CDS guidance C-CDA is in wide use today within EHRs and is cited in regulation, but there is currently no template specifically for CDS use, and existing templates may require population of data that is non-essential to a CDS guidance request vMR is used more heavily for clinical decision support and was the basis for the HeD UC1 solution, but there may be push back from EHR community if we required them to conform to both C-CDA (currently regulated in certification criteria) and vMR (would be regulated for CDS in certification criteria) The community is torn between the two, and is unsure which solution would be better for sending a request for CDS guidance to a CDS service Risk The HeD community is currently exploring the option of writing Implementation Guidance for both vMR and C-CDA and using pilots to determine which solution would be better for HeD. Community time and support team resources would be spent developing implementation guidance that may never be used (depending on which standard is selected after pilots) Ongoing and Planned Mitigation Actions C-CDA and vMR overview presentations will be given to the community this week in order to give them a better idea of how it could be used to support a CDS Guidance Request HeD Leadership is considering developing vMR as its primary implementation guidance, and developing C-CDA guidance only as time and resources allow Another option that is being considered is the use of a C-CDA-to-vMR transform, which would allow EHRs to continue using C-CDA alone but still utilize vMR within the CDS Guidance Request 10

Health eDecisions (HeD) Standards Risk vMR vs. C-CDA (continued) IG Options IDDescriptionProsCons AvMR alone; no C-CDA guidance within HeD UC2 IG This solution would most likely support the full scope of HeD UC2 and would be consistent with HeD UC1 EHRs would have to build in new logic to support vMR, even if they already support C- CDA BC-CDA alone; no vMR IG for HeD UC2 This solution would require minimal updates from EHRs that currently support C-CDA This would not be consistent with HeD UC1 It is unclear how well C-CDA can support HeD UC2 requirements as-is, and at minimum may require new C-CDA template(s) CvMR & C-CDA guidance in HeD UC2 IG; selection made at a future point in time This solution would allow us to thoroughly investigate both standards before determining which to go with, therefore giving more weight to a decision either way This would require more work than a single- standard approach Time and resources would be spent developing implementation guidance that would never be used outside of pilots DvMR with vMR-to-C- CDA transform specified as an appendix within IG This solution would have all of the benefits of both the vMR and C-CDA options, without having to use resources for guidance that may never be used This would require more work than a single- standard approach Unclear if a C-CDA-to-vMR transform would also be necessary (i.e. for response) and if so, how feasible it would be C-CDA may still require new template(s) to support a transform to vMR 11

Health eDecisions (HeD) Standards Risk SOAP vs. REST Background SOAP is widely used in the industry today; REST is considered to be the future standard for the industry Risk The HeD community would like to develop Implementation Guidance for both as different vendors may have a preference for one vs. the other However, if the use of SOAP vs. REST varies from vendor to vendor, ultimately this would necessitate EHRs and/or CDS Service Suppliers to support both, which would be a burden on implementers Ongoing and Planned Mitigation Actions We are raising this risk to the HeD Pilot community to get there input on how much of a burden this would be, and if they would instead prefer either SOAP or REST (and which one) Solution Options IDDescriptionProsCons ASOAP alone SOAP is in wide use today Vendors have stated they will not pilot if REST is not included BREST alone The industry seems to be moving towards REST Vendors which currently support SOAP alone for other interfaces would have to develop a RESTful interface CSOAP and REST in Implementation Guidance Vendors with a preference of SOAP vs. REST would be able to pilot whichever they are more comfortable with Would require more time and resources to develop IG Could result in burden on implementers to support both 12

Discussion Points and Activities for Week of 5/13 (Continued…)  Detailed Data Requirement Analysis o Review approach to complete document o Should we be using the data elements from the schema instead of in conjunction with the elements from Use Case 2? SDC team noticed that the Actions section had additional elements in the schema that weren’t in the Use Case 15

SDS & Harmonization HeD Leadership Agenda HeD WG Agenda for 5/16 Update on progress & decisions made last week HeD Standards Selection Risks Timeline review Detailed Data Requirement Analysis Follow-up on discussion with Dave Shields and Aziz Boxwala IG Update –Conformance Verbs –Data Model Approach –Functional Interaction Types –Vocab & Codeset inclusion into HeD UC2 IG: update from HL7? 16

