Docstoc

DoD EHR v7.0 HL7 EHR-S Profile Coding 040223GB

Document Sample
DoD EHR v7.0 HL7 EHR-S  Profile Coding 040223GB Powered By Docstoc
					 DoD EHR - For Public Distribution                                                        DoD EHR - HL7 EHR Mapping                                                                           HL7 EHR-S Profile Coding
HL7       HL7                        HL7                            HL7                                                    HL7                       HL7                                            DoD EHR            DoD EHR
EHR       EHR                        EHR                            EHR                                                    EHR                       EHR                                            Constrainable      Implementable
ID        Function                   Function                       Functional                                             Rationale                 Secondary                                      Functional Profile Functional Profile
          Name                       Statement                      Description                                                                      Citation                                       PRIORITY           REQUIRED
                                                                                                                                                                                                    CODING             CODING
                                                                                                                                                                                                    for Ambulatory - for Ambulatory -
                                                                                                                                                                                                    Outpatient       Outpatient
C         DIRECT CARE



C.1       Care Management



C.1.1.0   Health information                                                                                                                         ISO/TS 18308 Final Draft - Health
          capture, management, and                                                                                                                   Informatics - Requirements for an Electronic
          review                                                                                                                                     Health Record Architecture; ASTM E 1769
                                                                                                                                                     Standard Guide for Properties of Electronic
                                                                                                                                                     Health Records and Record Systems

C.1.1.1   Enable the provider to     Maintain and identify a single Key identifying information shall be stored for the Supports delivery of                                                        E-Essential       R-Required
          identify and locate a      patient record for each        patient record, and a lookup function shall use this effective healthcare,
          patient record             patient.                       information to uniquely identify the patient.        Improves efficiency,
                                                                                                                         Improves patient safety

C.1.1.2   Capture Patient            Capture demographic            Contact information including addresses and phone      Supports delivery of                                                     E-Essential       R-Required
          Demographics               information that is reportable numbers, as well as key demographic information        effective healthcare,
                                     and trackable over time.       such as date of birth, sex, and other information      Improves efficiency,
                                                                    should be stored for reporting purposes and the        Improves patient safety
                                                                    proper provision of care.
C.1.1.3   Manage Problem List        Create and maintain patient- A problem list may include, but is not limited to: •     Supports delivery of                                                     E-Essential       R-Required
                                     specific problem lists.        Chronic conditions, diagnoses, or symptoms • Visit-    effective healthcare,
                                                                    or stay-specific conditions, diagnoses, or symptoms    Improves efficiency,
                                                                    Problem lists must be managed over time, whether       Facilitates management
                                                                    over the course of a visit or stay or the life of a    of chronic conditions
                                                                    patient, allowing documentation of history
                                                                    information and tracking the changing character of
                                                                    the problem and its priority. All pertinent dates,
                                                                    including date noted, dates of any changes in
                                                                    problem specification or prioritization, and date of
                                                                    resolution, should be stored. The entire problem
                                                                    history for any problem in the list should be
                                                                    viewable.




 Version 7.0                                                                                               page 1 of 71                                                                     Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                      DoD EHR - HL7 EHR Mapping                                              HL7 EHR-S Profile Coding
HL7       HL7                      HL7                            HL7                                                   HL7                       HL7            DoD EHR            DoD EHR
EHR       EHR                      EHR                            EHR                                                   EHR                       EHR            Constrainable      Implementable
ID        Function                 Function                       Functional                                            Rationale                 Secondary      Functional Profile Functional Profile
          Name                     Statement                      Description                                                                     Citation       PRIORITY           REQUIRED
                                                                                                                                                                 CODING             CODING
                                                                                                                                                                 for Ambulatory - for Ambulatory -
                                                                                                                                                                 Outpatient       Outpatient
C.1.1.4   Manage Medication List   Create and maintain patient-   Medication lists must be managed over time,           Supports delivery of                     E-Essential       R-Required
                                   specific medication lists.     whether over the course of a visit or stay, or the    effective healthcare,
                                                                  lifetime of a patient. All pertinent dates, including Improves patient safety
                                                                  medication start, modification, and end dates,
                                                                  should be stored. The entire medication history for
                                                                  any medication should be viewable. Medication
                                                                  lists should not be limited to medication orders
                                                                  recorded in the EHR, but should also include
                                                                  patient-reported medications.

C.1.1.5   Manage Allergy List      Create and maintain patient-   Allergens should be uniquely identifiable whenever    Supports delivery of                     E-Essential       R-Required
                                   specific allergies and         possible. Allergen lists must be managed over time.   effective healthcare,
                                   reactions.                     All pertinent dates, including patient-reported       Improves efficiency,
                                                                  events, should be stored and the description of the   Facilitates management
                                                                  patient allergy should be modifiable over time. The   of chronic conditions,
                                                                  entire allergy history for any allergen should be     Facilitates self-health
                                                                  viewable.                                             management, Improves
                                                                                                                        patient safety


C.1.1.6   Manage Other Summary     Create and maintain patient-   Problem, medication, and allergy lists are examples   Supports delivery of                     E-Essential       R-Required
          Lists                    specific summary lists not     of summary lists. The EHR should enable the           effective healthcare,
                                   otherwise specified.           creation and maintenance of other types of patient    Improves efficiency,
                                                                  summary lists when appropriate for the patient or a   Facilitates management
                                                                  particular care setting.                              of chronic conditions,
                                                                                                                        Improves patient safety


C.1.1.7   Manage Patient History   Capture, review, and manage  Patient historical data related to previous medical     Supports delivery of                     E-Essential       R-Required
                                   medical, procedural, social, diagnoses, surgeries and other procedures               effective healthcare,
                                   and family history including performed on the patient, and relevant health           Facilitates management
                                   the capture of pertinent     conditions of family members should be captured.        of chronic conditions
                                   negative histories.          This data may take the form of a positive or a
                                                                negative such as: "The patient/family member has
                                                                had..." or "The patient/family member has not
                                                                had..."
C.1.1.8   Review chart summary     Make available a             A key feature of an electronic health record is its     Supports delivery of                     E-Essential       R-Required
                                   chronological, filterable,   ability to present, summarize, filter, and facilitate   effective healthcare,
                                   comprehensive review of the searching through the large amounts of data              Improves efficiency,
                                   patient's entire clinical    collected during the provision of patient care.         Facilitates management
                                   history, subject to          Much of this data is date or date-range specific and    of chronic conditions,
                                   confidentiality constraints. should be presented chronologically. Local              Improves patient safety
                                                                confidentiality rules that prohibit certain users of
                                                                the EHR from accessing certain patient information
                                                                must be supported.



 Version 7.0                                                                                             page 2 of 71                                         Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                           DoD EHR - HL7 EHR Mapping                                               HL7 EHR-S Profile Coding
HL7        HL7                         HL7                             HL7                                                    HL7                       HL7            DoD EHR            DoD EHR
EHR        EHR                         EHR                             EHR                                                    EHR                       EHR            Constrainable      Implementable
ID         Function                    Function                        Functional                                             Rationale                 Secondary      Functional Profile Functional Profile
           Name                        Statement                       Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
C.1.1.9    Capture Other Key Data      Capture, manage, and review     Key data may be captured using standardized code       Supports delivery of                     E-Essential        R-Required
                                       other key data not otherwise    sets or nomenclature, depending on the nature of       effective healthcare,
                                       specified and by a variety of   the data. Data may be entered by a variety of          Improves efficiency,
                                       caregivers.                     caregivers or other users, and the EHR should          Facilitates management
                                                                       maintain documentation of who entered data and         of chronic conditions,
                                                                       when.                                                  Improves patient safety


C.1.1.10   Capture and creation of     Create, addend, and             Clinical documents and notes may be created in a       Supports delivery of                     E-Essential        R-Required
           clinical documents and      authenticate transcribed or     narrative form, with or without using a template.      effective healthcare,
           notes                       directly-entered clinical       They may also be structured documents that result      Improves efficiency,
                                       documentation and notes.        in the capture of coded data. Each of these forms of   Facilitates management
                                                                       clinical documentation are important and               of chronic conditions,
                                                                       appropriate for different users and situations.        Improves patient safety


C.1.1.11   Capture external clinical   Capture clinical documents      Not all clinical documents and notes originate from    Supports delivery of                     E-Essential        R-Required
           documents                   and notes originating from      use of the EHR. Mechanisms for incorporating           effective healthcare,
                                       outside the EHR.                external clinical documentation and other clinically   Improves efficiency,
                                                                       relevant data should be available. Data                Facilitates management
                                                                       incorporated through these mechanisms should be        of chronic conditions,
                                                                       presented alongside natively captured                  Facilitates self-health
                                                                       documentation and notes wherever appropriate.          management, Improves
                                                                                                                              patient safety


C.1.1.12   Capture patient-provided Capture patient-provided           Patients may provide data for entry into the EHR or    Supports delivery of                     E-Essential        R-Required
           data                     data.                              be given a mechanism for entering this data            effective healthcare,
                                                                       directly. Patient-entered data should be viewable      Improves efficiency,
                                                                       and modifiable by the patient at a later time. Some    Facilitates management
                                                                       patient-entered data should be available for use by    of chronic conditions,
                                                                       care providers.                                        Facilitates self-health
                                                                                                                              management

C.1.1.13   Capture historical data     Capture and manage patient-     When first seen by a health care provider, patients    Supports delivery of                     EF-Essential Future R-Required
                                       reported or externally          typically bring with them clinical information from    effective healthcare,
                                       available patient clinical      past encounters. This and similar information must     Facilitates management
                                       history.                        be captured in the EHR and presented alongside         of chronic conditions,
                                                                       natively captured documentation and notes              Improves patient safety
                                                                       wherever appropriate.




