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1 Aug 2008 © 2002-2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc.

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Presentation on theme: "1 Aug 2008 © 2002-2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc."— Presentation transcript:

1 1 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off January 2009 Clinician Orientation HL7 Clinical Interoperability Council (CIC)

2 2 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Introductions Tell us a bit about yourself Your name and organization Why you are here today/this week What you hope to gain from todays session

3 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off3 Aug 2008 Welcome!

4 4 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Objectives for Today Convey mission and purpose of the HL7 Clinical Interoperability Council (CIC) Discuss how standards can support the clinical community Discuss how CIC conducts work Describe what standards look like Understand how to get involved Understand general information about HL7 and how workgroup meetings function

5 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off5 Aug 2008 Introduction to HL7 Crystal Kallem

6 6 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Health Level Seven, Inc. (HL7) An international standards development organization (SDO) established more than 20 years ago Creates standards for the exchange, management and integration of electronic healthcare information Develops specifications that enable disparate healthcare applications to exchange key sets of clinical and administrative data

7 7 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off HL7 Vision/Mission Vision To create the best and most widely used standards in healthcare. Mission HL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, the vendor community, fellow SDOs and patients. In all of our processes we exhibit timeliness, scientific rigor and technical expertise without compromising transparency, accountability, practicality, or our willingness to put the needs of our stakeholders first.

8 8 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Why Standards? Standards enable interoperability of healthcare information Three aspects of interoperability Technical: Moving data from system A to system B Semantic: Ensuring that system A and system B understand the data in the same way Process: Enabling business processes at organizations housing system A and system B to work together

9 9 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off HL7 Workgroups Multiple workgroups function within HL7 today addressing various aspects of standards development The Clinical Interoperability Council (CIC) is an official workgroup of HL7

10 10 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off HL7 Workgroup Meetings HL7 face-to-face workgroup meetings occur in January, May and September each year Workgroup meetings offer A chance to meet face-to-face to work on standards and conduct administrative work An opportunity to exchange knowledge and ideas that lead to advancement in healthcare information technology utilization

11 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off11 Aug 2008 Introduction to the Clinical Interoperability Council (CIC) Crystal Kallem

12 12 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off A Bit of History Early standards addressed what was needed as part of hospital information systems and departmental system Most current standards are transparent to the clinical community The needs for standards change as we progress with information technology The future must be different

13 13 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off 13 The Problem Data Collected or Generated During Patient Care Data Used

14 14 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Uses of Data Have Significant Overlap Reimbursement Management Research Quality Measurement & Patient Safety Population Health Reporting Clinical Data

15 15 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Goal: Exchange and Use of Data Patient Clinician Healthcare Data Systems Patient care Quality Improvement Research Reimbursement Post Marketing Safety Decision Support Administration & Mgt. Population Health Reporting … Data Uses Single SourceMultiple Uses

16 16 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Funding & Development Partners Research Surveillance Patient Care Regulatory Data Element: chest x-ray result

17 17 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Funding & Development Partners Research Surveillance Patient Care Regulatory Data Element: chest x-ray result ==== Data Mapping

18 18 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Funding & Development Partners Research Surveillance Patient Care Regulatory Data Element: chest x-ray result Global Data Standards: An agreed upon set of common data elements, how they are defined, and how they look electronically

19 19 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Where are the Gaps? No clinical content standards Siloed approaches for: Terminology Guidelines Performance measures EHR development & implementation Research … Clinician involvement

20 20 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off History of the CIC Initiated by HL7 in May 2006 Initial focus: Survey the landscape of clinically oriented standards efforts Many presentations providing a wealth of information, all available on the CIC web page CIC objectives are now a strategic priority for HL7

21 21 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off CIC Mission This Council provides the standards development framework, organizational processes and forums to collaborate with the clinical community to define content, flow and other domain requirements necessary to the development of robust health data standards. The Council will provide mechanism for clinical domains to develop common approaches to standards-related activities and form consensus on issues of interest among multiple groups. This Council will be unique to Health Level Seven in that the focus is on the clinical content, not the technology of the standards.

