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EHR Functional Model and Standard Health Level Seven (HL7) EHR SIG Gary Dickinson, Linda Fischetti, Sam Heard SIG Co-Chairs
© HL Outline History & Catalyst Functional Model –EHR Functions –Profiles Plan of attack!
© HL AHRQAgency for Healthcare Research and Quality (DHHS) CMSCenters for Medicare and Medicaid Services (DHHS), formerly Health Care Financing Administration (HCFA) DHHSUS Dept. of Health and Human Services EHRElectronic Health Record EHRFMEHR Functional Model EHR SIGHL7 EHR Special Interest Group HIMSSHealth Information Management Systems Society VA/VHAUS Veterans Health Administration Glossary
© HL Expert Panel Jeff Blair –NCVHS, Medical Record Institute Diane Carr –Queens Health Network –2002 Davies Recognition Award Simon Cohn, MD –Kaiser Permanente, IOM Ed Hammond, PhD –Duke University, IOM, HL7 BOD
© HL Expert Panel, cont Thomas Handler, MD –Gartner, HIMSS EHR/Davies Criteria Dipak Kalra, MD –NHS, UK Clem McDonald, MD –Regenstrief Institute, University of Indiana –LOINC Ron Parker –Canadian Health Infoway
© HL Expert Panel, cont Paul Tang, MD –Stanford University, IOM Charlene Underwood –Siemens, HIMSS EHR/Davies Criteria
© HL History & Catalyst
© HL EHR SIG Co-Chairs Linda Fischetti, RN MS US Department of Veterans Affairs Gary Dickinson Per-Sé Technologies, Inc. US Sam Heard, MD OpenEHR, Australia
© HL HL7 EHR SIG Formed January, 2002 Establishes EHR related priorities for HL7 Standardization –Architectural issues – working with other technical committees –Functional specification
© HL Original timeline Take 18 months to 2 years to write the standard And then….. A customer arrived……
© HL SCULLY URGES HOSPITALS TO HELP DEVELOP STANDARDIZED HEALTH RECORDS Tom Scully, Administrator of the federal Centers for Medicare and Medicaid Services, today urged hospital executives to work with the government to develop standardized electronic health records. Dateline, Washington, DC 21 st March 2003:
© HL Functional Model
© HL Project Target Initial Target EHR Functional Model and Standard- –Draft Standard for Trial Use Subsequently Full HL7 Standard –Normative Document
© HL Task Create a Functional Model –Determine care delivery functions that are required across all implementations –Determine infrastructure functions supporting care delivery –Determine care delivery functions that are required in particular settings –Allow for dynamic additions for innovation and elective functions Ballot this model as a standardised description of EHR functionality
© HL EHR Functional Model Infrastructure functions Care Delivery Functions Functional Profiles Vary across profiles Functional Profiles
© HL EHR Functions
© HL Core functionality Functional Profile 2 Functional Profile 1 Core specific functions Essential Core specific functions Essential Core generic functions Infrastructure functions
© HL Core and Added Functionality Profile 2Profile 1 Core specific functions Essential Added functions Desirable Added functions Desirable Core specific functions Essential Infrastructure functions Essential Performance and reliability enhancement Desirable Core generic functions Essential Added and innovative care delivery functionsDesirable
© HL Example functions Infrastructure functions Care delivery functions Functional Profiles Inpatient Medication Administration Record Bed management Demographic Management Security Security Security Security Standards Compliance Order Management Order Management Order Management Event Capture Event Capture Notes Notes Notes Results Reporting Results Reporting Results Reporting Drug-Drug Interactions Drug-Drug Interactions Drug-Drug Interactions.