 Version 7.0                                                                                                  page 3 of 71                                          Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                            DoD EHR - HL7 EHR Mapping                                                                            HL7 EHR-S Profile Coding
HL7       HL7                         HL7                               HL7                                                     HL7                       HL7                                            DoD EHR            DoD EHR
EHR       EHR                         EHR                               EHR                                                     EHR                       EHR                                            Constrainable      Implementable
ID        Function                    Function                          Functional                                              Rationale                 Secondary                                      Functional Profile Functional Profile
          Name                        Statement                         Description                                                                       Citation                                       PRIORITY           REQUIRED
                                                                                                                                                                                                         CODING             CODING
                                                                                                                                                                                                         for Ambulatory - for Ambulatory -
                                                                                                                                                                                                         Outpatient       Outpatient
C.1.2.0   Care Planning, Critical                                                                                                                         ISO/TS 18308 Final Draft - Health
          Paths, Protocols                                                                                                                                Informatics - Requirements for an Electronic
                                                                                                                                                          Health Record Architecture. (care plans);
                                                                                                                                                          HIMSS Electronic Health Record
                                                                                                                                                          Definitional Model June 2003 (protocols);
                                                                                                                                                          ASTM E 1769 Standard Guide for Properties
                                                                                                                                                          of Electronic Health Records and Record
                                                                                                                                                          Systems
C.1.2.1   Present clinical guidelines Present relevant information      Clinical guidelines may be site specific or industry-   Supports delivery of                                                     EF-Essential Future R-Required
                                      from knowledge resources to       wide standards. The ability to track                    effective healthcare,
                                      support data entry and clinical   implementation/approval dates, modifications and        Improves efficiency,
                                      documentation                     relevancy to specific domains or context should be      Facilitates management
                                                                        provided.                                               of chronic conditions,
                                                                                                                                Improves patient safety


C.1.3.0   Medication ordering and                                                                                                                         HIMSS Electronic Health Record
          management                                                                                                                                      Definitional Model June 2003
C.1.3.1   Enable medication           Create prescriptions or other     Different medication orders require different levels    Supports delivery of                                                     E-Essential        R-Required
          ordering                    medication orders with detail     and kinds of order detail, as do medication orders      effective healthcare,
                                      adequate for correct filling      placed in different situations. The EHR must            Improves efficiency,
                                      and administration by             support the correct level and kind of detail in each    Facilitates self-health
                                      pharmacy and clinical staff.      situation. Administration or patient instructions       management, Improves
                                                                        must be available for selection by the ordering         patient safety
                                                                        clinicians, or the ordering clinician must be
                                                                        facilitated in creating such instructions.
                                                                        Appropriate time stamps for all medication related
                                                                        activity must be generated.

C.1.3.2   Support medication          Provide information regarding When a clinician places an order for a medication, Supports delivery of                                                              E-Essential        R-Required
          formularies                 compliance of medication      that order may or may not comply with a formulary effective healthcare,
                                      orders with formularies.      specific to the patients location or insurance     Improves efficiency
                                                                    coverage. Whether the order complies with the
                                                                    formulary should be communicated to the ordering
                                                                    clinician at an appropriate point to allow the
                                                                    ordering clinician to decide whether to continue
                                                                    with the order. The EHR may also present
                                                                    formulary-compliant alternatives to the medication
                                                                    being ordered.




 Version 7.0                                                                                                    page 4 of 71                                                                     Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                         DoD EHR - HL7 EHR Mapping                                                                     HL7 EHR-S Profile Coding
HL7       HL7                        HL7                             HL7                                                     HL7                       HL7                                 DoD EHR            DoD EHR
EHR       EHR                        EHR                             EHR                                                     EHR                       EHR                                 Constrainable      Implementable
ID        Function                   Function                        Functional                                              Rationale                 Secondary                           Functional Profile Functional Profile
          Name                       Statement                       Description                                                                       Citation                            PRIORITY           REQUIRED
                                                                                                                                                                                           CODING             CODING
                                                                                                                                                                                           for Ambulatory - for Ambulatory -
                                                                                                                                                                                           Outpatient       Outpatient
C.1.3.3   Enable documentation of Present to appropriate             In a setting in which medication orders are to be       Supports delivery of                                          EF-Essential Future R-Required
          medication administration clinicians the medications       administered by a clinician rather than the patient     effective healthcare,
                                    that are to be administered to   him or herself, the EHR must provide the necessary      Improves efficiency,
                                    a patient and under what         information for these clinicians to do so. This         Improves patient safety
                                    circumstances and permit         includes presenting the list of medication orders
                                    documentation of                 that are to be administered, administration
                                    administration details.          instructions, times or other conditions of
                                                                     administration, dose and route, etc. Additionally,
                                                                     the clinician must be able to enter into the system
                                                                     information about what actually was or was not
                                                                     administered whether or not these facts conform
                                                                     with the medications as ordered. Appropriate time
                                                                     stamps for all medication related activity must be
                                                                     generated.
C.1.4.0   Orders, Referrals, and                                                                                                                       HIMSS Electronic Health Record
          Results Management                                                                                                                           Definitional Model June 2003
C.1.4.1   Enable ordering of         Submit diagnostic test orders For each orderable item, the appropriate detail and       Supports delivery of                                          E-Essential        R-Required
          diagnostic tests           based on specific care        instructions must be available for the ordering care      effective healthcare,
                                     provider input.               provider to complete. Orders for diagnostic tests         Improves efficiency,
                                                                   should be transmitted to the correct destination for      Improves patient safety
                                                                   completion or generate appropriate requisitions for
                                                                   communication to the relevant resulting agencies.

C.1.4.2   Enable placing of       Submit communicative or            The EHR should facilitate orders that are for the       Supports delivery of                                          O-Optional         M-Maybe
          communication and other administrative orders based        purposes of communication between care providers        effective healthcare,
          orders                  on specific care provider          rather than the performance of diagnostic tests or      Improves efficiency,
                                  input.                             the administration of medications.. Examples            Improves patient safety
                                                                     include orders to transfer a patient between units or
                                                                     to ambulate a patient. For each orderable item, the
                                                                     appropriate detail and instructions must be
                                                                     available for the ordering care provider to
                                                                     complete. Communication orders should be
                                                                     transmitted to the correct destination for
                                                                     completion.

C.1.4.3   Enable use of order sets   Provide order sets based on     Order sets allow a care provider to choose common       Supports delivery of                                          E-Essential        R-Required
                                     provider input or system        orders for a particular disease state or circumstance   effective healthcare,
                                     prompt.                         according to best practice or other criteria for        Improves efficiency,
                                                                     assembling the order set without having to generate     Facilitates management
                                                                     each order individually. The EHR may recommend          of chronic conditions,
                                                                     order sets in certain conditions or as the result of    Improves patient safety
                                                                     other clinical information being entered into the
                                                                     EHR. Or the order sets may simply be available for
                                                                     use by the ordering care provider.




 Version 7.0                                                                                                 page 5 of 71                                                               Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                          DoD EHR - HL7 EHR Mapping                                                                             HL7 EHR-S Profile Coding
HL7       HL7                       HL7                              HL7                                                      HL7                       HL7                                             DoD EHR            DoD EHR
EHR       EHR                       EHR                              EHR                                                      EHR                       EHR                                             Constrainable      Implementable
ID        Function                  Function                         Functional                                               Rationale                 Secondary                                       Functional Profile Functional Profile
          Name                      Statement                        Description                                                                        Citation                                        PRIORITY           REQUIRED
                                                                                                                                                                                                        CODING             CODING
                                                                                                                                                                                                        for Ambulatory - for Ambulatory -
                                                                                                                                                                                                        Outpatient       Outpatient
C.1.4.4   Enable ordering and       Enable the origination,          The EHR should allow the documentation and               Supports delivery of                                                      E-Essential        R-Required
          tracking of referrals     documentation and tracking       tracking of a referral from one care provider to         effective healthcare,
                                    of referrals between care        another, whether the referred to or referring            Improves efficiency,
                                    provider or care settings,       providers are internal or external to the healthcare     Facilitates management
                                    including clinical guidelines    organization using the EHR. Guidelines for               of chronic conditions
                                    and administrative details of    whether a particular referral for a particular patient
                                    the referral.                    is appropriate in a clinical context and with regard
                                                                     to administrative factors such as insurance should
                                                                     be provided to the care provider at the time the
                                                                     referral is created.

