1. Existing Service Specifications
VA D-1005 VA
1002AB

2. Agenda
Option Task 2: Identify and document requirements to expand, extend, and complete three existing service specifications
Services Overview
Reviews
Ordering Service
Unified Communication
Event Publication and Subscription
Summary and Next Steps

3. Services Overview

4. Ordering Service Overview
Ordering Service (ORD)
Service Functional Model (SFM) for ordering pharmacy, laboratory, radiology, consult, and nutritional services
Identifying orderable items
Create/modify orders
Role-based and appropriate access control
Common governance and orchestration
Extends ordering to Clinical Decision Support (CDS), workflow
Enables exchange of order sets and plans

5. Unified Communications Overview
Unified Communications Service (UCS)
SFM for delivering alerts, recommendations, and other notifications including , Short Message Service (SMS), and Voice Over Internet Protocol (VOIP)
Focus is on communications consumed by human actors
Key concepts
Dynamic routing—redirect messages via alternate delivery channels
Escalation—identifying alternate
Conversations—common topic or subject for messages that may span communication channels
Unmonitored—metadata (addresses, time) are archived, not content
Monitored—metadata and content are archived

6. Event Publication and Subscription Overview
Event Publication and Subscription (EPS)
SFM for services, components, and systems to subscribe to clinical events of interest and receive notice when new data are available
Defines concepts of topics, publication, and subscription
Additional capabilities
Content intervention—active intervention during
Publication of event data
Delivery to a specific subscriber
Content brokering—acting as intermediary
Managing content requests where original material is not made public
Negotiation of preferred format

7. Health IT Services Reference Architecture
These specifications are part of the Health IT Services Reference Architecture, a landscape of services supporting a health environment.

8. Health IT Services Reference Architecture
The Healthcare Services Specification Program (HSSP) is a virtual organization that joins Health Level 7 International (HL7) and the Object Management Group (OMG) .

9. Current State Policy, Business Drivers Requirements
Information Models (HL7) 
SFM (HL7) Standard for Trial Use (STU)  ORD, UCS, EPS
OMG  ORD
Request for Proposals (RFP) (OMG) 
Technical Specifications (OMG, Submitters) 
Profiles 

10. Review Process

11. DSTU Review Process Assembled a cross-disciplinary team
Clinical
Software architecture
Software development
Reviewed each Draft Standard for Trial Use (DSTU) specification
Group discussion of interfaces
Identification of issues
Collection of written feedback
Feedback collated and prioritized
Detailed feedback and recommendations in white paper
Sample presented today
We assembled a cross-disciplinary team including representatives from the clinical, software architecture, and software development domains. This team reviewed each DSTU specification, including group discussions, identification of issues, and collection of feedback, which was then collated and prioritized. This feedback appears in the Existing Services Specification Review whitepaper we delivered last week. For this presentation, I will summarize the feedback by pulling a few examples for each service.

12. ORDERING SERVICE

13. Recommendations (ORD)
Order Service Catalog Interface
Interface described is limited
Recommend expansion of use cases
Clarify substitution use case
Terminology-driven lookups
Other Recommendations (30)
Clarify UCS and EPS interactions and relationships
Expand and clarify interactions with Computerized Physician Order Entry (CPOE)
Expand discussion on reproducible workflow in the Executive Summary
Implement editorial corrections

14. Unified Communications

15. Recommendations (UCS)
Business Storyboards
Expand discussion of priority and delivery order; and expand storyboards (currently only two storyboards mention priority)
Client Interface
Blind carbon copy not addressed in client interfaces; develop additional use cases to clarify this functionality
Common Message Concepts
Expand priority field discussion; and add distinction between priority, delivery order, and effort
Other Recommendations (16)
Implement editorial corrections

16. Event Publication and Subscription

17. Event Publication and Subscription (EPS)
Overall
Review use of terms “event,” “message,” “topic,” and “channel”— recommend providing definitions that consider well-established semantics of these terms from other systems
Service Description and Purpose
Mentions parallel processing to enhance performance, many bus architectures and systems solve this issue—consider revising with unique benefit feature for healthcare
Other Recommendations (91)
Define standardized data packages
Reconsider service name due to overlap with other OMG areas
Implement editorial corrections

18. Summary and Next Steps

19. Summary Conducted a detailed review of the three specifications
ORD
UCS
EPS
Results
Primarily minor improvement recommendations
Clarify or expand use cases
Add more use cases
Implement editorial corrections throughout text and figures
Recommend cross-cutting services (e.g., workflow) not be defined in each service

20. Next Steps Implement editorial recommendations
Workgroup to consider and possibly implement other recommendations
Continue standardization process for all three services
Extend STU period for ORD, UCS, EPS
Initial submission to OMG for the ORD service in progress for December meeting
Standard for Trial Use (formerly Draft Standard for Trial Use)

21. Questions
Questions?

22. Technical Specification
HL7 and OMG
HL7
HL7 SOA SIG
SFM
OMG
Requirements
HL7 DSTU
OMG HDTF
OMG RFP
ANSI Standard
RFP Responders
SOA—Service Oriented Architecture
SIG—Special Interest Group
SFM—Service Functional Model
DSTU—Draft Standard for Trial Use (Note: This term is now called STU, Standard for Trial Use.)
ANSI—American National Standards Institute
OMG—Object Management Group
HDTF—Healthcare Data Task Force
RFP—Request for Proposal
Technical Specification
Lessons Learned