Update on Conversation with Dave Shields Transactional Layers 17 Transport and Security Response Service: e.g., DSS Response Element Response Items Organizer/Container: e.g., HeD Action Groups Element Response Item Payload: e.g., VMR Proposal Transport and Security Request Service: e.g., DSS Request Element Request Items Organizer/Container: e.g: VMR or CCDA Request Item Payload: e.g., VMR Clinical Statement  The response needs to include context elements (e.g., patient) that were not part of the HeD UC1 spec.  The request and response should have parallel approaches  The response wrapper would be in a class/complexType called CDSOutput This type would incorporate appropriate pieces of the HeD schema (e.g., actionGroup, actionSentences, etc).  To not have a two-way dependency between vMR and HeDS (HeD schema from UC1), we will move the current CDSInput and CDSOutput types from the vMR namespace into a new namespace The cdsInput and CDSOutput will continue to be part of the vMR specification and project  So the response will look like this: DSS Response Element Contains CDSOutput (new name space, new type that imports HeDS types) Contains vMR Clinical Statements (in vMR namespace; further CDSOutput will be designed so that clinical statements from other types can be incorporated (e.g., FHIR), but this is out of scope for HeD UC2)

Discussion Points and Activities for Week of 5/13 (Continued…)  IG update o Have determined which sections will be populated internally, and which sections will be community homework. Have also drafted a timeline for completion of each section. Internal team beginning to populate the Introduction section, and will be ready for Leadership review on 5/21 o Should Conformance Verbs include the full HL7 v3 list or to cut out the May/Need Not per ONC’s direction? SHALL: an absolute requirement SHALL NOT: an absolute prohibition against inclusion SHOULD/SHOULD NOT: best practice or recommendation. There may be valid reasons to ignore an item, but the full implications must be understood and carefully weighed before choosing a different course MAY/NEED NOT: truly optional; can be included or omitted as the author decides with no implications o Data Model Approach Talking point at HL7 Patient Care/SD/CDS WG Joint session: the XML format of HeD schema/expression language is not as useful/valuable as a more generalizable model (e.g. UML) would be What’s useful to an implementer? What’s in our purview? 19

Discussion Points and Activities for Week of 5/13 (Continued…)  IG update (continued…) o Functional Interaction Types How many should we focus on? –Drug Dosing Calculation –Immunization Forecasting –Disease Management –Quality Measure Evaluation –Transition of Care Support –Prediction Rule Evaluation – APACHE score, AHRQ Pneumonia Severity Index, etc. –Severity of Illness Assessment – Charlson index, etc. Will these be included in the main IG document, or can they be submitted as examples (allowing them to come after the other materials) o Vocab & Codeset inclusion into HeD UC2 IG: update from HL7? How will we leverage Vocab & Terminology WG/work o Reinstate scrum calls – Friday only? 20

Appendix 21

Use Case 2 – CDS Guidance Service Transactions CDS Guidance Requestor 2. CDS Response (Clinical Data, Supporting Evidence, Supporting Reference, Actions, Attribute-Value List, Response Metadata & Exceptions) CDS Guidance Supplier 1. CDS Request (Clinical Data & Context) INSERT SELECTED STANDARDS HERE

Use Case 2: CDS Guidance Service Transactions - Standards per Transaction #TransactionServiceOrganizer/ContainerItem Payloads Reference Information Model 1 CDS Request (patient data and potentially context) Decision Support Service (DSS) Context Aware Retrieval Application (Infobutton) CDS Knowledge Artifact Implementation Guide (HeD UC1 IG) Consolidated CDA Virtual Medical Record (vMR) Context Aware Retrieval Application (Infobutton) Virtual Medical Record (vMR) Consolidated CDA (hL7 Clinical Statements) HL7 Version 3 Standard: Order Set Publication, Release 1 Federal Health Information Model (FHIM) HL7 v2.x HL7 v3 2 CDS Response (guidance and/or other response elements) Decision Support Service (DSS) Context Aware Retrieval Application (Infobutton) CDS Knowledge Artifact Implementation Guide (HeD UC1 IG) HL7 Version 3 Standard: Order Set Publication, Release 1 Consolidated CDA Virtual Medical Record (vMR) Context Aware Retrieval Application (Infobutton) Virtual Medical Record (vMR) Consolidated CDA (HL7 Clinical Statements) HL7 Version 3 Standard: Order Set Publication, Release 1 Federal Health Information Model (FHIM) HL7 v2.x HL7 v3

