1. © 2015 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Ensuring reusability between PHMR and C-CDA 09/25/2013 1 PHMR Harmonization

2. © 2015 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Use Cases PHMR data is communicated to an EHR System C-CDA documents can be exchanged between EHR Systems Providers may want to copy information from PHMR to a Consolidated CDA Document to communicate issues to other providers. Transfer of information from C-CDA documents to PHMR does not fit either the PHMR or C-CDA Use Case 09/25/2013 2

3. © 2015 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Current State Current specifications are not generally compatible  Creates challenge to reuse PHMR data in C-CDA exchange 09/25/2013 3 Consolidated Results Section Consolidated Results Organizer Consolidated Vital Signs Section Consolidated Vital Signs Organizer Consolidated Vital Signs Observation PHM Results Section PHM Results Organizer PHM Vital Signs Section PHM Vital Signs Organizer PHM Metric Numeric Observation PHM Metric Waveform Series Observation PHM Metric Coded Observation PHM Metric String Observation PHM Metric Enum Integer Observation PHM Metric Observation Consolidated Results Observation

4. © 2015 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Proposed State PHMR Templates derive from Consolidated CDA where necessary.  Allows direct reuse of PHMR content in CCDA  Reduces cognitive load on developers 09/25/2013 4 Consolidated Results Section Consolidated Results Organizer Consolidated Vital Signs Section Consolidated Vital Signs Organizer Consolidated Vital Signs Observation PHM Results Section PHM Results Organizer PHM Vital Signs Section PHM Vital Signs Organizer PHM Metric Numeric Observation PHM Metric Waveform Series Observation PHM Metric Coded Observation PHM Metric String Observation PHM Metric Enum Integer Observation PHM Metric Observation Consolidated Results Observation PHM Quantitative Measurement

5. © 2015 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Waveforms are Challenging Waveforms not compatible as defined:  C-CDA Vital Signs Observation Observation.classCode = 'OBS'  PHMR Waveform Observation Observation.classCode = 'OBSSER' 09/25/2013 5

6. © 2015 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Existing Waveform has problems Media is NOT a component the series, rather an alternative representation of it. PHM Measurement Waveform Observation should be an OBSCOR, not an OBS Period applies to all OBSCOR in OBSSER, not just one OBSCOR Cardinality issues = No way to report multiple correlated values (e.g., BP + HR) 09/25/2013 6 Metric Waveform Series Observation (OBSSER) Untitled (OBSCOR) Measurement Waveform Observation (OBS) Measurement Waveform Sample Period Observation (OBS) Untitled Observation Media (OBS) 0..* 1 1 1

7. © 2015 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. OBSSER and OBSCOR OBSSERobservation series Container for Correlated Observation Sequences sharing a common frame of reference. All Observations of the same cd must be comparable and relative to the common frame of reference. For example, a 3-channel ECG device records a 12-lead ECG in 4 steps (3 leads at a time). Each of the separate 3-channel recordings would be in their own "OBSCOR". And, all 4 OBSCOR would be contained in one OBSSER because all the times are relative to the same origin (beginning of the recording) and all the ECG signals were from a fixed set of electrodes. OBSCORcorrelated observation sequences Container for Observation Sequences (Observations whose values are contained in LIST<>'s) having values correlated with each other. Each contained Observation Sequence LIST<> must be the same length. Values in the LIST<>'s are correlated based on index. E.g. the values in position 2 in all the LIST<>'s are correlated. This is analogous to a table where each column is an Observation Sequence with a LIST<> of values, and each row in the table is a correlation between the columns. For example, a 12-lead ECG would contain 13 sequences: one sequence for time, and a sequence for each of the 12 leads. 09/25/2013 7

8. © 2015 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Proposed Waveform Structure Puts media at same level as series Corrects OBSCOR nesting Corrects Sample Period nesting Enables multiple value types Enables compatibility with Consolidated CDA 09/25/2013 8 Waveform Observation (OBS) Waveform Series Observation (OBSSER) Measurement Waveform Observation (OBSCOR) Measurement Waveform Sample Period Observation (OBS) Untitled Observation Media (OBS) 0..* 1 1 1..*