1. Health eDecisions RI/ Pilots Sub-Workgroup April 29th, 2013 10/11/20111

2. Agenda Announcements Review and Revisit of Goals Review of RI/Pilot Sub-WG Timeline “Show and Tell” – Victor Lee and the Vocab and Terminology Work CDC Pilot Updates: AllScripts and NewMentor (Million Hearts – MU NQF 68) IG updates Vocab Updates VA and Wolters Kluwer IG Updates Vocab Updates CDC and Practice Fusion IG Updates Vocab Updates vMR updates – Aziz and Shu Review Support tools Review Action Items, Next Steps

3. Announcements We will be continuing our work … Next meeting May 6th, 2013 (plan for a 90 minute meeting) Continue to work on pilot activities –Pilot updates –Working Sessions 10/11/20113

4. Pilots 10/11/20114 OrganizationPilot LeadEmailOrganization’s Role Wolters Kluwer HealthSue Johnson/Steve Claypool/Howard Strasberg/Christy May sjohnson@uptodate.com steve.claypool@wolterskluwer.com howard.strasberg@wolterskluwer.com christy.may@wolterskluwer.com Service Supplier/Artifact Supplier OpenCDSDavid Shieldsdavid.shields@opencds.orgService Supplier Zynx Health Claude Nanjo (primary) Bernadette Minton Victor Lee CNanjo@zynx.comCNanjo@zynx.com (primary) bminton@zynx.com bminton@zynx.com VLee@zynx.com Service Supplier/Artifact Supplier Medexter Healthcare Klaus-Peter Adlassnig Karsten Fehre kpa@medexter.com kf@medexter.com Service Supplier newMentor Julie Scherer Matt Pfeffer jscherer@newmentor.com mpfeffer@newmentor.com Service Supplier/Artifact Supplier CDC Shu McGarvey Laura Conn aky1@cdc.gov lbk1@cdc.govGovernment /Service Supplier/Artifact Supplier NextGen Dr. Sarah Corley Dr. Jeff Friedlin Gary Wietecha scorley@nextgen.comscorley@nextgen.com, jfriedlin@nextgen.com,jfriedlin@nextgen.com Gwietecha@nextgen.com EHR Vendor Practice Fusion Lauren Fifield Michael Poremba lfifield@practicefusion.com mporemba@practicefusion.com EHR Vendor AllScripts Douglas Gentile Robin Williams (primary) Douglas.Gentile@allscripts.com Robin.Williams3@allscripts.comRobin.Williams3@allscripts.com (primary)EHR Vendor Design ClinicalsDewy Howelldeweyhowell@designclinicals.comEHR Vendor SuccessEHSClaude Ouimet claudeo@successehs.com EHR Vendor Applied PathwaysPaul Arnonepaul.arnone@appliedpathways.comService Supplier

5. Support Team Support Team: Pilots Lead: Jamie Parker: jamie.parker@esacinc.comjamie.parker@esacinc.com Pilot Support: Christina Arenas: christina.arenas@esacinc.comchristina.arenas@esacinc.com Subject Matter Expert: Aziz Boxwala: aziz.boxwala@meliorix.comaziz.boxwala@meliorix.com Subject Matter Expert: Bryn Rhodes: bryn@veracitysolutions.combryn@veracitysolutions.com Use Case 1: Dave Shevlin: d.s.shevlin@accenturefederal.comd.s.shevlin@accenturefederal.com Implementation Guide: Lynette Elliot: lynettte.elliott@esacinc.comlynettte.elliott@esacinc.com SDO Support: Anna Langhans: anna.langhans@accenture.comanna.langhans@accenture.com 10/11/20115

6. HeD Pilots Goal Goal The goal of this initiative is to produce, consume and where feasible, execute implementable CDS interventions. 1.Event Condition Action Rules (ECA Rules) 2.Order Sets 3.Documentation Templates Pilot Scope 1.Health eDecisions will apply defined aspects of the Implementation Guide in a real-world setting. 2.Modify the Implementation Guide to ensure it is usable 3.Submission of explicit feedback to sub workgroups such as vMR and vocabulary and terminology to close gaps 4.The real-world pilots evaluate not only the technology, standards and model (VMR), but also provide a test bed to evaluate the interaction of technology, implementation support, and operational infrastructure required to meet Health eDecisions use case 1 objectives at the stakeholder or organization levels. 5.Demonstrate intent of artifact (specifically structures and semantics) are communicated either by direct execution or by translation to native format 6.Ensure Completeness and consumability of artifact