Use Case 2: CDS Guidance Service Transactions - Standards per Transaction #TransactionTransport Authentication/ Authorization EncryptionVocab & Code Set 1 CDS Request (patient data and potentially context) SOAP REST SAML TLS LOINC SNOMED CT CVX Manufacturers of Vaccines (MVX) OID RxNorm ICD-9-CM and ICD-10-CM HCPCS C80 - Clinical Document and Message Terminology Component NQF Value Sets ICD-10-PCS UCUM CPT C154 NDC FDA Route Administration HL7 Vocabulary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) 2 CDS Response (guidance and/or other response elements) SOAP REST SAML TLS LOINC SNOMED CT CVX Manufacturers of Vaccines (MVX) OID RxNorm ICD-9-CM and ICD-10-CM HCPCS C80 - Clinical Document and Message Terminology Component NQF Value Sets ICD-10-PCS UCUM CPT C154 NDC FDA Route Administration HL7 Vocabulary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)

CDS Guidance Request Transaction: Service Standards Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale Decision Support Service (DSS) HITSC Rating:* M: 78.69 A: 88.6 SI: 33.33 T: 72.71 (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: Response Metadata; (N) Does not Fit: Yes One significant gap is DSS will tie to SOAP. There is significant industry movement towards REST. DSS has 2 levels, one is model of the service which is implementation agnostic. Could support standard with implementation based on REST, but it would have to be developed. DSS is designed to be able to support patient data, unlike Infobutton. Has broader scope than Infobutton * M: Maturity A: Adoptability SI: S&I Specific T: Total Context Aware Retrieval Application (Infobutton) HITSC Rating* M: 90.08 A: 92.11 SI: 47.62 T: 82.07 (Y) Fits: Context; Supporting Evidence; Supporting Resource (P) Partially Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response (N) Does not Fit: Clinical; Actions; Attribute Value List; Response Meta Data No Can send some patient data, but not designed to support rich patient data payload like DSS

CDS Guidance Response Transaction: Service Standards Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale Decision Support Service (DSS) HITSC Rating:* M: 78.69 A: 88.6 SI: 33.33 T: 72.71 (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: Response Metadata; (N) Does not Fit: Yes One significant gap is DSS will tie to SOAP. There is significant industry movement towards REST. DSS has 2 levels, one is model of the service which is implementation agnostic. Could support standard with implementation based on REST, but it would have to be developed. DSS is designed to be able to support patient data, unlike Infobutton. Has broader scope than Infobutton * M: Maturity A: Adoptability SI: S&I Specific T: Total Context Aware Retrieval Application (Infobutton) HITSC Rating:* M: 90.08 A: 92.11 SI: 47.62 T: 82.07 (Y) Fits: Context; Supporting Evidence; Supporting Resource (P) Partially Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response (N) Does not Fit: Clinical; Actions; Attribute Value List; Response Meta Data No Can send some patient data, but no designed to support rich patient data payload like DSS

