EHR Functional Model and Standard Health Level Seven (HL7) EHR SIG Gary Dickinson, Linda Fischetti, Sam Heard SIG Co-Chairs

Outline History & Catalyst Functional Model Plan of attack! EHR Functions Profiles Plan of attack! © HL7 2003

Glossary AHRQ Agency for Healthcare Research and Quality (DHHS) CMS Centers for Medicare and Medicaid Services (DHHS), formerly Health Care Financing Administration (HCFA) DHHS US Dept. of Health and Human Services EHR Electronic Health Record EHRFM EHR Functional Model EHR SIG HL7 EHR Special Interest Group HIMSS Health Information Management Systems Society VA/VHA US Veterans Health Administration © HL7 2003

Expert Panel Jeff Blair Diane Carr Simon Cohn, MD Ed Hammond, PhD 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 © HL7 2003

Expert Panel, con’t Thomas Handler, MD Dipak Kalra, 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 © HL7 2003

Expert Panel, con’t Paul Tang, MD Charlene Underwood Stanford University, IOM Charlene Underwood Siemens, HIMSS EHR/Davies Criteria © HL7 2003

History & Catalyst © HL7 2003

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 © HL7 2003

HL7 EHR SIG Formed January, 2002 Establishes EHR related priorities for HL7 Standardization Architectural issues – working with other technical committees Functional specification © HL7 2003

Original timeline Take 18 months to 2 years to write the standard And then….. A customer arrived…… © HL7 2003

Dateline, Washington, DC 21st March 2003: 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.” © HL7 2003

Functional Model © HL7 2003

Project Target Initial Target EHR Functional Model and Standard- Draft Standard for Trial Use Subsequently Full HL7 Standard Normative Document © HL7 2003

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 © HL7 2003

EHR Functional Model Care Delivery Functions Infrastructure functions Profiles Functional Profiles Care Delivery Functions Vary across profiles Infrastructure functions © HL7 2003

EHR Functions © HL7 2003

Core generic functions <- Essential -> Core functionality Functional Profile 1 Functional Profile 2 Core specific functions Essential Core specific functions Essential Core generic functions <- Essential -> Infrastructure functions <- Essential -> © HL7 2003

Core and Added Functionality Profile 1 Profile 2 Added functions Desirable Added functions Desirable Core specific functions Essential Core specific functions Essential Added and innovative care delivery functions Desirable Core generic functions Essential Performance and reliability enhancement Desirable Infrastructure functions Essential © HL7 2003

Example functions Functional Profiles Care delivery functions Inpatient Medication Administration Record Bed management Order Management Order Management Order Management Event Capture Event Capture Event Capture Event Capture Notes Notes Notes Notes Notes Notes Results Reporting Results Reporting Results Reporting Drug-Drug Interactions Drug-Drug Interactions Drug-Drug Interactions. Care delivery functions Infrastructure functions Demographic Management Demographic Management Security Security Security Security Security Security Security Security Standards Compliance Standards Compliance © HL7 2003

Increasing granularity © HL7 2003

Increasing granularity © HL7 2003

Functional domain hierarchies Care Delivery Functions ePrescribing Medication orders Warnings Patient preferences Administration recording © HL7 2003

Functional dependencies © HL7 2003

Functional dependencies © HL7 2003

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 © HL7 2003

Functional profiles © HL7 2003

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 © HL7 2003

Care setting profiles Institute of Medicine Agree standard care settings Minimal functionality required Express in EHR Functional Model Review functions Ballot functions © HL7 2003

Example functions Profiles Care delivery functions Inpatient Outpatient Home Medication Administration Record Medication Administration Record Lifestyle Bed management Wellness Reminders Wellness Reminders Order Management Order Management Order Management Event Capture Event Capture Event Capture Event Capture Notes Notes Notes Notes Notes Notes Results Reporting Results Reporting Results Reporting Drug-Drug Interactions Drug-Drug Interactions Drug-Drug Interactions. Care delivery functions Demographic Management Demographic Management Security Security Security Security Security Security Security Security Standards Compliance Standards Compliance Infrastructure functions © HL7 2003

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 © HL7 2003

Profiles Profiles Care Delivery Functions Infrastructure functions Care Setting Profiles Use Profiles Care Delivery Functions Infrastructure functions © HL7 2003

Profiles Profiles Registered – Not in standard Part of Standard Registered – Not in standard “How-to” is part of Standard Care Setting Profiles Provider Profiles Vendor Profiles Professional Association Profiles Regulation Profiles Accreditation Profiles © HL7 2003

Use of Profiles Profiles Outpatient HIPAA Care Setting Profiles Provider Profiles Professional Association Profiles Regulation Profiles Vendor Profiles Outpatient Product X Oncologist Guideline HIPAA © HL7 2003

Use of the Model: Vendor Application profile Laboratory result management Domains Chronic disease Prompts and recalls ePrescribing © HL7 2003

Use of the Model: Provider Laboratory result management Application Profile 1 Application Profile 2 Provider profile Domains Chronic disease Prompts and recalls ePrescribing © HL7 2003

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 © HL7 2003

Project Work & Timeline © HL7 2003

Plan of Attack EHR Functions EHR Care Setting Profiles HL7 EHR SIG 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 © HL7 2003

Plan of Attack (cont.) EHR Registered Use Profile “How-to” Government: CMS, VA, FDA… Accreditation Providers, Practitioners Vendors Professional Societies Patients, consumers? © HL7 2003

Project Timeline… 21 July 23-24 July End July 1 August 1 September Ballot draft published - ready for meeting 23-24 July Open EHR SIG Meeting End July Ballot draft revised - ready to ballot 1 August Ballot opens 1 September Ballot closes © HL7 2003

Project Timeline… 8-12 September 2003 9-11 September 2003 HL7 Fall Working Group Meeting Memphis, Tennessee 9-11 September 2003 EHR SIG Meeting Reconciliation of ballot comments © HL7 2003

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) © HL7 2003

Linda Fischetti, RN Veterans Health Administration Linda.Fischetti@med.va.gov Gary Dickinson Per-Sé Technologies, Inc. gary.dickinson@per-se.com Sam Heard, MD OpenEHR, Australia sam.heard@bigpond.com Contacts

© 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 © HL7 2003

EHR SIG Work Plan Functional Perspectives, con’t Service Oriented Architecture functions Communication functions Interface functions Multimedia functions HL7 trigger events, messages, query/response In and outbound data streams © HL7 2003

EHR SIG Work Plan Functional Perspectives, con’t Reporting and notification functions Outbound data streams © HL7 2003

Functional dependencies © HL7 2003