22 22 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off CIC Mission This Council provides the standards development framework, organizational processes and forums to collaborate with the clinical community to define content, flow and other domain requirements necessary to the development of robust health data standards. The Council will provide mechanism for clinical domains to develop common approaches to standards-related activities and form consensus on issues of interest among multiple groups. This Council will be unique to Health Level Seven in that the focus is on the clinical content, not the technology of the standards.

23 23 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off CICs Role 1.Actively engage clinicians in standardizing their domains 2.Provide a community for those standardizing their domain 3.Provide a forum and process for harmonization of data elements and clinical information model 4.Maintain awareness of, employ, and teach the best methodology for clinical content representation 5.Provide a process for clinical content representation and access to experience 6.Provide infrastructure, process and imprimatur associated with an international SDO 7.Access port through which clinical content can be made available to HL7 technical community, i.e., for development of messages, documents, profile, services, etc. Near-term products with a long-term outlook

24 24 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Questions/comments?

25 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off25 Aug 2008 Methodology for Developing Standards and DAMs Anita Walden

26 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off26 Aug 2008 Terms You May Hear

27 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off27 Aug 2008 Version 2.x APPROVED AS AN ANSI STANDARD JUNE 26, The HL7 version 2 standard has the aim to support hospital workflows. HL7 version 2 defines a series of electronic messages to support administrative, logistical, financial as well as clinical processes Most widely implemented standard for healthcare information in the world.

28 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off28 Aug 2008 Example: What A Computer Understands MSH|^~\&|GHH LAB|ELAB-3|GHH OE|BLDG4| ||ORU^R01|CNTRL- 3456|P|2.4 PID||| ||EVERYWOMAN^EVE^E^^^^L|JONES| |F||| 153 FERNWOOD DR.^ ^STATESVILLE^OH^35292||(206) |(206) ||||AC ||67-A4335^OH^ OBR|1|845439^GHH OE| ^GHH LAB|15545^GLUCOSE||| ||||||||| ^PRIMARY^PATRICIA P^^^^MD^^|||||||||F|||||| ^HIPPOCRATES^HOWARD H^^^^MD OBX|1|SN|1554-5^GLUCOSE^POST 12H CFST:MCNC:PT:SER/PLAS:QN||^182|mg/dl|70_105|H|||F

29 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off29 Aug 2008 Version 3.0 Uses an object-oriented development methodology and a Reference Information Model (RIM) to create messages. The RIM is an essential part of the HL7 Version 3 development methodology, as it provides an explicit representation of the semantic and lexical connections that exist between the information carried in the fields of HL7 messages.Reference Information Model

30 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off30 Aug 2008 Example (XML)

31 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off31 Aug 2008 Class : 1. A kind or category of things or concepts. 2. A definition of objects, in terms of properties (attributes, methods, and relationships) that all objects of the class have in common. Model : A representation of a problem or subject area that uses abstraction to express the relevant concepts. A model is often a collection of schema and other documentation.

32 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off32 Aug 2008 Data Element In metadata, the term data element is an atomic unit of data that has:metadata An identification such as a data element namedata element name A clear data element definitiondata element definition One or more representation termsrepresentation terms Optional enumerated values Code (metadata)Code (metadata) A list of synonyms to data elements in other metadata registries Synonym ringSynonym ring

33 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off33 Aug 2008 Data Element Example Data Element NameClinical Data DefinitionPermissible Values Set Identification of Patient TB Status Identification of Patient's Status Suspected case of active TB; Confirmed case of active TB; LTBI; Contact of case of TB;

34 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off34 Aug 2008 Reference Information Model (RIM) The Reference Information Model (RIM) is the cornerstone of the HL7 Version 3 development process.Reference Information Model An object model created as part of the Version 3 methodology, the RIM is a large pictorial representation of the clinical data (domains) and identifies the life cycle of events that a message or groups of related messages will carry.Version 3 It is a shared model between all the domains and as such is the model from which all domains create their messages.