CDS Guidance Request Transaction: Organizer/Container Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale CDS Knowledge Artifact Implementation Guide (HeD UC1 IG) HITSC Rating:* M: 61.39 A: 86.84 SI: 35.71 T: 64.62 (Y) Fits: (Sender) CDS Response; (Receiver) CDS Response; Clinical; Supporting Evidence; Supporting Resource; Actions; Attribute Value List; (P) Partially Fits: Context; Response Metadata (N) Does not Fit: Exceptions No UC1 is not designed to carry patient data If CCDA is chosen, would probably have to use related HL7 Clinical statements for the Item Payload bucket. If vMR is chosen, would probably have to use the vMR Clinical Statements for the Item Payload bucket External options may exist for transforming CCDA request into a vMR component Develop options for both CCDA and vMR * M: Maturity A: Adoptability SI: S&I Specific T: Total Consolidated CDA HITSC Rating:* M: 53.59 A: 80.70 SI: 33.33 T: 58.48 (Y) Fits: Clinical; (P) Partially Fits: (N) Does not Fit: Context, Supporting Evidence; Supporting Resource; Actions; Attribute Value List; Response Metadata; Exceptions Yes Can transform CCDA request into a vMR component from the execution system Not everything from CCDA goes easily into vMR, but vMR is designed to easily accept CCDA components

CDS Guidance Request Transaction: Organizer/Container Rationale (continued…) Standard Summary of Findings from UCR Crosswalk Keep?Rationale Virtual Medical Record (vMR) HITSC Rating:* M: 78.06 A: 81.58 SI: 33.33 T: 70.08 (Y) Fits: Clinical; Attribute Value List (P) Partially Fits: CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Context; Supporting Evidence; Supporting Resource; Actions; (N) Does not Fit: Response Metadata; Exceptions Yes Lighter weight than the other options Developed specifically for clinical decision support computability Intended to be used for this initiative, and has recently been enhanced in this respect * M: Maturity A: Adoptability SI: S&I Specific T: Total

CDS Guidance Response Transaction: Organizer/Container Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale CDS Knowledge Artifact Implementation Guide (HeD UC1 IG) HITSC Rating:* M: 61.39 A: 86.84 SI: 35.71 T: 64.62 (Y) Fits: (Sender) CDS Response; (Receiver) CDS Response; Clinical; Supporting Evidence; Supporting Resource; Actions; Attribute Value List; (P) Partially Fits: Context; Response Metadata (N) Does not Fit: Exceptions Yes Fits Clinical; Supporting Evidence; Supporting Resource; Actions data requirements Attribute value list is not supported in UC1 schema, however the schema does allow extensions using XSD Would use subset of HeD UC1 schema that may require further modifications * M: Maturity A: Adoptability SI: S&I Specific T: Total Consolidated CDA HITSC Rating:* M: 53.59 A: 80.70 SI: 33.33 T: 58.48 (Y) Fits: Clinical; (P) Partially Fits: (N) Does not Fit: Context, Supporting Evidence; Supporting Resource; Actions; Attribute Value List; Response Metadata; Exceptions Probably No There is a profile in IHE that uses DSS and returns IHE as an output. But hasn’t been finalized within IHE Lacks the ability to group and organize things the way that UC1 does Do not anticipate using, unless modification or subset of UC1 approach does not work

CDS Guidance Response Transaction: Organizer/Container Rationale (continued…) Standard Summary of Findings from UCR Crosswalk Keep?Rationale Virtual Medical Record (vMR) HITSC Rating:* M: 78.06 A: 81.58 SI: 33.33 T: 70.08 (Y) Fits: Clinical; Attribute Value List (P) Partially Fits: CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Context; Supporting Evidence; Supporting Resource; Actions; (N) Does not Fit: Response Metadata; Exceptions No (Probably) Does fit this situation, however CDS Knowledge artifact may be the better option UC1 action would need to be modified to represent payload for UC2 regarding vMR May need a model agnostic response Do not anticipate using, unless modification or subset of UC1 approach does not work * M: Maturity A: Adoptability SI: S&I Specific T: Total HL7 Version 3 Standard: Order Set Publication, Release 1 HITSC Rating:* M: 46.20 A: 75.44 SI: 33.33 T: 53.31 (Y) Fits: Supporting Evidence; Supporting Resource; Response Metadata (P) Partially Fits: Clinical; Context; Actions (N) Does not Fit: Attribute Value List; Exceptions No (Probably) Some vendors may want to support this as an option, however CDS Knowledge Artifact is the better option Adoption of this standard is low, so there is not a driving reason to extend support to it

