Stephen.Hufnagel@tma.osd.mil , editor October 8, 2011 DRAFT-D EHR System Function and Information Model (EHR-S FIM): DC 1.8.2 Immunization Management Demonstration Prototype Stephen.Hufnagel@tma.osd.mil , editor October 8, 2011 DRAFT-D REQUESTED ACTION: Please help improve the EHR System Functional Model (EHR-FM) by providing suggested improvements to the editor, so they can be considered for incorporation into future versions of the EHR-S FM. 2/28/2019 DRAFT WORKING DOCUMENT

DRAFT WORKING DOCUMENT Executive Summary For EHR-S FIM Release 2.1, this project has the dual purpose to 1) add core information models for each EHR-S FM function in support of the design of business objects, which are suitable to be composed into reusable business components and their associated standards-based information-exchange messages, documents and services and 2) make the EHR-S FM easier to analyze and to specify & to test an interoperable EHR (iEHR). The approach is to use an architecture modeling tool to represent the EHR-S FIM and then generate appropriate views, reports, XML and HTML renderings of each EHR-S function’s scenarios, requirements, actors, actions, dependencies, business rules, information & data, which can be adapted or refined to support specific profiles (e.g., project needs). The DoD-VA Joint Immunization Capability (JIC) project is proposed as a demonstration prototype. 2/28/2019 DRAFT WORKING DOCUMENT

This Document’s Purpose Prototype Information Model approach for EHR System Functional Model (EHR-S FM), Release 2.1. For each EHR-S FM Function: Scenario: Business Process Model based on function statement, description & criteria Requirements (conformance criteria) Business Rules Conceptual Information Model based on function statement, description & criteria Logical Data Model ISSUE: As this becomes a standard, what should be the basis to define the data elements for each logical data module/class or should we NOT define the data elements? HL7 RIM, DAMS, DIMS, DCLs, etc. US Federal Heath Information Model (FHIM) Other information models (Canada, New Zealand, GB, Singapore) Dependencies among functions (“see also”) Assertions and Common Actors, Actions, Data Element Set, data dictionary (UC Simplification) Service, Message or Document Profiles: content & transport interoperable standards-specifications REQUESTED ACTION: Provide suggestions to increase the fidelity, to Improve the quality and to increase the usability of the EHR-S FM. 2/28/2019 DRAFT WORKING DOCUMENT

DRAFT WORKING DOCUMENT 1.8.2 Immunization Scenario based on EHR-S FM 1.8.2 Statement and Description NOTE: Similarities with more generic 1.8.1 Manage Medication Administration scenario. Note: EHR-S FIM OV-7 concept & OV-5 activity models will help standardize verbs & nouns NOTE separation of OV-6a business rules! 2/28/2019 DRAFT WORKING DOCUMENT

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DRAFT WORKING DOCUMENT Note: EHR-S FIM OV-7 concept & OV-5 activity models will help standardize verbs & nouns QUESTION: Is an allergen reaction a type of adverse reaction/event? 2/28/2019 DRAFT WORKING DOCUMENT

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DRAFT WORKING DOCUMENT Should EHR-S FM R2 include these Operational Views (OVs)? DoD Architectural Framework views used for discussion convenience OV-1 High Level Operational Concept Graphic - High level graphical and textual description of operational concept (high level organizations, missions, geographic configuration, connectivity, etc.). Recommendation = OPTIONAL, may be a nice concept view. OV-2 Operational Node Connectivity Description - Operational nodes, activities performed at each node, and connectivities and information flow between nodes. Recommendation = OPTIONAL , may be a useful view. OV-3 Operational Information Exchange Matrix - Information exchanged between nodes and the relevant attributes of that exchange such as media, quality, quantity, and the level of interoperability required. Recommendation = YES OV-4 Organizational Relationships Chart - Command, control, coordination, and other relationships among organizations. Recommendation = NO 2/28/2019 DRAFT WORKING DOCUMENT

Should EHR-S FM R2 include these Operational Views (OVs)? OV-5 Operational Activity Model - Activities, relationships among activities, inputs and outputs. In addition, overlays can show cost, performing nodes, or other pertinent information. Recommendation = YES, (Level 1: access to care, provision of care, population health, manage the business) OV-6a Operational Rules Model - One of the three products used to describe operational activity sequence and timing that identifies the business rules that constrain the operation. Recommendation = YES, shown as a part of slide 4 OV-6b Operational State Transition Description - One of the three products used to describe operational activity sequence and timing that identifies responses of a business process to events. Recommendation = YES, if we want to show triggers. OV-6c Operational Event-Trace Description - One of the three products used to describe operational activity sequence and timing that traces the actions in a scenario or critical sequence of events. Recommendation = YES, can be shown as slide 4 or as a sequence diagram. OV-7 Logical Data Model - Documentation of the data requirements and structural business process rules of the Operational View. Recommendation = YES, this is slide 7 2/28/2019 DRAFT WORKING DOCUMENT

Should EHR-S FM R2 include these Views? AV-1 Overview and Summary Information - Scope, purpose, intended users, environment depicted, analytical findings (if applicable) Recommendation = YES AV-2 Integrated Dictionary - Definitions of all terms used in all products. Recommendation = YES, this is a traditional data dictionary TV-1 Technical Standards Profile - Extraction of standards that apply to the given architecture. (e.g., information exchanges) Recommendation = YES, this can be a part of the Information Exchange matrix. TV-2 Technical Standards Forecast - Description of emerging standards that are expected to apply to the given architecture (e.g., information exchanges), within an appropriate set of timeframes. Recommendation = NO SV-4a/SV-4b Systems/Services Functionality Description - The SV-4a documents system functional hierarchies and system functions, and the system data flows between them. Recommendation = YES, this is the EHR-S FM SV-5a Operational Activity to Systems Function Matrix SV-5a is a specification of the relationships between the set of operational activities applicable to the set of SV-4 system functions applicable to that architecture. 2/28/2019 DRAFT WORKING DOCUMENT

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BACKUP: Requirements for Level 1 Dependent Functions DC.1.3.2 Manage Patient Advance Directives DC.1.4.1 Manage Allergy, Intolerance and Adverse Reaction List DC.1.4.4 Manage Immunization List DC.1.8 Documentation of Care, Measurements and Results DC.1.8.2 Manage Immunization Administration DC.2.2.1 Support for Condition Based Care and Treatment Plans, Guidelines, Protocols DC.2.3.2 Support for Medication and Immunization Administration DC.2.7.1 Access Healthcare Guidance S.1.1 Registry Notification S.2.2 Report Generation S.2.2.2 Standard Report Generation S.3.7.1 Clinical Decision Support System Guidelines Updates IN.1.1 Entity Authentication IN.1.2 Entity Authorization. IN.1.3 Entity Access Control IN.1.6 Secure Data Exchange IN.1.7 Secure Data Routing IN.2.4 Extraction of Health Record Information IN.2.5.1 Manage Unstructured Health Record Information IN.2.5.2 Manage Structured Health Record Information IN.4.1 Standard Terminologies and Terminology Models IN.4.2 Maintenance and Versioning of Standard Terminologies IN.4.3 Terminology Mapping IN.5.1 Interchange Standards IN.5.2 Interchange Standards Versioning and Maintenance IN.6 Business Rules Management 2/28/2019 DRAFT WORKING DOCUMENT

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DRAFT WORKING DOCUMENT Level 2 Dependencies 2/28/2019 DRAFT WORKING DOCUMENT