C.1.4.5   Route and manage results Route, manage and present         The EHR should present results of tests in an easily     Supports delivery of                                                      EF-Essential Future R-Required
                                   current and historical test       accessible manner and to any care providers who          effective healthcare,
                                   results to appropriate clinical   may need to access them. Flow sheets, graphs, or         Improves efficiency,
                                   personnel for review, filtering   other tools should be provided to allow care             Facilitates management
                                   and comparison.                   providers to view or uncover trends in test data         of chronic conditions,
                                                                     over time. In addition to making results viewable,       Facilitates self-health
                                                                     in many cases it is appropriate for the EHR to send      management, Improves
                                                                     results to appropriate care providers using an           patient safety
                                                                     electronic messaging systems, pagers, or other
                                                                     mechanism. Results may also be routed to patients
                                                                     electronically or in the form of a letter.

C.1.4.6   Enable the ordering of    Communicate with regulatory- While the EHR is not expected to fulfill the                 Supports delivery of                                                      EF-Essential Future R-Required
          blood products            approved Blood Bank            functional requirements of blood bank software, it         effective healthcare,
                                    software to provide needed     must interact with a blood bank system in the              Improves efficiency,
                                    information on blood usage     creation of orders for blood products and the              Improves patient safety
                                    and orders for blood products. documentation of use of blood products in the
                                                                   provision of care.
C.1.5.0   Consents and                                                                                                                                  American Dental Association Specification
          Authorizations                                                                                                                                No. 1000 for a Standard Clinical
                                                                                                                                                        Architecture for the Structure and Content of
                                                                                                                                                        an Electronic Health Record. (consent)

C.1.5.1   Manage consents and       Create, maintain, and verify     Treatment decisions are documented and include           Facilitates self-health                                                   EF-Essential Future R-Required
          authorizations            patient data and treatment       the extent of information, verification levels and       management, Improves
                                    decisions in the form of         exposition of treatment options. This                    patient safety
                                    consents and authorizations      documentation will ensure that decisions made at
                                                                     the discretion of the patient/family/responsible
                                                                     party govern the actual care that is delivered or
                                                                     withheld.




 Version 7.0                                                                                                  page 6 of 71                                                                      Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                  DoD EHR - HL7 EHR Mapping                                              HL7 EHR-S Profile Coding
HL7       HL7                       HL7                         HL7                                                 HL7                       HL7            DoD EHR            DoD EHR
EHR       EHR                       EHR                         EHR                                                 EHR                       EHR            Constrainable      Implementable
ID        Function                  Function                    Functional                                          Rationale                 Secondary      Functional Profile Functional Profile
          Name                      Statement                   Description                                                                   Citation       PRIORITY           REQUIRED
                                                                                                                                                             CODING             CODING
                                                                                                                                                             for Ambulatory - for Ambulatory -
                                                                                                                                                             Outpatient       Outpatient
C.1.5.2   Enable capture,           Capture, maintain and       The EHR should provide mechanisms for recording     Supports delivery of                     EF-Essential Future R-Required
          maintenance and access to provide access to patient   advanced directives, the date and circumstances     effective healthcare,
          patient advanced          advanced directives         under which the directives were received, and the   Facilitates self-health
          directives                                            location of any paper records of advanced           management, Improves
                                                                directives as appropriate.                          patient safety




 Version 7.0                                                                                         page 7 of 71                                         Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                        DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7       HL7                       HL7                             HL7                                                     HL7                       HL7            DoD EHR            DoD EHR
EHR       EHR                       EHR                             EHR                                                     EHR                       EHR            Constrainable      Implementable
ID        Function                  Function                        Functional                                              Rationale                 Secondary      Functional Profile Functional Profile
          Name                      Statement                       Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                     CODING             CODING
                                                                                                                                                                     for Ambulatory - for Ambulatory -
                                                                                                                                                                     Outpatient       Outpatient
C.2       Clinical Decision
          Support


C.2.1.0   Health information
          capture and review
C.2.1.1   Support for standard      Offer rule-based prompts to    When a clinician fills out an assessment, data           Supports delivery of                     EF-Essential Future R-Required
          assessments               support the adherence to       entered triggers the system to prompt the assessor       effective healthcare,
                                    practice guideline standards   to consider issues that would help assure a              improves patient safety
                                    at the point of information    complete/accurate assessment. A simple                   and efficiency, and
                                    capture.                       demographic value or presenting problem (or              facilitates management
                                                                   combination) could provide a template for data           of chronic conditions.
                                                                   gathering that represents best practice in this
                                                                   situation, e.g. Type II diabetic review, fall and 70+,
                                                                   rectal bleeding etc. As another example, to
                                                                   appropriately manage the use of restraints, the EHR
                                                                   would provide an online alert defining the
                                                                   requirements for a behavioral health restraint when
                                                                   it is selected. -
C.2.1.2   Support for Patient       Offer rule-based prompts       When a clinician fills out an assessment, data           Supports delivery of                     EF-Essential Future R-Required
          Context-enabled           based on patient-specific data entered is matched against data already in the           effective healthcare,
          Assessments               at the point of information    system to identify potential linkages. For example,      improves patient safety
                                    capture.                       the system could scan the medication list and the        and efficiency, and
                                                                   knowledge base to see if any of the symptoms are         facilitates management
                                                                   side effects of medication already prescribed.           of chronic conditions
                                                                   Important but rare diagnoses could be brought to
                                                                   the doctor’s attention – for instance ectopic
                                                                   pregnancy in a woman of child bearing age who
                                                                   has abdominal pain.

C.2.1.3   Support for identifying   Identify anomalies and          When personal health information is collected           Supports delivery of                     EF-Essential Future R-Required
          anomalies or potential    potential problems, or other    directly during a patient visit input by the patient,   effective healthcare,
          problems                  patient "flags" and provide     or acquired from an external source (e.g. images,       improves patient safety
                                    prompts for consideration at    lab results), it is important to be able to identify    and efficiency, and
                                    the point of information        anomalies or potential problems that may be             facilitates management
                                    capture.                        patient-specific, given the individual's personal       of chronic conditions.
                                                                    health profile, or changes warranting further
                                                                    assessment. For example: significant trends (lab
                                                                    results, weight), reported problems (e.g. insomnia) -




 Version 7.0                                                                                                page 8 of 71                                          Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                             DoD EHR - HL7 EHR Mapping                                                                              HL7 EHR-S Profile Coding
HL7         HL7                         HL7                              HL7                                                     HL7                        HL7                                           DoD EHR            DoD EHR
EHR         EHR                         EHR                              EHR                                                     EHR                        EHR                                           Constrainable      Implementable
ID          Function                    Function                         Functional                                              Rationale                  Secondary                                     Functional Profile Functional Profile
            Name                        Statement                        Description                                                                        Citation                                      PRIORITY           REQUIRED
                                                                                                                                                                                                          CODING             CODING
                                                                                                                                                                                                          for Ambulatory - for Ambulatory -
                                                                                                                                                                                                          Outpatient       Outpatient
C.2.1.4     Patient and family          Capture patient and family       Decision support functions should permit                Improves patient safety Institute of Medicine (IOM). Committee on EF-Essential Future R-Required
            preferences                 preferences at the time of       consideration of patient/family preferences and         and facilitates self-   Health Care in America. Crossing the quality
                                        information intake and           concerns, such as with language, medication             health management.      chasm: A new health system for the 21st
                                        integrate them into clinical -   choice, invasive testing, and advanced directives.                              century. - National Academy Press: Institute
                                        decision support at all                                                                                          of Medicine. 2001. - Laine C, Davidoff F.
                                        appropriate opportunities.                                                                                       Patient-centered medicine. A professional -
                                                                                                                                                         evolution. JAMA 1996 Jan 10;275(2):152-6.

C.2.2.0     Care Planning, Critical
            Paths, Protocols
C.2.2.1     Support for disease based                                                                                                                       Payne TH. Computer Decision Support
            protocols (acute care)                                                                                                                          Systems. CHEST 2000; 118:47S-52S. - -
                                                                                                                                                            Hunt DL, Haynes RB, Hanna SE, Smith K.
                                                                                                                                                            Effects of computer-based clinical decision
                                                                                                                                                            support systems on physician performance
                                                                                                                                                            and patient outcomes: a systematic review.
                                                                                                                                                            JAMA 1998;280:1339-1346. -

C.2.2.1.1   Support for standardized    Identify the appropriate     At the time of the clinical encounter, the EHR will Supports delivery of                                                             EF-Essential Future R-Required
            disease based protocols     protocols for the management provide standard care protocols.                    effective healthcare and
                                        of specific diseases.                                                            improves efficiency.