© HL Increasing granularity
© HL Increasing granularity
© HL Functional domain hierarchies Medication orders Warnings Patient preferences Administration recording Care Delivery Functions ePrescribing
© HL Functional dependencies
© HL Functional dependencies
© HL EHR Function Specification Triplet For each functional element specified: 1) WHAT - Statement of function(ality) 2) WHY - Rationale (for inclusion) 3) Conformance Criteria How = Implementation - OUT OF SCOPE
© HL Functional profiles
© HL What are functional profiles? Sets of functions –Care setting specific Based on consensus –Purpose specific Registered for specific use Not controlled through standards process Standard Registered
© HL Care setting profiles Institute of Medicine –Agree standard care settings –Minimal functionality required Express in EHR Functional Model –Review functions –Ballot functions
© HL Example functions Infrastructure functions Care delivery functions Profiles Outpatient Inpatient Home Wellness Reminders Medication Administration Record Bed management Lifestyle Wellness Reminders Medication Administration Record Demographic Management Security Security Security Security Standards Compliance Order Management Order Management Order Management Event Capture Event Capture Notes Notes Notes Results Reporting Results Reporting Results Reporting Drug-Drug Interactions Drug-Drug Interactions Drug-Drug Interactions.
© HL What are registered functional profiles? Sets of functions –Determined by users –Determined by authoritative bodies –Defined by quality or safety initiatives –Defined by regulation –Defined by payors
© HL Profiles Infrastructure functions Care Delivery Functions Use Profiles Care Setting Profiles
© HL Profiles Provider Profiles Care Setting Profiles Vendor Profiles Regulation Profiles Professional Association Profiles Accreditation Profiles Part of Standard Registered – Not in standard How-to is part of Standard
© HL Use of Profiles Provider Profiles Care Setting Profiles Vendor Profiles Regulation Profiles Professional Association Profiles Outpatient Oncologist Guideline HIPAA Product X
© HL Use of the Model: Vendor Application profile Application Profile 1 Application Profile 1 ePrescribing Laboratory result management Chronic disease Prompts and recalls Domains
© HL Provider profile Use of the Model: Provider Application Profile 1 Application Profile 2 ePrescribing Laboratory result management Chronic disease Prompts and recalls Domains
© HL EHR SIG Work Plan Deliverables Top down functional decomposition –References and sources Standard care setting functional profiles –EHR SIG/IOM collaboration Functional profile How-to –Guidance: build, adapt, extend and integrate profiles –Registry, conformance
© HL Project Work & Timeline
© HL Plan of Attack EHR Functions HL7 EHR SIG EHR Care Setting Profiles HL7 EHR SIG, IOM collaboration Profile per setting –E.g. acute inpatient, ambulatory, long-term care, care in the community, home health, Integrated Delivery Network
© HL Plan of Attack (cont.) EHR Registered Use Profile How-to Government: CMS, VA, FDA… Accreditation Providers, Practitioners Vendors Professional Societies Patients, consumers?
© HL Project Timeline… 21 July Ballot draft published - ready for meeting July Open EHR SIG Meeting End July Ballot draft revised - ready to ballot 1 August Ballot opens 1 September Ballot closes
© HL Project Timeline… 8-12 September 2003 HL7 Fall Working Group Meeting Memphis, Tennessee 9-11 September 2003 EHR SIG Meeting Reconciliation of ballot comments
© HL How to Participate Join HL7 Subscribe to HL7 EHR SIG Listserver (HL7 members) Attend open public sessions (no HL7 membership required) Join teleconference calls (HL7 members) Join ballot group (HL7 members) Review ballot draft (no HL7 membership required) Vote and submit pertinent comments (HL7 members)
Contacts Linda Fischetti, RN Veterans Health Administration Gary Dickinson Per-Sé Technologies, Inc. Sam Heard, MD OpenEHR, Australia
© HL7 2003
EHR SIG Work Plan Functional Perspectives Front-end user functions –Explicit functions –Extrinsic - externally invoked process/action Embedded functions –Implicit functions –Intrinsic - bound to internal process
© HL EHR SIG Work Plan Functional Perspectives, cont Service Oriented Architecture functions Communication functions –Interface functions –Multimedia functions Interface functions –HL7 trigger events, messages, query/response –In and outbound data streams
© HL EHR SIG Work Plan Functional Perspectives, cont Reporting and notification functions –Outbound data streams
© HL Functional dependencies
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