35 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off35 Aug 2008 Other Terms You May Hear Balloting – Voting process. Before a standard is ANSI-approved, it must be balloted by the HL7 membership. Public Comment – Releasing developed standards to the community for review and comment CDISC – Clinical Data Interchange Standards Consortium – An organization that develops and supports standards for clinical research use EHR – Electronic Health Record Message* – Atomic unit of data transferred between electronic systems. It is comprised of a group of segments in a defined sequence. Project Scope Statement – Form completed by project team to outline the project. This form is used by HL7 to review approve official HL7 projects that may be balloted as an official HL7 standard SNOMED CT (Systematized Nomenclature of Medicine -- Clinical Terms)- Terminology for diseases, findings, procedures, microorganisms, pharmaceuticals. reducing the variability in the way data is captured, encoded and used for clinical care of patients and research.

36 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off36 Aug 2008 Domain Analysis Model The DAM is a set of requirements which are submitted to design and implementation procedures and processes (e.g., HL7 specification development). It is a structured way to describe and document the information requirements of a particular area of interest (or domain). A description of the domain or environment

37 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off37 Aug 2008 DAM Methodology and Process

38 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off38 Aug 2008 Domain Analysis Model Content Document Business Process - Clinicians Storyboard- Patient Scenarios – Clinician Glossary/data elements – Clinician/Data Manager Activity diagram – Clinician/Data Manager Use case model – Clinician/Modeler Message content (data requirements)-Modeler Class model (aka Domain Analysis Model)-Modelers State diagram -Modeler Business rules – Clinicians/Data Managers/Modelers

39 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off39 Aug 2008 Storyboard/Scenario Example Darlene Dobson goes to the local office of her state Department of Motor Vehicles to renew her drivers license and fills out a Drivers License Renewal form. The license clerk requests her current drivers license and using the drivers license number, S , inquires on the status of her current drivers license, sees that it is active but scheduled to expire in three weeks, verifies that Darlenes date of birth and current address are the same as the data currently in the system, enters Darlenes responses from the form indicating that she has not been convicted of a moving motor vehicle violation in the previous three years and that she does not have any health issues that affect her driving ability. After that information is entered the system sends an inquiry to the state court system for moving motor vehicle violations in the previous three years and after receiving a response that there have been none, requests payment information. Darlene indicates she would like to pay with a MasterCard debit card and gives the card to the license clerk. The clerk enters the MasterCard number and expiration date. The registry system sends an electronic request to MasterCard to have the $35 drivers license renewal fee debited from Darlenes account and credited to the Departments bank account. After receiving an acceptance response from the MasterCard system, the registry system prints Darlenes new drivers license good for three years and a payment receipt. Given that the entire visit only took 10 minutes, Darlene leaves the office with a smile on her face.

40 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off40 Aug 2008 Use Case Requirements Analysis: Building a Domain Analysis Model HL7 Training;May 1, 2007,Norman Daoust, HDF Contributor for Ioana Singureanu,

41 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off41 Aug 2008 CV Activity Model

42 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off42 Aug 2008 CV Class Model Example

43 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off43 Aug 2008 Methodology for Developing DAMs Gather existing information Data Elements/Definitions Forms/Data Dictionaries Engage and meet w/ Stakeholders to discuss project and gather additional existing information Initial Face to Face meeting with Domain Stakeholders Create small working group to define data elements and definitions Weekly-Bi/Weekly Teleconferences or webinars, 2- Face 2 Face mtgs a year to accomplish largest amount of work Subset work- break up data elements into smaller chunks of work Some domains are too large to accomplish all at once Focus on domain data elements only-General Data Elements are developed by others groups Public Comment – the entire community should have opportunity to review defined data elements Have webinars to review work with broader community Publicize activities Develop a standards and DAM maintenance plan

44 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off44 Aug 2008 Identify tools used to develop UML /ActivityModels Use common class models examples CV TB Platform independent Methodology for Developing DAMs (cont.)

