1. NIEM Healthcare Domain FHIM/S&I Framework Strategy 4/7/2011

2. Background Focus of Study – NIEM Healthcare Domain Strategy to Integrate Healthcare Standards and Technologies with the National Information Exchange Model (NIEM). – From Modeling perspective – From IEPD perspective – Tool Requirements FHIM and S&I Framework – How they potentially fit in Audience ONC Decision Makers, Information Modelers, and Architects Anyone Interested in NIEM and Healthcare Recommendations for way forward Authors: John McKim, Monica Morris Lead by Steve Wagner and Anand Basu Output – Whitepaper – details of what is contained in this presentation – This Presentation Interactions and Resources – Discussions with PMO – Justin Stekervetz (Justin.Stekervetz@dhs.gov>)Justin.Stekervetz@dhs.gov – Discussions with John Quinn and others at HL7 – Discussion with NIEM Modelers (USCIS)

3. Dimensions of the Study Business Case – what are objectives, payback, and costs for ONC to integrate with NIEM from a business perspective? Model Integration – Is it technically feasible and if so, what are the classes/types that would make up the NIEM Healthcare Domain, including their structure within the domain, and how would they be integrated with the current NIEM model? IEPD Integration – Is there value in using the IEPD approach and if so, what is the best approach to integrate FHIM/S&I Framework models and processes with the NIEM IEPD Repository and IEPD Life Cycle? Conformance – what does it mean for models and schemas to be either NIEM conformant or support NIEM conformance with respect to the IEPD process and the schemas themselves? Tool Integration – defines how ONC tooling would need to integrated with the model and IEPD process through conformance to the NIEM Tooling Architecture. FHIM and the S&I Framework Utilization to support the creation and maintenance of a Healthcare Domain within NIEM.

4. The Business Case for NIEM Integration Benefits to the Healthcare Community – Expanding the Use and Reach of Healthcare Data – Potential Use of IEPD Process – Potential to Address PCAST Report Issues and Suggested Way Forward Universal Exchange Language, Finer Granularity, Metadata Benefits to the NIEM Community – Healthcare Types and Schemas – MDHT Disadvantages – Potentially Expensive – Expansion of MDHT – Model Mismatch – Significant Effort Needed Recommendations and Findings – Benefits Far Outweigh Disadvantages – Potential Additional Analysis, especially in Model Integration Area.

5. Healthcare/NIEM Model Integration (Model Mismatch) Healthcare Models (FHIM/S&I Framework) – Based on UML and MDA – MDHT/CDA Consolidation/Constraining RIM Classes – Separated into Healthcare Domains Labs, Pharmacy, Security and Privacy, Problems, Allergies, Orders, etc. – HL7 RIM: Only Representation of Foundation Classes – Messaging and Documentation: HL7 V2, V3, CDA NIEM – Conceptual Model is in RDF – NIEM Core: Foundation Classes (Represented in XML Schema) – IEPD Process Not Model Driven NIEM Compliant Tools – Messaging and Documentation Document defined by nc:Document Messaging Behavior – defined in IEPD

6. NIEM Core Health Care NIEM Healthcare Domain Managed Independently Of NIEM Core by ONC Composed of -NIEM Healthcare Core Subdomain -NIEM Health Subdomains - Extends NIEM Core

7. Proposed Approach for NIEM Healthcare Domain NIEM Healthcare Core Subdomain NIEM Core 3 Potential Approaches NIEM Healthcare Lab Subdomain NIEM Healthcare Pharmacy Subdomain NIEM Healthcare Problem Subdomain...... FHIM Domains FHIM Developed Potentially 100 or More Subdomains Extends/ Augments Extends/ Augments

