Standards Analysis Summary vMR – Pros Designed for computability Compact Wire Format Aligned with HeD Efforts – Cons Limited Vendor Adoption thus far Represents an additional required format for EHRs – If vendors do choose or have the ability to consume HeD artifacts this may not be a con and may actually make it easier to consume the HeD work

Standards Analysis Summary (cont.) CDA (C-CDA & QRDA) – Pros Well specified for various use cases Established Vendor Basis Aligned with MU – Cons Difficult for computability Expensive wire format

Standards Analysis Conclusion Conclusion – Long-term goal is to ensure that there is a single, consistent model for patient information in a CDS exchange – Important to move towards that goal as much as possible, while still enabling bridges to that approach using current technology – Should provide a solution that allows flexibility, but still enables interoperability.

Solution Options Considered During HL7 CDS WG call (5/21) & Standards SWG Call (5/22) Option 1: Base implementation guidance on Functional Interaction Type – Guidance would be provided on individual functional interaction types the standard selected would vary for each type – Feedback: Would only be able to develop guidance on a few functional interaction types Too dependent on functional interaction types Would be difficult for implementers to build solutions for any scenarios or functional interaction types not included in the guidance Option 2: Provide mapping of HeD UC2 requirements to vMR, C-CDA and QRDA – High-level guidance would be included on how to translate mappings into implementation profiles along with a few example implementation profiles based on functional interaction types – Feedback: Guidance would not be specific enough to be “implementation ready” Allows for too much flexibility

Long-term Industry Need Foundational Model HeD UC2 Data Requirements vMR Future Standards? QRDAC-CDA Solution Option Presented during 5/23 All Hands Call Community Feedback from 5/23 All Hands Call: Outside of HeD UC2 scope Not feasible within HeD UC2 timeline In order to support multiple payload standards while still promoting interoperability, a solution that leverages a foundational model (ex. FHIM) was proposed to the community:

HeD UC2 Final Proposed Solution Based on feedback from all proposed solutions last week, the HeD Leadership Team is proposing the following solution: Create implementation guidance that leverages vMR as the base model but is aligned with C-CDA and QRDA (semantics, terminologies, and templates) to the highest extent possible. – Solution will be to update the vMR model to align with the semantics of C-CDA and QRDA to the extent possible and reasonable – vMR is a streamlined data model for CDS. This model is at a similar level of granularity to models such as Green CDA Pursue both SOAP and REST for the updated DSS IG for September 2013 – Based on pilots, a choice may be made between SOAP and REST We will utilize the Functional Interaction Types to guide the IG development – Use as building blocks of data that are coordinated to meet functional interaction types – Have a section in the IG having profiles that people vote on for different interaction types if we feel confident. If we don’t feel confident, then they will strictly be examples – Leverage pilots from UC1 for functional interaction types. Can start with Immunization Forecasting and Quality Measure Evaluation. See what feedback we get and if any other interaction types would be useful

Long-term Industry Need HeD UC2 Scope Potential future or parallel work Updated vMR Model HeD UC2 Data Requirements QRDA Semantics C-CDA Semantics HeD UC2 Final Proposed Solution The revised solution approach still aligns with the long-term industry need, but has been limited to a more manageable and Use Case-appropriate scope: Foundational Model (e.g. FHIM) Future Standards? QRDAC-CDA Harmonized vMR/QDM Model

Request Service: DSS Request Element Request Items Organizer/Container: vMR Request Item Payload: vMR Clinical Statement vMR Payload This approach would support vMR as the payload standard with mappings to CCDA and QRDA CDS Request

CDS Response HeD Schema/vMR Response Service: DSS Response Element Response Items Organizer/Container: Harmonized vMR/HeD Schema Response Item Payload: vMR Clinical Statements

HeD UC2 Guidance Subworkstream HeD UC2 Guidance Subworkstream vMR Extensions Subworkstream vMR Extensions Subworkstream vMR-QRDA-CCDA Alignment Subworkstream vMR-QRDA-CCDA Alignment Subworkstream DSS Subworkstream DSS Subworkstream IG and Standards Development Activities to support HeD UC2 Solution New Decision Support Service (DSS) IG Updated DSS Standard Updated vMR DAM Updated vMR XML IG Updated HeD UC1 IG DSS Profile for CDS Request with SOAP DSS Profile for CDS Response with SOAP DSS Profile for CDS Request with REST DSS Profile for CDS Response with REST vMR Container Profiles for Response & Request vMR guidance for request payload Semantics guidance, leveraging modified vMR DAM Examples based on functional interaction type Add in section detailing how DSS is intended to work with REST for general use Modify DSS to accommodate REST, as necessary Extend vMR with context (for request) and actions (for response) as specified in UC2 Modify vMR to align with QRDA & C-CDA semantics Align XML IG with updated vMR DAM as necessary Align HeD UC1 IG with updated vMR DAM as necessary HeD S/vMR guidance for response payload

Key Milestone Dates for September Ballot Administrative Deadlines: HL7 Notification of Intent to Ballot: July 7 HL7 Initial Content Deadline: July 14 – Need to determine whether a full draft of the IG can be ready and submitted through E2E review by July 14. – Need to have discussion on possible options for completing IG and conducting E2E review Content Deadlines: HeD End-to-End Review Period: July 1-July 11 HeD Consensus Review Period: July 18-July 24 HL7 Final Content Deadline: August 4 HL7 Examples Deadline: August 19 With this timeline, we have less than 5 weeks to complete our IG in preparation for the review process, and 10 weeks total before ballot materials are due, including ballot materials for related ballots (e.g. update to vMR standard). 11