7. Timeline 10/11/20117 Goal & Activities EST. Time DatesDeliverables Kickoff /Establish Goals & Partnerships: - Review HeD Initiative Goals - Review Piloting Process & Resources - Define Value Statement - Define HeD Pilot Goals & Success Metrics - Establish & Approve Pilots - Develop Pilot Briefs 4 wks. (reality 5 weeks) 1/07-2/25 (we missed 2 meetings in January pushing our Dates back) -Wiki Capturing Pilot Deliverables -Established Partnerships -Documented Value Statements and Success Metrics -Documented Pilot Briefs Pilot Configuration: - Establish Pilot Test Environment & Resources - Establish Pilot Implementation & Testing Process - Develop & Review Pilot Configuration 2 wks. (reality- 4 weeks) 2/25-3/25 -Use Case is Updated with HL7 Comments (3/4) -Approved Pilot Briefs -Committed Pilot Resources -Documented & Reviewed Pilot Configuration Guide -Weekly Feedback on Use-Cases & IG Alignment Pilot Development : - Setup & Develop Pilot Prototypes - Review prototypes 6 wks. or less depending on Pilot activity 3/25 – 5/6 -Use Case is Updated with HL7 Comments (3/4) -Weekly Pilot Development Status Updates -Weekly Feedback on Use-Cases & IG Alignment -Updates to Pilot Configuration Guides Pilot Testing & Showcase : - Complete Testing - Prepare Solution Showcase 2wks5/6 -5/20-Weekly Pilot Testing Updates & KPIs -Showcase -Prepare for HL7 Pilot Wrap-up : - Develop Lessons Learned an ONC Feedback - Review Initiative Goal Alignment - Establish Next-Steps 2 wks.5/20 – 6/3-Documented ONC Feedback - Next Steps Action Plan We are Here

8. Vocabulary and Terminology Show and Tell Victor Lee – Zynx Member of the Vocabulary and Terminology Team 10/11/20118

9. Vendor Engagement Discussion 10/11/20119 EHRArea of InterestPotential Match Design ClinicalsOrder SetsZynx AllScriptsECA Rules –NQMF Rule (for Ambulatory Setting) NewMentor (have catalog for rules in ambulatory setting) Practice FusionAnything MU centered CDC Success EHS?? Next GenECA Rule (potential)? VADocumentation Template Wolters Kluwer

10. Pilot Updates: NewMentor – AllScripts (ECA Rule Million Hearts –NQF 68) Team: Julie Scherer - NewMentor Bryn Rhodes – Internal Support Robin Williams – AllScripts Notes on the IG Notes on the Vocab Work 10/11/201110

11. Pilot Updates: Wolters Kluwer – VA (Documentation Template) Team: Christy May -Wolters Kluwer ???? – Internal Ken Kawamoto - VA Notes on the IG Notes on the Vocab and Terminology Work 10/11/201111

12. Pilot Updates: Zynx – DesignClinicals (Order Set- Heart Failure ) Team: Claude Nanjo and Victor Lee Zynx ???? – Internal Support Dewy Howell – DesignClinicals Notes on the IG Notes on the Vocab and Terminology Work 10/11/201112

13. Pilot Update: CDC – Practice Fusion (ECA Rule) TEAM: Shu McGarvey - CDC Aziz Boxwala – Internal Support Jamie Parker– Standing in for Practice Fusion Notes on the IG Notes on the Vocab Work Updates to the vMR – (based on converting the rule from HQMF to HeD and the needs of the CDC) We will be meeting with the CDS WG on Wednesday to update them on this work 10/11/201113