CDS Guidance Request Transaction: Item Payloads Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale Context Aware Retrieval Application (Infobutton) HITSC Rating M: 90.08 A: 92.11 SI: 47.62 T: 82.07 (Y) Fits: Context; Supporting Evidence; Supporting Resource (P) Partially Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response (N) Does not Fit: Clinical; Actions; Attribute Value List; Response Meta Data No The information that is contained in infobutton is already represented in vMR, or if not can be Can use infobutton as a reference to modify vMR or CCDA * M: Maturity A: Adoptability SI: S&I Specific T: Total Virtual Medical Record (vMR) HITSC Rating:* M: 78.06 A: 81.58 SI: 33.33 T: 70.08 (Y) Fits: Clinical; Attribute Value List (P) Partially Fits: CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Context; Supporting Evidence; Supporting Resource; Actions; (N) Does not Fit: Response Metadata; Exceptions Yes The vMR has relevant information in a reasonable format The contents and scope of the vMR are aligned with the requirements of the Use Case Maintained by CDS WG As a reference model, part of its purpose is to provide exchangeable representation clinical information

CDS Guidance Request Transaction: Item Payloads Rationale (Continued…) Standard Summary of Findings from UCR Crosswalk Keep?Rationale Consolidated CDA HITSC Rating:* M: 53.59 A: 80.70 SI: 33.33 T: 58.48 (Y) Fits: Clinical; (P) Partially Fits: (N) Does not Fit: Context, Supporting Evidence; Supporting Resource; Actions; Attribute Value List; Response Metadata; Exceptions Yes Several stake holders have a business need to have this supported A methodology is needed to be able to reflect changes, which currently does not exist * M: Maturity A: Adoptability SI: S&I Specific T: Total HL7 Version 3 Standard: Order Set Publication, Release 1 HITSC Rating:* M: 46.20 A: 75.44 SI: 33.33 T: 53.31 (Y) Fits: Supporting Evidence; Supporting Resource; Response Metadata (P) Partially Fits: Clinical; Context; Actions (N) Does not Fit: Attribute Value List; Exceptions No Order Set does not hold patient data, not suitable for request transaction

CDS Guidance Response Transaction: Item Payloads Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale Context Aware Retrieval Application (Infobutton) HITSC Rating:* M: 90.08 A: 92.11 SI: 47.62 T: 82.07 (Y) Fits: Context; Supporting Evidence; Supporting Resource (P) Partially Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response (N) Does not Fit: Clinical; Actions; Attribute Value List; Response Meta Data No The information that is contained in infobutton is already represented in vMR, or if not can be Can use infobutton as a reference to modify vMR or CCDA * M: Maturity A: Adoptability SI: S&I Specific T: Total Virtual Medical Record (vMR) HITSC Rating:* M: 78.06 A: 81.58 SI: 33.33 T: 70.08 (Y) Fits: Clinical; Attribute Value List (P) Partially Fits: CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Context; Supporting Evidence; Supporting Resource; Actions; (N) Does not Fit: Response Metadata; Exceptions Yes The vMR has relevant information in a reasonable format The contents and scope of the vMR are aligned with the requirements of the Use Case Maintained by CDS WG As a reference model, part of its purpose is to provide exchangeable representation clinical information

CDS Guidance Response Transaction: Item Payloads Rationale (Continued…) Standard Summary of Findings from UCR Crosswalk Keep?Rationale Consolidated CDA HITSC Rating:* M: 53.59 A: 80.70 SI: 33.33 T: 58.48 (Y) Fits: Clinical; (P) Partially Fits: (N) Does not Fit: Context, Supporting Evidence; Supporting Resource; Actions; Attribute Value List; Response Metadata; Exceptions No Several stake holders have a business need to have this supported A methodology is needed to be able to reflect changes, which currently does not exist However, CCDA is not a commonly used standard for the response transaction * M: Maturity A: Adoptability SI: S&I Specific T: Total HL7 Version 3 Standard: Order Set Publication, Release 1 HITSC Rating:* M: 46.20 A: 75.44 SI: 33.33 T: 53.31 (Y) Fits: Supporting Evidence; Supporting Resource; Response Metadata (P) Partially Fits: Clinical; Context; Actions (N) Does not Fit: Attribute Value List; Exceptions No Order set model contains recommendations for clinical actions, which is applicable to the types of outputs relevant in the Use Case Unsure of adoptibility of this standard in CDS Guidance

