1. HL7 NLM EHR Project alschuler.spinosa CommerceNet Webify Liora Alschuler liora@the-word-electric.com

2. RFP: Develop Phase I EHR Query-Response Message Set The system components will be assembled from existing open source implementations, the initial components of which are: Transport/encryption/data integrity - candidate CDC PHIN-MS Phase I EHR Query-Response Message Set- developed within NLM project by modifying existing messages

3. Contract: how quick & how dirty is quick & dirty? 5 weeks 120 hours Lightweight Find and retrieve baseline, human-readable information

4. Objectives How easy can we make it to request and receive human-readable information? What HL7 components are available? Identify Implement Major deliverables: Operational prototype, proof-of-concept software and implementation guide Report on what works as-is, what requires modification, constraint or extension, where gaps lie and recommendations on best direction moving forward Input into the standards development and refinement process

5. Scenario: Client: requestor, low-end, small office, low- cost, simple, web-enabled Server: data source, high-end, large facility, more sophisticated technically Client can request, receive documents; Server can respond to query, supply documents Server backend database has mix of data sources including non-CDA reports, CDA, V2 and V3 lab results

6. Primary components CDCs Version 2 PHINMS messaging system MS SQL Server database development license used locally by CommerceNet, other participants, including HL7, to supply own license Version 3 query/response messages: Shared Messages, Medical Records Utility to transform unstructured documents into CDA R1 (non-XML body): Webify Client application for query definition and viewing of retrieved documents: Webify Style sheet for displaying CDA R1 documents: adapted from one developed for CDA Claims Attachements (ASIG stylesheet)

7. Interim report Infrastructure Messages Data

8. Interim report: infrastructure PHIN-MS Requires addition of asp message handler CDC had not implemented message handler talking to asp page; this was in the functional spec, but undocumented, so it took abit of time Now developed and working, will be deliverable back to CDC

9. Input into standards process: Should review with security and accountability SIG Interim report: infrastructure

10. Interim report: Messaging Candidate areas of V3: V3 messages to be considered: (from RFP) Transport Specifications: ebXML, Release 1 DSTU - Pending Board Approval Webservices SOAP/WSDL Profile, Release 1 DSTU - Pending Board Approval MLLP, Release 1 ( Membership #1 ) Common Domains: Shared Messages: Act Status Topic Act Reference Topic QUMT (document query and query response) Infrastructure Management: Transmission Infrastructure: Generic Message Transmission Polling Message Transmission Infrastructure Management: Query Infrastructure: Query Control Act Topic Infrastructure Management: Master File/Registry Infrastructure: Master File Registry Topic Health and Clinical Management: Clinical Document Architecture Laboratory: Result Topic Medical Records: Document Topic RCMR (document request & retrieve) Public Health Reporting: ICSR Topic other, as desired (eg, Pharmacy, Blood Bank and so on)

11. Interim report: Messaging Input into standards process: Query messages: QUMT (document query and response) - - CQ/OO/MRM: Review query parameters Review document parameters in query response Retrieve messages: RCMR (document request and retrieve) – MRM/SDTC Accelerate creation of MRM query-by-parameter message Future consideration: query-by-example (new MRM/SDTC project), constrained for implementation Promote use of MRM retrieve messages, possibly open issue with OO as well

12. Interim report: clinical content 4 types of native data format: CDA Henry Levin 7 th (Release 1 Membership ballot sample) MS Word CCR sample by Dr. Tom Sullivan Transform to CDA V2 lab result Result sample provided by Mike Henderson Transform to CDA V3 lab result Result in development (HIMSS 2004 as basis)

13. Interim report: clinical content Input into standards process: CDA R1 sample: no issues Word to CDA: no issues V2 lab to CDA: rich source of issues to bring forward within SDTC, in conjunction with O&O

14. Lab2CDA Transformation Issues 1. document ID: for every transform or every source document? 2. timestamp: time of source report creation? transmission? time of transform? 3. document type code: no LOINC scale=doc 4. provider: CDA assumes role in encounter; relationship to lab unclear 5. referring physician: anticipates an encounter 6. lab tech: no such role 7. order status: no such status 8. authentication: who is the authenticator?

15. Interim report: clinical content Input into standards process: CDA R1 sample: no issues Word to CDA (show): no issues V2 lab to CDA: rich source of issues to bring forward within SDTC & O&O, many resolved in R2 V3 lab to CDA: in progress… input to O&O: Sample generation non-trivial because in active development Cross-enterprise interaction modeling an incremental challenge beyond V2 Schema generation complex (multiple CMETs) … this just in… sample available from HIMSS demo 2004 courtesy Epic systems

16. Functional description Client: Invoke Send Query GUI, enter query parameters (patient ID; optional: document type, provider, date range) Completed query, packaged in PHINMS and sent to Server. Server unpacks query, searches for corresponding artifacts, formats response per guidelines, and sends response to Client listing matching data. Client (requesting system) receives response, unpacks message, and renders response as HTML list in browser. User selects one or more records to retrieve, sends request to Server. Server unpacks request, identifies records to be retrieved; if needed, transforms them to CDA R1, packages in message and sends back to Client. One or more documents received, can be displayed by Client using CDA R1 style sheet on Client java-enabled web browser.

17. ClientServer Client Sends HL7 Query Server gets data from db and creates a HL7 V3 response Server sends HL7 Response with a list of document metadata Client parses HL7 V3 response and displays it on screen Client Sends HL7 Query with specific document ID Server transforms/gets CDA document from db and creates a HL7 V3 response Server sends HL7 Response with a CDA document Client parses CDA document response and displays it on screen

18. Do you have a referral for Zsazsa from June 03? patientID=x123 docType=LOINCxxx date=YYYYmmDD Yes, several Ill take that one Okay, here it is Thanks!

19. Application overview Requesting a document

20. Showing whats available

21. Transforming the document

22. … and delivery

23. Thank you! Questions?