C.2.2.1.2   Support for context         Identify the appropriate         At the time of the clinical encounter, the EHR will     Supports delivery of                                                     EF-Essential Future R-Required
            sensitive disease-based     protocols for the management     evaluate patient specific data and recommends           effective healthcare and
            protocols                   of specific diseases that are    tests, treatments, medications, immunizations,          improves efficiency.
                                        adjusted to the patient          referrals and evaluations based on a patient’s health
                                        specific profile.                profile.
C.2.2.1.3   Support for on-going        Identify appropriate             The EHR evaluates incoming changes in patient           Supports delivery of                                                     EF-Essential Future R-Required
            management                  modifications to the care plan   data, such as new lab results or medication orders      effective healthcare and
                                        in response to new clinical      and provides recommendations for tests,                 improves efficiency.
                                        data at the time and during      treatments, medications, immunizations, referrals
                                        the course of a clinical         and evaluations as appropriate.
                                        encounter.
C.2.2.1.4   Identification of           Identify deviations from the     The EHR evaluates instances where a chronic       Supports delivery of                                                           EF-Essential Future R-Required
            deviations from standard    standard protocols.              disease management protocol is not being followed effective healthcare and
            protocols                                                    and notifies the provider of such variances       improves efficiency.

C.2.2.2     Support for chronic                                                                                                                             Hunt DL, Haynes RB, Hanna SE, Smith K.
            disease protocols                                                                                                                               Effects of computer-based clinical decision
                                                                                                                                                            support systems on physician performance
                                                                                                                                                            and patient outcomes: a systematic review.
                                                                                                                                                            JAMA 1998;280:1339-1346. -




 Version 7.0                                                                                                     page 9 of 71                                                                       Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                         DoD EHR - HL7 EHR Mapping                                                                        HL7 EHR-S Profile Coding
HL7         HL7                        HL7                           HL7                                                 HL7                        HL7                                         DoD EHR               DoD EHR
EHR         EHR                        EHR                           EHR                                                 EHR                        EHR                                         Constrainable      Implementable
ID          Function                   Function                      Functional                                          Rationale                  Secondary                                   Functional Profile Functional Profile
            Name                       Statement                     Description                                                                    Citation                                    PRIORITY              REQUIRED
                                                                                                                                                                                                CODING                CODING
                                                                                                                                                                                                for Ambulatory - for Ambulatory -
                                                                                                                                                                                                Outpatient       Outpatient
C.2.2.2.1   Support for standard       Identify protocols for        At the time of the clinical encounter, the EHR       Supports delivery of                                                  EF-Essential Future R-Required
            chronic disease            standard chronic disease      provides a standard protocol for chronic disease     effective healthcare,
            management-based           management                    management. Examples include standard chronic        improves efficiency,
            protocols                                                disease order sets, link-outs to reference text.     and supports the
                                                                                                                          management of chronic
                                                                                                                          conditions.
C.2.2.2.2   Support for context        Identify patient specific     The EHR evaluates patient specific data and          Supports delivery of                                                  EF-Essential Future R-Required
            sensitive chronic disease chronic disease management recommends tests, treatments, medications,               effective healthcare,
            management                 recommendations.              immunizations, referrals and evaluations based on a improves efficiency,
                                                                     patient’s chronic disease history.                   and supports the
                                                                                                                          management of chronic
                                                                                                                          conditions.
C.2.2.2.3   Support for ongoing        Identify routine chronic      The EHR evaluates incoming changes in patient        Supports delivery of                                                  EF-Essential Future R-Required
            chronic disease            disease management            data, such as new lab results or medication orders effective healthcare,
            management                 recommendations based on      and provides recommendations for tests,              improves efficiency,
                                       changes in patient data.      treatments, medications, immunizations, referrals and supports the
                                                                     and evaluations.                                     management of chronic
                                                                                                                          conditions.
C.2.2.2.4   Support the identification Identify deviations from      The EHR evaluates instances where a chronic          Supports delivery of                                                  EF-Essential Future R-Required
            of deviations from chronic chronic disease management disease management protocol is not being followed effective healthcare,
            disease management         protocols.                    and notifies the provider of such variances          improves efficiency,
            protocols                                                                                                     and supports the
                                                                                                                          management of chronic
                                                                                                                          conditions.
C.2.2.3     Support for interactive    Provide the patient with      Patients with specific chronic diseases need to      Supports delivery of      Holman H, Lorig K. Patients as partners in      EF-Essential Future R-Required
            patient chronic disease    decision support for self-    follow self-management plans that may include        effective healthcare,     managing chronic disease. - Partnership is a
            management                 management of a chronic       schedules for home monitoring, lab tests, and        improves efficiency,      prerequisite for effective and efficient health
                                       condition in between patient- clinical check ups; recommendations about            supports the              care. BMJ - 2000 Feb 26;320(7234):526-7 -
                                       provider encounters.          nutrition, physical activity, tobacco use, etc.; and management of chronic     Lorig KR, Sobel DS, Stewart AL, Brown BW
                                                                     guidance or reminders about medications. The         conditions; and           Jr, Bandura A, Ritter P, Gonzalez VM,
                                                                     patient may be allowed to enter data and track       facilitates self-health   Laurent DD, Holman HR. Evidence
                                                                     progress, share data with the provider, or           management.               suggesting that a chronic disease self-
                                                                     communicate with the provider via secure                                       management program can improve health
                                                                     messaging.                                                                     status while reducing hospitalization: a
                                                                                                                                                    randomized trial. Med Care 1999 Jan;37(1):5-
                                                                                                                                                    14
C.2.3.0     Medications, medication
            management




 Version 7.0                                                                                               page 10 of 71                                                                  Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                             DoD EHR - HL7 EHR Mapping                                                                             HL7 EHR-S Profile Coding
HL7         HL7                          HL7                            HL7                                                      HL7                       HL7                                             DoD EHR            DoD EHR
EHR         EHR                          EHR                            EHR                                                      EHR                       EHR                                             Constrainable      Implementable
ID          Function                     Function                       Functional                                               Rationale                 Secondary                                       Functional Profile Functional Profile
            Name                         Statement                      Description                                                                        Citation                                        PRIORITY           REQUIRED
                                                                                                                                                                                                           CODING             CODING
                                                                                                                                                                                                           for Ambulatory - for Ambulatory -
                                                                                                                                                                                                           Outpatient       Outpatient
C.2.3.1     Support for medication                                                                                                                         Bates DW et al. Effect of computerized
            ordering                                                                                                                                       physician order entry and a team intervention
                                                                                                                                                           on prevention of serious medication errors.
                                                                                                                                                           JAMA 1998;280:1311-1316. - - Bates DW et
                                                                                                                                                           al. The impact of computerized physician
                                                                                                                                                           order entry on medication error prevention.
                                                                                                                                                           JAMIA 1999;6:313-321. - - Raschke RA et
                                                                                                                                                           al. A computer alert system to prevent injury
                                                                                                                                                           from adverse drug events. JAMA
                                                                                                                                                           1998;280:1317-1320. - - Chertow GM et al.
                                                                                                                                                           Guided Medication dosing for inpatients
                                                                                                                                                           with renal insufficiency. JAMA
                                                                                                                                                           2001;286:2839-2844. - - Evans RS et al. A
                                                                                                                                                           computer-assisted management program for
                                                                                                                                                           antibiotics and other anti-infective agents.
                                                                                                                                                           NEJM 1998; 338:232-238. - - Hunt DL,
                                                                                                                                                           Haynes RB, Hanna SE, Smith K. Effects of
                                                                                                                                                           computer-based clinical decision support
                                                                                                                                                           systems on physician performance and
                                                                                                                                                           patient outcomes: a systematic review.
                                                                                                                                                           JAMA 1998;280:1339-1346. - - Mekhjian
                                                                                                                                                           HS et al. Immediate benefits realized
                                                                                                                                                           following implementation of physician order
                                                                                                                                                           entry at an academic medical institution.
                                                                                                                                                           JAMIA 2002;9:529-539. -



C.2.3.1.1   Support for standard drug,   Identify drug-drug, drug-      The EHR provides basic drug-drug, drug-allergy,          Improves patient safety                                                   EF-Essential Future R-Required
            food, allergy and            allergy, drug-food, and        and drug-food interaction checking at levels             and efficiency and
            weight/age-based dosing      weight/age appropriate dose    appropriate to the health care entity. That is, a site   supports delivery of
            interaction checking         recommendations at the point   can choose which level of interaction checking to        effective healthcare.
                                         of medication ordering.        incorporate in the HER such as severe versus
                                                                        moderate.




 Version 7.0                                                                                                     page 11 of 71                                                                     Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                               DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7         HL7                          HL7                               HL7                                                     HL7                       HL7            DoD EHR            DoD EHR
EHR         EHR                          EHR                               EHR                                                     EHR                       EHR            Constrainable      Implementable
ID          Function                     Function                          Functional                                              Rationale                 Secondary      Functional Profile Functional Profile
            Name                         Statement                         Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                            CODING             CODING
                                                                                                                                                                            for Ambulatory - for Ambulatory -
                                                                                                                                                                            Outpatient       Outpatient
C.2.3.1.2   Other support for            Identify other potential issues   Additional areas of medication support include non- Improves patient safety                      E-Essential        R-Required
            medication ordering          at the point of prescribing.      drug interactions , patient preferences,              and efficiency and
                                         Provide suggested alternatives    contraindications specific to the individual (e.g.    supports delivery of
                                         for these other issues or for     pregnancy, occupation); The EHR would provide effective healthcare.
                                         standard medication issues as     alternatives as appropriate, such as a generic brand,
                                         appropriate Support               a different dosage, a different drug, or no drug
                                         medication administration         (“watchful waiting”). In addition, the EHR will
                                         management and workflow to        suggest lab order monitoring as appropriate. - -
                                         alert providers in real-time to
                                         potential administration
                                         errors such as wrong drug,
                                         wrong dose, wrong route,
                                         wrong time and patient.