CDS Guidance Request Transaction: Transport Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale SOAP HITSC Rating:* M: 100.00 A: 100.00 SI: 100.00 T: 100.00 (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: Yes There is currently implementation guidance on DSS to be used with SOAP, not REST Has the capabilities and functions needed for this initiative * M: Maturity A: Adoptability SI: S&I Specific T: Total REST HITSC Rating:* M: 100.00 A: 100.00 SI: 42.86 T: 88.30 (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: Yes Industry is moving towards using REST Guidance could be written for DSS to work with REST

CDS Guidance Response Transaction: Transport Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale SOAP HITSC Rating:* M: 100.00 A: 100.00 SI: 100.00 T: 100.00 (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: Yes There is currently implementation guidance on DSS to be used with SOAP, not REST Has the capabilities and functions needed for this initiative * M: Maturity A: Adoptability SI: S&I Specific T: Total REST HITSC Rating: M: 100.00 A: 100.00 SI: 42.86 T: 88.30 (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: Yes Industry is moving towards using REST Guidance could be written for DSS to work with REST

CDS Guidance Request Transaction: Authentication/Authorization Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale SAML HITSC Rating:* M: 100.00 A: 100.00 SI: 100.00 T: 100.00 (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: * M: Maturity A: Adoptability SI: S&I Specific T: Total

CDS Guidance Response Transaction: Authentication/Authorization Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale SAML HITSC Rating:* M: 100.00 A: 100.00 SI: 100.00 T: 100.00 (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: * M: Maturity A: Adoptability SI: S&I Specific T: Total

CDS Guidance Request Transaction: Encryption Standard Summary of Findings from UCR Crosswalk Keep?Rationale TLS HITSC Rating:* M: 100.00 A: 100.00 SI: 42.86 T: 88.30 (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: * M: Maturity A: Adoptability SI: S&I Specific T: Total

CDS Guidance Response Transaction: Encryption Standard Summary of Findings from UCR Crosswalk Keep?Rationale TLS HITSC Rating:* M: 100.00 A: 100.00 SI: 42.86 T: 88.30 (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: * M: Maturity A: Adoptability SI: S&I Specific T: Total

Solution Plan View the different combination of standards, across the different buckets, and determine the viability of each implementation option Decide which implementation option(s), and therefore combination of standards, is the best approach Document reasons why certain implementation options were chosen or not chosen View the different combination of standards, across the different buckets, and determine the viability of each implementation option Decide which implementation option(s), and therefore combination of standards, is the best approach Document reasons why certain implementation options were chosen or not chosen

Solution Plan Next Steps Decide which implementation option(s), and therefore combination of standards, will be used as the approach in the IG and incorporated into the final design

Gap Mitigation Plan Identify any gaps for all standards under consideration Determine if the gap is for the request or response transaction, or both Document recommendations on how to close the gap (i.e. modification to existing standard) Identify any gaps for all standards under consideration Determine if the gap is for the request or response transaction, or both Document recommendations on how to close the gap (i.e. modification to existing standard)

Gap Mitigation Plan Next Steps: Pull out the standards which have gaps requiring modifications and document in the IG Contact the SDO to initiate modification needed Gaps that are related to a standard being utilized in a manner which it has not previously been designed for will be addressed and written into the IG Pull out the standards which have gaps requiring modifications and document in the IG Contact the SDO to initiate modification needed Gaps that are related to a standard being utilized in a manner which it has not previously been designed for will be addressed and written into the IG

SDS & Harmonization HeD Leadership Agenda WG call presentations during Thursday WG meeting Update on progress & decisions made last week HeD Standards.

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SDS & Harmonization HeD Leadership Agenda WG call presentations during Thursday WG meeting Update on progress & decisions made last week HeD Standards.

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