14. Pilot Support Tools and Feedback channels Discussion Board: http://wiki.siframework.or g/HeD+Pilot+Activities#H eD_Pilot_Discussionhttp://wiki.siframework.or g/HeD+Pilot+Activities#H eD_Pilot_Discussion Vocabulary and Terminology Feedback: http://wiki.siframework.or g/HeD+Pilot+Toolshttp://wiki.siframework.or g/HeD+Pilot+Tools 10/11/201114

15. Action Items & Next Steps Continue to monitor timeline Continue pilot work Going forward each pilot group will be giving a report out at each meeting As needed and necessary we will be discussing issues and challenges during the pilot activities Update the IG Update the Vocabulary and Terminology work Identify additional support resources if necessary

16. Meeting Reminder Pilots Work stream meets (next meeting: May 6th, 2013) Every Monday 1-2:30 pm EDT See Wiki homepage for meeting details: http://wiki.siframework.org/Health+eDecisions+Homepage http://wiki.siframework.org/Health+eDecisions+Homepage 10/11/201116

17. Appendix A: Success Criteria NOTE: This is a work –in-progress we will need to re-evaluate this after Pilot Project Plans Discuss Pilot Success Criteria: Individual Criteria Initiative Criteria EHR Involvement - DONE Production (at least one of each artifact and consumption of those artifacts) –Addressed as part of the Pilot Project Plans (who will be doing which artifacts) Successful implementation of artifacts –EHR involvement »Validate artifact – perhaps Pilots focuses on this ? »Execute the artifact Cross initiative function »Potential Alignment with eDOC and esMD »SDC Alignment with MU 3 objective »10% knowledge based engine (align 402b) »ACTION ITEM: Review MU3 Criteria »Determine the delivery model we want to pilot External (i.e. cloud service) Assets are portable (can be run locally) Discuss this with the group 10/11/201117

18. Appendix B In Scope/Out of Scope 10/11/201118

19. Scope of Use Case 1 This Use Case defines the requirements to build a standard for the contents of CDS Knowledge artifacts. The use case focuses on the following artifact types: Event Condition Action (ECA) Rules, Order Sets, and Documentation Templates. To support this purpose the Use Case has one scenario: A CDS Knowledge Artifact Supplier makes computable CDS Knowledge Artifact available to CDS Artifact Integrator (From HeD Use Case: CDS Artifact Sharing) 10/11/201119

20. In Scope Standards to structure medical knowledge in a shareable and executable format for use in CDS In Scope Artifact Types (definitions for these artifact types can be found in Appendix A) –Event Condition Action Rules –Order Sets –Documentation Templates 10/11/201120

21. Out of Scope Tools: –Authoring tools, source “content” management. –Terminology server and mapping tools including management of concept coordination. –Semantic processing of text, including structured string processing and natural language processing. System Functions –Messaging Layer –Means of sharing –Security Authoring, creation and maintenance of clinical decision support knowledge Knowledge Repository Design Search and query mechanisms Implementation in systems User presentation, Transport layers Market factors: regulatory incentive/mandate, liability shield, IP shield (patent/licensing litigation), certification body, marketplace design, test procedures, FDA rules Clinical Decision Support Services (this will be covered in Use Case 2 CDS Guidance Services) CDS Content Development Activities, including the distribution and sharing of artifacts Context-Aware information retrieval (HL7 Information Button) – This will be covered in UC 2 (CDS Guidance) 10/11/201121

22. Pre and Post Conditions Pre-Conditions –CDS Artifact Supplier makes CDS artifacts available for search and consumption by CDS Artifact Integrators _ ACTION ITEMS (Clarify this –what is a precondition for this to be useful) –CDS Artifact integrator has the means to obtain the knowledge artifact from a CDS Repository (e.g. they have either browsed or queried the CDS Repository for available artifacts) –CDS Artifact Integrator Selects Artifacts of Interest to Use in their CDS System Post Conditions –The CDS Knowledge Artifact Supplier has sent the CDS Knowledge Artifact to the requesting CDS Artifact Integrator –CDS Artifact has been received by CDS Integrator and is available for processing –CDS Artifact is available for mapping, structural transformations and local adaptation –Strategy 10/11/2011 22 Decision: In the pilot activities we will not directly address these as part of our pilot. We will focus the pilot activities on those tasks which occur between the pre and post condition