C.2.3.2     Support for medication       Alert providers in real-time to   To reduce medication errors, when a provider            Improves patient safety                  EF-Essential Future R-Required
            administration.              potential administration          administers a medication, the EHR will support          and efficiency and
                                         errors such as wrong drug,        matching each medication and the patient’s ID           supports delivery of
                                         wrong dose, wrong route,          bracelet and alert the provider in real-time of         effective healthcare.
                                         wrong time and patient in         potential administration errors such as wrong drug,
                                         support of medication             wrong dose, wrong route, wrong time and patient.
                                         administration management         In addition, other clinical check, such as allergies,
                                         and workflow.                     drug-lab and drug-drug interactions can be
                                                                           performed at the time of administration.
                                                                           Documentation of the administration in the
                                                                           electronic MAR is a by-product of administering
                                                                           the medication. Administration details, as well as
                                                                           additional patient information such as injection
                                                                           site, vital signs, and pain assessments, is captured
                                                                           at the point of care, and automatically documented
                                                                           in the patient's electronic health record. In
                                                                           addition, access to online drug monograph
                                                                           information allows providers to check details about
                                                                           a drug and enhances patient education

C.2.4.0     Orders, Referrals, Results
            and Care Management




 Version 7.0                                                                                                      page 12 of 71                                          Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                          DoD EHR - HL7 EHR Mapping                                                                                HL7 EHR-S Profile Coding
HL7         HL7                     HL7                              HL7                                                      HL7                         HL7                                            DoD EHR            DoD EHR
EHR         EHR                     EHR                              EHR                                                      EHR                         EHR                                            Constrainable      Implementable
ID          Function                Function                         Functional                                               Rationale                   Secondary                                      Functional Profile Functional Profile
            Name                    Statement                        Description                                                                          Citation                                       PRIORITY           REQUIRED
                                                                                                                                                                                                         CODING             CODING
                                                                                                                                                                                                         for Ambulatory - for Ambulatory -
                                                                                                                                                                                                         Outpatient       Outpatient
C.2.4.1     Support for non-        Identify necessary order entry   Possible order entry components include, but are         Improves patient safety     Payne TH. Computer Decision Support           EF-Essential Future R-Required
            medication ordering     components for non-              not limited to: missing results required for the         and efficiency and          Systems. CHEST 2000; 118:47S-52S. - - -
                                    medication orders that make      order, suggested corollary orders, notification of       promotes the delivery of    Stair TO. Reduction of Redundant
                                    the order pertinent, relevant    duplicate orders, institution-specific order             effective healthcare.       Laboratory Orders by Access to
                                    and resource conservative at     guidelines, guideline-based orders/order sets, order                                 Computerized Patient Records. Computers in
                                    the time of provider order       sets, order reference text, patient diagnosis specific                               Emergency Medicine 1998;16:895-897. - -
                                    entry; and flag any              recommendations pertaining to the order. Also, to                                    Sanders DL, Miller RA. The effects on
                                    inappropriate orders based on    include flags for orders that may be inappropriate                                   clinician ordering patterns of a computerized
                                    patient profile. -               or contraindicated for specific patients (e.g. X-rays                                decision support system for neuroradiology
                                                                     for pregnant women). - -                                                             imaging studies. Proc AMIA Symp
                                                                                                                                                          2001;:583-587. - - Hunt DL, Haynes RB,
                                                                                                                                                          Hanna SE, Smith K. Effects of computer-
                                                                                                                                                          based clinical decision support systems on
                                                                                                                                                          physician performance and patient outcomes:
                                                                                                                                                          a systematic review. JAMA 1998;280:1339-
                                                                                                                                                          1346. - - Chin HL, Wallace P. Embedding
                                                                                                                                                          guidelines into direct physician order entry:
                                                                                                                                                          simple methods, powerful results. Proc
                                                                                                                                                          AMIA Symp 1999:;221-225.



C.2.4.2     Support for result      Support evaluation and           Examples of result interpretation include, but are       Improves patient safety,    Poom EG, Kuperman GJ, Fiskio J, Bates          EF-Essential Future R-Required
            interpretation          provider notification of         not limited to: abnormal result                          efficiency, and supports    DW. Real-time notification of laboratory
                                    results within the context of    evaluation/notification, trending of results (such as    the delivery of effective   data requested by users through
                                    the patient's clinical data.     discrete lab values), evaluation of pertinent results    healthcare.                 alphanumeric pagers. JAMIA 2002;9:217-
                                    SUGGEST: Evaluate results        at the time of provider order entry (such as                                         222. - - Kuperman GL et al. Improving
                                    and notify provider of results   evaluation of lab results at the time of ordering a                                  response to critical laboratory results with
                                    within the context of the        radiology exam), evaluation of incoming results                                      automation. JAMIA 1999;6:512-522. - -
                                    patient’s clinical data. -       against active medication orders. - -                                                Bates DW et al. Reducing the frequency of
                                                                                                                                                          errors in medicine using information
                                                                                                                                                          technology. JAMIA 2001;8(4):299-308. - -

C.2.4.3     Support for referrals
C.2.4.3.1   Support for referral    Evaluate referrals within the The EHR links appropriate data elements or lack             Supports delivery of                                                       EF-Essential Future R-Required
            orders                  context of a patient’s clinical thereof when a healthcare referral is                     effective healthcare,
                                    data. -                         generated/ordered, including pertinent results,           improves efficiency,
                                                                    demographic and insurance data elements, guiding          and facilitates
                                                                    the provider in placing the order. For example,           management of chronic
                                                                    when a urology referral is ordered for urinary            conditions.
                                                                    frequency (this could be captured in the order as a
                                                                    data element) the EHR evaluates recent lab results
                                                                    (like a U/A or urine culture) and advises to provider
                                                                    to do work-up for a basic UTI first before sending
                                                                    the referral.




 Version 7.0                                                                                                 page 13 of 71                                                                         Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                              DoD EHR - HL7 EHR Mapping                                                                            HL7 EHR-S Profile Coding
HL7         HL7                         HL7                               HL7                                                     HL7                        HL7                                         DoD EHR            DoD EHR
EHR         EHR                         EHR                               EHR                                                     EHR                        EHR                                         Constrainable      Implementable
ID          Function                    Function                          Functional                                              Rationale                  Secondary                                   Functional Profile Functional Profile
            Name                        Statement                         Description                                                                        Citation                                    PRIORITY           REQUIRED
                                                                                                                                                                                                         CODING             CODING
                                                                                                                                                                                                         for Ambulatory - for Ambulatory -
                                                                                                                                                                                                         Outpatient       Outpatient
C.2.4.3.2   Support for referral        Evaluate patient data and      For example, the EHR recommends a referral for             Supports delivery of                                                   O-Optional         M-Maybe
            recommendations             suggest appropriate referrals. smoking cessation if nicotine addiction is listed in       effective healthcare,
                                                                       the patient’s problem list or the patient is described     improves efficiency,
                                                                       as a “smoker” through documentation in the EHR,            and facilitates
                                                                       having evaluated the patient’s data for the presence       management of chronic
                                                                       of a prior smoking cessation referral order or the         conditions.
                                                                       actual referral documentation.

C.2.4.4     Support for Care Delivery

C.2.4.4.1   Support for safe blood      Alert providers in real-time to   To reduce blood administration errors, when a           Supports delivery of                                                   EF-Essential Future R-Required
            administration              potential blood administration    provider administers a blood product, the HER will      effective healthcare and
                                        errors such as wrong blood,       support matching each blood product and the             improves patient safety
                                        wrong cross match, wrong          patient’s ID bracelet and alert the provider in real-   and efficiency
                                        source, wrong date and time,      time of potential administration errors such as
                                        and wrong patient.                wrong product, wrong route, wrong time, and
                                                                          wrong patient. In addition, other clinical checks,
                                                                          such as allergy checking, can be performed at the
                                                                          time of administration. Documentation of the
                                                                          administration in the EHR is a by-product of
                                                                          administering the blood product.

C.2.4.4.2   Support for accurate        Alert providers in real-time to   To ensure the accuracy of specimen collection,          Supports delivery of                                                   EF-Essential Future R-Required
            specimen collection         potential specimen collection     when a provider obtains specimens from a patient,       effective healthcare and
                                        errors, such as wrong patient,    the EHR matches each specimen collection                improves patient safety
                                        wrong specimen type, wrong        identifiers and the patient’s ID bracelet and alerts    and efficiency
                                        collection means, and wrong       the provider in real-time of potential collection
                                        date and time.                    errors such as wrong patient, wrong specimen type,
                                                                          wrong means of collection, wrong site, and wrong
                                                                          date and time. Documentation of the collection in
                                                                          the EHR is a by-product of collecting the specimen.