45 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off45 Aug 2008 Roles Stakekholders –provide clinical content and information Project Manager – facilitate process Data Manager or Informaticists – gather requirements, create artifacts Modeler – design models

46 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off46 Aug 2008 Key to Success Identify a Project Manager Keeps the process moving Ensures all key stakeholders are involved Identifies scope Communicates needs, status Facilitates meetings Ensures products are produced w/in timeframe Keeps project within budget and scope

47 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off47 Aug 2008 Meetings Recommendations Initial kick of meeting of all stakeholders Inform them of project Gather information Identify stakeholder working groups participants Weekly or bi-weekly Web/Teleconferences Created and Define Data Elements Participants – stakeholders, project manager, informaticists/data manager Modeler will attend once data elements have been developed 1-2 Face to Face mtgs a year to accomplish large chuncks of work Present work at conferences and working group mtgs Attend HL7 CIC mtgs Attend HL7 CIC Data Element Facilitation mtgs Biweekly mtg to assist groups with the process, monitor status and keep consistency between DAMs

48 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off48 Aug 2008 Tooling Recommendations Communication tools Conference phone # Web Conferencing system Modeling tools Examples: Visio/Enterprise Architecture/Rational Software Model Spreadsheet - data gathering Excel Website for accessing data standard

49 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off49 Aug 2008 Helpful Hints for a Sound Process Providing stakeholders with information to respond to will speed up the process. Giving them blank slate will take more time for decision making Scope Data Elements/Definitions Identify where data elements and DAMs will be stored for public access Engage those groups early on Be aware other standards development activities and their direction Hold meetings on a consistent schedule Inconsistency reduces participation Use Ontologies Keep DAMs General not specific to a tool or process

50 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off50 Aug 2008 Work Done to Date Meredith Nahm

51 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off51 Aug 2008 Information Model Domain Analysis Model (what concepts & how grouped) HL7 RIM based models Content for EHR screens Inference Model Clinical Guidelines Decision Support Performance Measures Concept Model Ontology Formal Logic Definitions *Adapted from model in Rector, et al 2004 MEDINFO/IMIA. Full reference in slide notes. Accomplishing the Goal Requires Standardizing the Clinical Domain * Data Elements Link concept to terminologies Link concept to definition Content Language Knowledge

52 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off52 Aug 2008 Example Inference Model * *In reality, these rules would be written in a syntax that resembles computer code Information Model Concept Model Inference Model Decision Support: Confirmed cases of TB should be flagged for local health authority notification (from CDC)

53 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off53 Aug 2008 Example Concept Model Information Model Concept Model Inference Model Concept Model: Foot Toe part Lower extremity part

54 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off54 Aug 2008 Example Information Model Information Model Concept Model Inference Model

55 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off55 Aug 2008 Information Models & Level of Abstraction Act Procedure Percutaneous Coronary Intervention

56 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off56 Aug 2008 What is the RIM? Entity classCode determinerCode Id code quantity name desc statusCode existanceTime telecom riskCode handlingCode Role classCode Id Code negationInd Addr telecom statusCode effectiveTime certificateText Quantity positionNumber RoleLink typeCode effectiveTime source n 1 target 0.. n outboundLink inboundLink player playedRole scoper scopedRole 0.. n n Participation typeCode functionCode contextControlCode sequenceNumber negationInd noteTest time moodCode awarenessCode signatureCode signatireText performedInd substitutionCondition- Code Act classCode moodCode Id code negationInd derivationExpr title text statusCode effectiveTime activityTime availabilityTime priorityCode confidentialityCode repeatNumber interruptablrInd levelCode independentInd uncertaintyCode reasonCode languageCode ActRelationship typeCode inversionInd contextControlCode contextConductionInd sequenceNumber priorityNumber pauseQuantity checkpointCode splitCode joinCode negationInd conjunctionCode localVariableName seperatableInd inboundRelationship outboundRelationship 0.. n source 1 1 target n 1 Reference Information Model (RIM): Provides consistency across domains and levels of granularity HL7 Reference Information Model, normative content, Version: V (11/22/2003), ModelID: RIM_0202. available from hl7.org

57 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off57 Aug 2008 Can be Represented in the HL7 RIM HL7 Reference Information Model, normative content, Version: V (11/22/2003), Model ID: RIM_0202. available from hl7.org

58 58 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Important Take-Away Messages Models must be consistent across clinical areas For example, blood pressure must be represented and defined the same way. A gift of data elements and ontology! Modeling should be consistent. A gift of the RIM! Synchronization enables: Computable guidelines Information exchange and use Challenges We use natural language imprecisely Different areas need different granularity Information Model Concept Model Inference Model