8. Healthcare/NIEM Model Integration (continued) Development of NIEM Healthcare Domain – Managed by ONC – Contains NIEM Healthcare Core Subdomain Basic Healthcare Types Extends NIEM Core Types – Contains NIEM Healthcare Subdomains Labs, Pharmacy, Security and Privacy, Problems, Allergies, Orders, etc. Potential Approaches to NIEM Healthcare Core – Develop New Foundation Classes from Scratch More tightly integrated with NIEM – Use HL7 RIM/Data types with NIEM ITS Legacy Approach Dependent on HL7 ITS – Hybrid approach – Extend/Modify HL7 RIM Keep same HL7 Types, Add New Types, Closer NIEM Integration than ITS. Approaches to Extending NIEM Types – Create New Types by extending NIEM Core hcc:HealthCarePerson would extend nc:Person – Extend NIEM Classes with new data – Augmentation Augment nc:Person with additional data NIEM and CDA Documents – Extend nc:DocumentType – Map CDA types to nc:DocumentType Properties

9. Healthcare/NIEM Model Integration Recommendations NIEM Healthcare Core – 2 Concurrent Efforts New Foundation Classes Harmonized with HL7 RIM and NIEM – PCAST Aware HL7 RIM ITS (Legacy Core) Utilization of NIEM UML Profile NIEM Model in UML MDHT Modifications – Automated Conformance Checking Utilize NIEM RDF Models – Extend for RDF/OWL – Express Healthcare Domain in RDF – Utilized by MDHT Tools – NIEM Will work with us on this effort

10. Proposed Approach for IEPD Integration S&I Framework IEP Workgroups Health Care Core NIEM Core Labs Phar macy FHIM UML Modeling Lab Result Healthcare Types MDHT Tools (enhanced) ONC NIEM Healthcare Domain NIEM IEPD Repository ONC Governance Board Other IEP Workgroups

11. IEPD Integration Strategy Preliminaries – FHIM Develops Healthcare Subdomains – ONC Creates Local IEPD Repository – ONC Creates NIEM Healthcare Governance Body – MDHT Implements NIEM Tool Architecture Scenario Planning – Use Cases, Business Context – S&I Framework IEP Groups, Facilitate Workgroups – MDHT Support, Repository Interfaces Analyze Requirements – Create UML Model with NIEM UML Profile – S&I Framework IEP Groups Works with FHIM Group – Work with FHIM to Extend/Modify Health Core Types – MDHT Extended to work with ONC IEPD Repository

12. IEPD Integration Strategy (Cont) Map and Model – mapping to core types – S&I IEP Groups – Mapping Tables – MDHT Tools Automates Process Apply Constraints Building and Validating – MDHT Tools Automates Process Schema Development (Reference, Constraint, Extension) MDHT Repository Interfaces Assembling and Documenting (prepares IEPD) – MDHT Tools Automates Process Publishing and Implementing – MDHT Repository Integration

13. NIEM Conformance Conformance – NIEM XML Schemas conform to the NIEM Naming and Design Rules (NDR). – NIEM XML Instances conform by validating to the Schemas – NIEM IEPDs conform to the IEPD Specification Strategy – Healthcare Core classes extended/integrated with NIEM Core Types, Activities, Roles, Associations – MDHT Tools would generate NIEM compliant XML Schemas. – MDHT Tools would Enforce NDR Conformance

14. Tools Integration MDHT Tools – Implements NIEM Tooling Architecture Interfaces User, System, IEPD, Import/Export, etc. – Integrates with NIEM Repositories – NIEM UML Profile – NIEM Core in UML – Utilize RDF/OWL Strategy – MDHT Tools implements NIEM Tooling Architecture

15. FHIM, MDHT Tools, and S&I Framework FHIM – Creates Healthcare Domain S&I Framework – IEP Development MDHT Tools – Supports all Activities – Model Driven – Integrated with IEPD Repository and Processes FHIM, MDHT Tools, and S&I Framework

16. Whitepaper Recommendations Benefits Outweigh Costs of NIEM Integration FHIM Develops Healthcare Domain – Work with HL7 – Develop New Foundational Classes S&I Framework Develops IEPs MDHT Enhancements – NIEM Aware – NIEM Tool Architecture Interfaces RDF/OWL/UML Modeling – Compatible with NIEM Conceptual Model