C.2.5.0     Health Maintenance:
            Preventive Care and
            Wellness
C.2.5.1     Support for preventive      Identify patient specific         At the time of the patient-provider encounter, the      Supports the delivery of U.S. Preventive Services Task Force.          E-Essential        R-Required
            services and wellness       suggestions/reminders,            EHR provides protocols for preventive care and          effective healthcare and http://www.ahrq.gov/clinic/uspstfix.htm - -
                                        screening tests/exams, and        wellness. Examples include but are not limited to,      improves efficiency.     Reference: Hunt DL, et. al. Effects of
                                        other preventive services in      routine immunizations (adult and well baby care),                                Computer-based Clinical Decision Support
                                        support of routine preventive     age and sex appropriate screening exams (such as                                 on Physician Performance and Patient
                                        and wellness patient care         PAP smears).                                                                     Outcomes. JAMA.1998:280;1339-1346.
                                        standards.




 Version 7.0                                                                                                     page 14 of 71                                                                     Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                          DoD EHR - HL7 EHR Mapping                                                                          HL7 EHR-S Profile Coding
HL7       HL7                        HL7                             HL7                                                    HL7                        HL7                                         DoD EHR            DoD EHR
EHR       EHR                        EHR                             EHR                                                    EHR                        EHR                                         Constrainable      Implementable
ID        Function                   Function                        Functional                                             Rationale                  Secondary                                   Functional Profile Functional Profile
          Name                       Statement                       Description                                                                       Citation                                    PRIORITY           REQUIRED
                                                                                                                                                                                                   CODING             CODING
                                                                                                                                                                                                   for Ambulatory - for Ambulatory -
                                                                                                                                                                                                   Outpatient       Outpatient
C.2.5.2   Support for interactive    Notify the patient and/or       Examples include but are not limited to time           Supports the delivery of   U.S. Preventive Services Task Force.        E-Essential        R-Required
          reminders for preventive   appropriate provider of those   sensitive patient and provider notification of:        effective healthcare,      http://www.ahrq.gov/clinic/uspstfix.htm -
          services and wellness      preventive services, tests,     evaluation of patient preventive/wellness needs        improves efficiency;       Reference: Hunt DL, et. al. Effects of
                                     behavioral actions that are     based on past due dates for patient appointments,      and facilitates self-      Computer-based Clinical Decision Support
                                     due for patient in-between      labs, immunizations or exams; also appropriate         health management.         on Physician Performance and Patient
                                     patient-provider encounters.    reminders about lifestyle behaviors such as                                       Outcomes. JAMA.1998:280;1339-1346. - -
                                                                     nutrition, exercise, tobacco use. E.g. a Pap test
                                                                     reminder might be sent to the patient a couple of
                                                                     months prior to the test being due , at 3 month
                                                                     intervals, and then brought to the attention of the
                                                                     administrator or clinician 9 months after it is past
                                                                     due.
C.2.6.0   Supportive Functions
C.2.6.1   Support for              Collect environment and           Standardized surveillance performance measures        Supports the delivery of                                                EF-Essential Future R-Required
          environmental/population surveillance data captured at     that are based on known patterns of disease           effective healthcare and
          monitoring               the time of the patient-          presentation can be identified by aggregating data improves efficiency.
                                   provider encounter for use in     from multiple input mechanisms. Elements include,
                                   clinical state monitoring of      but are not limited to patient demographics,
                                   health risks from the             resource utilization, presenting symptoms, acute
                                   environment and/or                treatment regimens, laboratory and imaging study
                                   population.                       orders and results and genomic and proteomic data
                                                                     elements. Identification of known patterns of
                                                                     existing diseases involves aggregation and analysis
                                                                     of these data elements by existing relationships.
                                                                     However, the identification of new patterns of
                                                                     disease requires more sophisticated pattern
                                                                     recognition analysis. Early recognition of new
                                                                     patterns requires data points available early in the
                                                                     disease presentation. Demographics, ordering
                                                                     patterns and resource use (e.g., ventilator or
                                                                     intensive care utilization pattern changes) are often
                                                                     available earlier in the presentation of non-
                                                                     predictable diseases. Consumer-generated
                                                                     information is also valuable with respect to
                                                                     surveillance efforts.




 Version 7.0                                                                                                 page 15 of 71                                                                   Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                            DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7       HL7                        HL7                               HL7                                                    HL7                         HL7            DoD EHR            DoD EHR
EHR       EHR                        EHR                               EHR                                                    EHR                         EHR            Constrainable      Implementable
ID        Function                   Function                          Functional                                             Rationale                   Secondary      Functional Profile Functional Profile
          Name                       Statement                         Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                         CODING             CODING
                                                                                                                                                                         for Ambulatory - for Ambulatory -
                                                                                                                                                                         Outpatient       Outpatient
C.2.6.2   Support for notification   Alert providers and public        Automated notification is the process by which the Supports the delivery of                       EF-Essential Future R-Required
          and response               health officials with the         system alerts individual care providers or care         effective healthcare and
                                     appropriate level of              managers that an event has occurred and requires improves efficiency.
                                     notifications in the event of a   attention. This process gives a care provider the
                                     health risk.                      ability to determine individual preferences for
                                                                       notification with respect to any patient. The ability
                                                                       to subscribe at the time of ordering to individual
                                                                       data-specific preferences adds significant flexibility
                                                                       to the provider and/or care manager. Preferences
                                                                       for notification should be based on the type and
                                                                       urgency of data as well as the individual care
                                                                       provider's specific clinical privileges within the
                                                                       organization. For example, an elevation of HIV-1
                                                                       RNA viral load from 20,000 copies / ml might be
                                                                       best managed by the physician privileged to treat
                                                                       AIDS patients and therefore, notification with
                                                                       expectation of action is best sent to that individual.
                                                                       In this example, the Cardiology consultant may be
                                                                       able to subscribe to notification, but with the ability
                                                                       to consult an appropriately privileged physician.



C.2.6.3   Support for monitoring     Monitor if expected actions       Escalation has similar prerequisites as automated Supports the delivery of                        EF-Essential Future R-Required
          and escalation             have been taken in the event      notification. Of great importance to the escalation effective healthcare and
                                     of a health risk and              process is the ability to match a care provider’s     improves efficiency.
                                     subsequent notification and       clinical privileges with the clinical requirements of
                                     escalate notification if they     the escalation.
                                     have not. - If introductory
                                     clause needs to come first,
                                     OK. In the event of a health
                                     risk and the subsequent
                                     notification, monitor if
                                     expected actions have been
                                     taken, escalating notification
                                     if they have not.

C.2.6.4   Support for clinical       Provide evidence-based            Examples include but are not limited to: disease       Supports the delivery of                   EF-Essential Future R-Required
          guidance                   guideline-based information       specific protocols, care management protocols (fall    effective healthcare,
                                     and knowledge to the point of     management), and wellness management, as well          improves patient safety
                                     care for use in clinical          as context-specific links to other knowledge           and efficiency, and
                                     decisions and care planning       resources. For example, when a cough and blood         facilitates management
                                                                       stained sputum is noted, provider is directed to       of chronic conditions.
                                                                       relevant online information.




 Version 7.0                                                                                                  page 16 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                     DoD EHR - HL7 EHR Mapping                                                                          HL7 EHR-S Profile Coding
HL7       HL7                     HL7                           HL7                                                     HL7                        HL7                                       DoD EHR              DoD EHR
EHR       EHR                     EHR                           EHR                                                     EHR                        EHR                                       Constrainable      Implementable
ID        Function                Function                      Functional                                              Rationale                  Secondary                                 Functional Profile Functional Profile
          Name                    Statement                     Description                                                                        Citation                                  PRIORITY             REQUIRED
                                                                                                                                                                                             CODING               CODING
                                                                                                                                                                                             for Ambulatory - for Ambulatory -
                                                                                                                                                                                             Outpatient       Outpatient
C.2.6.5   Support for knowledge   Enable the accessibility of   An individual will be able to find reliable             Facilitates self-health    U.S. Department of Health and Human          EF-Essential Future R-Required
          access for patients     reliable information about    information to answer a health question, follow up      management and             Services, Healthy People 2010, Health
                                  wellness, disease             from a clinical visit, identify treatment options, or   supports the delivery of   Communication Focus Area. (USDHHS
                                  management, treatments, and   other health information needs. The information         effective healthcare.      2000)
                                  related information.          may be linked directly from entries in the PHR, or                                 http://www.healthypeople.gov/document/HT
                                                                may be accessed through other means such as key                                    ML/Volume1/11HealthCom.htm - ; Science
                                                                word searching.                                                                    Panel on Interactive Communication and
                                                                                                                                                   Health. Wired for Health and Well-Being:
                                                                                                                                                   the Emergence of Interactive Health
                                                                                                                                                   Communication. Washington, DC: US
                                                                                                                                                   Department of Health and Human Services,
                                                                                                                                                   US Government Printing Office, April 1999 .
                                                                                                                                                   http://www.health.gov/scipich/pubs/finalrepo
                                                                                                                                                   rt.htm