59 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off59 Aug 2008 How This Helps Reporting to quality improvement registries Computable guidelines / Electronic updating guideline changes to decision support Joint Commission reporting Aggregating data Chart review

60 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off60 Aug 2008 Participating in CIC Crystal Kallem

61 61 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off How to Participate & Stay Informed CIC meeting on January 18 th, 9am-5pm Monthly conference calls 2009 schedule will soon be posted to the CIC web page and distributed through the CIC list service CIC list service for communications CIC web page mes.cfm&src2=cic/index.cfm mes.cfm&src2=cic/index.cfm CIC wiki (logon: wiki / wikiwiki)

62 62 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off CIC Work in Progress Outreach to clinical professional societies Ambassador program module to get the word out Communication toolkit Clinical domain analysis models Tuberculosis Acute coronary syndrome Diabetes Mental health Master data element repository

63 63 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off How Can You Help Contribute clinical subject matter expertise Participate in CIC projects Advocate and endorse CIC activities Link related industry projects to CIC

64 64 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Benefits of a Partnership Together, we can: Enable each other Create standards that are invisible in the success of clinical interoperability Influence policy and politics Share successes

65 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off65 Aug 2008 Tomorrows CIC Meeting Agenda TimeTopicLocation Q1: 9:00-10:30Welcome/introductions Agenda review Instructions for co-chair elections Information sharing Discussion/Q&A Salon V 10:30-11:00Break Q2: 11:00-12:30Information sharing (cont.) Discussion/Q&A Salon V 12:30-1:45Lunch Q3: 1:45-3:00Work session Framework for CIC Expected end products/services Discussion/Q&A Salon V 3:00-3:30Cookie Break! Q4: 3:30-5:00Metadata registries Agenda planning for next meeting Salon V

66 66 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Additional Information Visit the HL7 Clinical Interoperability Council (CIC) web site at: &src2=cic/index.cfm &src2=cic/index.cfm CIC Co-chairs: Sam Brandt, MD SIEMENS Medical Solutions Ed Hammond, PhD Duke University Medical Center Crystal Kallem, RHIA American Health Information Management Association Meredith Nahm Duke Translational Medicine Institute

67 67 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Thank you for coming! Q & A

68 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off68 Aug 2008 Extra Slides (not active at this time)

69 69 Aug 2008 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off Proposed Future Infrastructure Steering Committee Representatives of organizations pledging support Executive Committee Elected co-chairs (initially) Membership Open/Public Workgroup A Workgroup B Workgroup C Workgroup D Workgroup E Workgroup F Administrative and Operational Support Provided/Facilitated by HL7

70 © Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off70 Aug 2008 Role Process Role of CIC in Context Entity Harmonize data elements across standards Establish certification criteria that includes EHR data content requirements Gather standards from SDOs, IHE, & others; consult with implementers Adoptor/ Vendors Standards Harmonization Implementation Implement content standards and data element specifications Gaps filled by SDOs, IHE, & others Feedback loop: Activity Information Flow: DRAFT HITSP Infrastructure Support Identify data elements that overlap domains U.S. Standards & Gaps Feedback Loop Evaluate data elements and harmonize across domains (when feasible). Data elements already used in technical standards will also feed into the process. Receive data element specs from clinical domain experts in prescribed formats HL7 CIC CertificationCCHIT EHR vendors apply for certification Master repository of data elements Map data elements to EHR-S FM and corresponding certification criteria Submit domain analysis model for HL7 ballot & ballot reconciliation Identify Data Needs SMEs Define data needs across all major categories of data use (primary patient care (all disciplines), research, quality, population health and reimbursement management) and document in prescribed CIC format with CIC guidance/support Map data elements to existing HL7 templates/value sets Supported by HL7, CIC, and Other Technical Experts Identify and prioritize domains requiring work, evaluate gaps and identify actions/new projects (SME/CIC collaboration) Tools/Resources CDISC defines research representation caBIG defines compliance level Many more


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