 Version 7.0                                                                                            page 17 of 71                                                                   Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                        DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7       HL7                      HL7                              HL7                                                      HL7                       HL7            DoD EHR            DoD EHR
EHR       EHR                      EHR                              EHR                                                      EHR                       EHR            Constrainable      Implementable
ID        Function                 Function                         Functional                                               Rationale                 Secondary      Functional Profile Functional Profile
          Name                     Statement                        Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                      CODING             CODING
                                                                                                                                                                      for Ambulatory - for Ambulatory -
                                                                                                                                                                      Outpatient       Outpatient
C.3       Operations,
          Management and
          Communication
C.3.1.0   Clinical Workflow        Manage tasks related to          Since the electronic health record will replace the      Support delivery of                      EF-Essential Future R-Required
          Tasking                  components of the electronic     paper chart, tasks that were based on the paper          effective healthcare;
                                   health record with appropriate   artifact must be effectively managed in the              improve patient safety;
                                   timeliness.                      electronic environment. A set of functions must          improve efficiency
                                                                    exist in the EHR-S to provide a way to
                                                                    accommodate electronically any workflow that
                                                                    previously depended on the existence of a physical
                                                                    artifact (such as the paper chart, a phone message
                                                                    slip) in a paper based system. Tasks differ from
                                                                    other more generic communication among
                                                                    participants in the care process because they are a
                                                                    call to action and target completion of a specific
                                                                    workflow in the context of a patient's health record
                                                                    (including a specific component of the record).
                                                                    Tasks also require disposition (final resolution) as a
                                                                    part of the direct care workflow and may not
                                                                    necessarily require a response back to the original
                                                                    sender like other forms of communication. For
                                                                    example, in a paper based system, physically
                                                                    placing charts in piles for processing creates a
                                                                    physical queue of tasks related to those charts. This
                                                                    queue of tasks (for example, a set of patient phone
                                                                    calls to be returned) shall be supported
                                                                    electronically so that the list (of patients to be
C.3.1.1   Linking of tasks with                                     Tasks is visible to must be linked to a patient or
                                   Linkage of tasks to a relevant called)in the EHR-Sthe appropriate user or role for        Support delivery of                      O-Optional         M-Maybe
          related medical record   part of the electronic health to a component of a patient's medical record. To            effective healthcare;
          entities                 record or to a specific patient. link a task to the related part of an electronic         improve patient safety;
                                                                    healthcare record, the EHR-S requires: a                 improve efficiency
                                                                    description of the task; the person (or person-role)
                                                                    expected to complete the task; and the data that is
                                                                    the subject of the task (an instance of a patient or
                                                                    component of the patient's medical record). An
                                                                    example of a well-defined task is "Nurse Johnson
                                                                    must report to Mrs. Smith that the strep test was
                                                                    negative." The EHR-S will facilitate efficient
                                                                    workflow by navigating to the appropriate area of
                                                                    the record to ensure that the appropriate test result
                                                                    for the correct patient is reviewed. Other examples
                                                                    of tasks might involve fulfillment of orders or
                                                                    responding to patient phone calls.




 Version 7.0                                                                                                page 18 of 71                                          Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                       DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7       HL7                      HL7                            HL7                                                      HL7                       HL7            DoD EHR            DoD EHR
EHR       EHR                      EHR                            EHR                                                      EHR                       EHR            Constrainable      Implementable
ID        Function                 Function                       Functional                                               Rationale                 Secondary      Functional Profile Functional Profile
          Name                     Statement                      Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                    CODING             CODING
                                                                                                                                                                    for Ambulatory - for Ambulatory -
                                                                                                                                                                    Outpatient       Outpatient
C.3.1.2   Clinical Task Routing    Assignment, delegation         Tasks must at all times be assigned to at least one      Support delivery of                      EF-Essential Future R-Required
                                   and/or transmission of tasks   user or role for disposition. Whether the task is        effective healthcare;
                                   to the appropriate parties.    assignable and to whom the task can be assigned          patient safety; improve
                                                                  will be determined by the specific needs of              efficiency
                                                                  practitioners in a care setting. Task-assignment lists
                                                                  help users prioritize and complete assigned tasks.
                                                                  For example, after receiving a phone call from a
                                                                  patient, the triage nurse routes or assigns a task to
                                                                  return the patient's call to the physician who is on
                                                                  call. This decision is made by a person involved in
                                                                  the care process and cannot be easily automated, so
                                                                  the EHR-S will allow, where appropriate, manual
                                                                  assignment of tasks or system triggered task
                                                                  creation and assignment. An example of a system
                                                                  triggered task is when lab results are received
                                                                  electronically, the EHR-S creates a task for
                                                                  clinician review automatically (without the need
                                                                  for human intervention). Task assignment ensures
                                                                  that all tasks are disposed of by the appropriate
                                                                  person or role and allows efficient interaction of
                                                                  entities in the care process.



C.3.1.3   Clinical Task tracking   Track tasks to guarantee that In order to reduce the risk of errors during the care Support delivery of                          EF-Essential Future R-Required
                                   each task is administered to process due to missed tasks, the EHR-S shall           effective healthcare;
                                   and completed appropriately. provide appropriate mechanisms for viewing and         patient safety;
                                                                 tracking unresolved tasks, work lists, task status,
                                                                 unassigned tasks or other tasks where a risk of
                                                                 omission exists. For example, the EHR-S will
                                                                 create a report to show test results that have not
                                                                 been reviewed by the ordering provider based on an
                                                                 interval appropriate to the care setting.




 Version 7.0                                                                                              page 19 of 71                                          Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                       DoD EHR - HL7 EHR Mapping                                              HL7 EHR-S Profile Coding
HL7       HL7                      HL7                            HL7                                                      HL7                     HL7            DoD EHR            DoD EHR
EHR       EHR                      EHR                            EHR                                                      EHR                     EHR            Constrainable      Implementable
ID        Function                 Function                       Functional                                               Rationale               Secondary      Functional Profile Functional Profile
          Name                     Statement                      Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                  CODING             CODING
                                                                                                                                                                  for Ambulatory - for Ambulatory -
                                                                                                                                                                  Outpatient       Outpatient
C.3.2.0   Clinical Communication                                  Healthcare requires communications between
                                                                  various participants: patients, doctors, nurses,
                                                                  chronic disease care managers, pharmacies,
                                                                  laboratories, payers, consultants, etc. An effective
                                                                  EHRS supports communication across all relevant
                                                                  participants, reduces the overhead and costs of
                                                                  healthcare-related communications, and provides
                                                                  automatic tracking and reporting. The list of
                                                                  communication participants is determined by the
                                                                  care setting and may change over time. Because of
                                                                  concerns about scalability of the specification over
                                                                  time, communication participants for all care
                                                                  settings are not enumerated here because it would
                                                                  limit the possibilities available to each care setting
                                                                  and implementation.. However, communication
                                                                  between providers and between patients and
                                                                  providers will be supported in all appropriate care
                                                                  settings. Implementation of the EHR-S enables new
                                                                  and more effective channels of communication,
                                                                  significantly improving efficiency and patient care.
                                                                  The communication functions of the EHR-S will
                                                                  eventually change the way participants collaborate
                                                                  and distribute the work of patient care.



C.3.2.1   Inter-provider           Support electronic messaging   Messaging among providers involved in the care           Support delivery of                    E-Essential       R-Required
          communication            (inbound and outbound)         process can range from real time communication           effective healthcare;
                                   between providers to trigger   (for example, fulfillment of an injection while the      patient safety;
                                   or respond to pertinent        patient is in the exam room), to asynchronous            management of chronic
                                   actions in the care process,   communication (for example, consult reports              conditions; improve
                                   document non-electronic        between physicians). Some forms of inter-                efficiency;
                                   communication (such as         practitioner communication will be paper based
                                   phone calls, correspondence    and the EHR must be able to produce appropriate
                                   or other encounters) and       documents.
                                   generate paper message
                                   artifacts where appropriate.




 Version 7.0                                                                                              page 20 of 71                                        Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                            DoD EHR - HL7 EHR Mapping                                                    HL7 EHR-S Profile Coding
HL7       HL7                        HL7                               HL7                                                      HL7                           HL7            DoD EHR            DoD EHR
EHR       EHR                        EHR                               EHR                                                      EHR                           EHR            Constrainable      Implementable
ID        Function                   Function                          Functional                                               Rationale                     Secondary      Functional Profile Functional Profile
          Name                       Statement                         Description                                                                            Citation       PRIORITY           REQUIRED
                                                                                                                                                                             CODING             CODING
                                                                                                                                                                             for Ambulatory - for Ambulatory -
                                                                                                                                                                             Outpatient       Outpatient
C.3.2.3   Pharmacy                   Provide features to enable        When a medication is prescribed, the prescription        Support delivery of                          EF-Essential Future R-Required
          Communication              bidirectional communication       will be routed electronically to the pharmacy. This      effective healthcare;
                                     of information electronically     information will be used to avoid transcription          improve efficiency;
                                     between practitioners and         errors and facilitate detection of potential adverse     management of chronic
                                     pharmacies.                       reactions. Upon filling the prescription, information    conditions
                                                                       will be sent back to the practitioner to indicate that
                                                                       the patient received the medication. If there is a
                                                                       question from the pharmacy, that message can be
                                                                       sent electronically to the provider and presented
                                                                       with their other tasks.

C.3.2.2   Provider/Patient/Family    Trigger or respond to             For example, when test results arrive, the physician     Support delivery of                          EF-Essential Future R-Required
          Communication              electronic messaging              may wish to message the patient with a normal test       effective healthcare;
                                     (inbound and outbound)            result. The patient may wish to request a refill by      management of chronic
                                     between providers and             messaging the physician rather than placing a            conditions; improve
                                     patients or patient               phone call. Patients with chronic disease such as        efficiency; facilitate self
                                     representatives with pertinent    asthma may wish to message their peak flow logs          health management
                                     actions in the care process       to their physician. A hospital may wish to message
                                     while documenting non-            selected patients about a new smoking cessation
                                     electronic communication          program. It is unlikely that the EHR-S can facilitate
                                     (such as phone calls,             self-health management without providing a means
                                     correspondence or other           for communication between patient and
                                     encounters) and generating        practitioner.
                                     paper message artifacts where
                                     appropriate.

C.3.2.4   Patient, Family and Care   Identify and make available       After the practitioner has ordered educational           Support delivery of                          E-Essential        R-Required
          Giver Education            electronically or in print        materials, the EHR-S will provide access to a            effective healthcare;
                                     information any educational       library of educational materials either within the       management of chronic
                                     or support resources for          EHR-S itself or in conjunction with another              conditions; improve
                                     patients, families, and           application. This access could be provided as a          efficiency; facilitate self
                                     caregivers that are most          printout or electronically via a message to the          health management
                                     pertinent for a given health      patient.
                                     concern, condition, or
                                     diagnosis and which are
                                     appropriate for the person (s).

C.3.2.5   Communication with         Support communication and The EHR-S will include features to communicate                   Support delivery of                          EF-Essential Future R-Required
          Medical Devices            presentation of data captured with medical devices as appropriate to the care              effective healthcare;
                                     from medical devices.         setting. Examples include: vital signs, home                 Management of chronic
                                                                   diagnostic devices for chronic disease management,           conditions Improve
                                                                   laboratory machines, bar coded artifacts (medicine,          efficiency
                                                                   immunizations, demographics, history,
                                                                   identification).




 Version 7.0                                                                                                  page 21 of 71                                               Version Date: 23 February 2004
    DoD EHR - For Public Distribution                                                 DoD EHR - HL7 EHR Mapping                                                                          HL7 EHR-S Profile Coding
HL7        HL7                  HL7                             HL7                                                  HL7                         HL7                                        DoD EHR               DoD EHR
EHR        EHR                  EHR                             EHR                                                  EHR                         EHR                                        Constrainable      Implementable
ID         Function             Function                        Functional                                           Rationale                   Secondary                                  Functional Profile Functional Profile
           Name                 Statement                       Description                                                                      Citation                                   PRIORITY              REQUIRED
                                                                                                                                                                                            CODING                CODING
                                                                                                                                                                                            for Ambulatory - for Ambulatory -
                                                                                                                                                                                            Outpatient       Outpatient
S          SUPPORTIVE



S.1        Clinical Support



S.1.1.0    Disease Registries   Enable the automated transfer   The EHR-S supports the addition of new registries    1. Support delivery of      Disease specific registries are exemplified by EF-Essential Future R-Required
                                of formatted demographic        through the addition of formatted data transfer      effective healthcare - 2.   the long-standing cancer registry system that
                                and clinical information to     protocols but does not necessarily provide support   Improve patient safety -    exists in each state and supported by
                                local disease specific          for the disease registry itself.                     3. Facilitate               institution-based tumor registries in many
                                registries for patient                                                               management of chronic       health care institutions. See
                                monitoring and subsequent                                                            conditions                  http://www.cdc.gov/cancer/npcr/index.htm
                                epidemiological analysis.                                                                                        for more information.

S.1.2.0    Donor Management     Provide capability to capture   Provide capability to capture and share needed       2. Improve patient          Organ donor transplant management is a       EF-Essential Future R-Required
           Support              and share needed information    information on potential organ and blood donors      safety - 4. Improve         complex interaction of many coordinated
                                on potential organ and blood    and recipients. Make this information available to   efficiency                  bodies that extends beyond the institutions
                                donors and recipients.          internal and external donor matching agencies.                                   involved in organ harvesting and
                                                                                                                                                 transplantation. This system is described at
                                                                                                                                                 http://www.optn.org/about/transplantation/m
                                                                                                                                                 atchingProcess.asp. -




    Version 7.0                                                                                       page 22 of 71                                                                    Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                      DoD EHR - HL7 EHR Mapping                                                                          HL7 EHR-S Profile Coding
HL7       HL7                    HL7                               HL7                                                 HL7                        HL7                                          DoD EHR            DoD EHR
EHR       EHR                    EHR                               EHR                                                 EHR                        EHR                                          Constrainable      Implementable
ID        Function               Function                          Functional                                          Rationale                  Secondary                                    Functional Profile Functional Profile
          Name                   Statement                         Description                                                                    Citation                                     PRIORITY           REQUIRED
                                                                                                                                                                                               CODING             CODING
                                                                                                                                                                                               for Ambulatory - for Ambulatory -
                                                                                                                                                                                               Outpatient       Outpatient
S.1.3.0   Provider Locator       Maintain current directory of     Maintain current directory of provider information 1. Support delivery of      Unique identification of providers along with E-Essential      R-Required
                                 provider information in           in accordance with relevant laws, regulations, and effective healthcare - 4.   appropriate demographics is already being
                                 accordance with relevant          conventions, including full name, address          Improve efficiency          done in healthcare and will form an essential
                                 laws, regulations, and            or physical location, and a 24x7                                               component of the National Provider
                                 conventions.                      telecommunications address (e.g. phone or pager                                Identifier in the US under HIPAA
                                                                   access number) for the purposes of the following:                              (http://aspe.hhs.gov/admnsimp/nprm/npinpr
                                                                                                                                                  m.pdf). Role based access to systems is an
                                                                                                                                                  essential component of any security system.
                                                                                                                                                  An example of role based access as it applies
                                                                                                                                                  to the EHR by the Open Architecture for
                                                                                                                                                  Secure Internetworking Services (OASIS)
                                                                                                                                                  may be found at
                                                                                                                                                  http://www.cl.cam.ac.uk/~km/MW2001-
                                                                                                                                                  talk.pdf. OASIS is a not-for-profit global
                                                                                                                                                  consortium that drives the development,
                                                                                                                                                  convergence and adoption of e-business
                                                                                                                                                  standards
                                                                                                                                                  (http://www.cl.cam.ac.uk/~km/MW2001-
                                                                                                                                                  talk.pdf). - While current provider location is
                                                                                                                                                  a convenience item that relates mostly to
                                                                                                                                                  customer satisfaction it elevates to a level of
                                                                                                                                                  vital importance when communicating
                                                                                                                                                  critical test results
                                                                                                                                                  (http://www.macoalition.org/documents/CT
                                                                                                                                                  RPractices.pdf)

S.1.3.1   Maintain provider      Maintain a current directory                                                                                                                                  E-Essential       R-Required
          demographics           of practitioners that, in
                                 addition to demographic
                                 information, contains data
                                 needed to determine levels of
                                 access required by the EHR
                                 security system.

S.1.3.2   In facility Location   Provide provider location or                                                                                                                                  E-Essential       R-Required
                                 contact information on a
                                 facility's premises.
S.1.3.3   On Call Location       Provide provider location or                                                                                                                                  E-Essential       R-Required
                                 contact information when on
                                 call.
S.1.3.4   General Location       Provide locations or contact                                                                                                                                  E-Essential       R-Required
                                 information at which the
                                 provider practices, in order to
                                 direct patients or queries.




 Version 7.0                                                                                             page 23 of 71                                                                   Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                         DoD EHR - HL7 EHR Mapping                                                                               HL7 EHR-S Profile Coding
HL7       HL7                        HL7                             HL7                                                   HL7                          HL7                                            DoD EHR            DoD EHR
EHR       EHR                        EHR                             EHR                                                   EHR                          EHR                                            Constrainable      Implementable
ID        Function                   Function                        Functional                                            Rationale                    Secondary                                      Functional Profile Functional Profile
          Name                       Statement                       Description                                                                        Citation                                       PRIORITY           REQUIRED
                                                                                                                                                                                                       CODING             CODING
                                                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                                                       Outpatient       Outpatient
S.1.4.0   Patient Locator            Maintain current directory of   STATEMENT: Maintain current directory of              1. Support delivery of       Patient location is an essential part of the   E-Essential       R-Required
                                     patient information in          patient information in accordance with relevant       effective healthcare - 2.    patient record, which, by IOM definition in
                                     accordance with relevant        privacy and other applicable laws, regulations, and   Improve patient safety -     their 1991 report forms the basis of an EHR
                                     privacy and other applicable    conventions, including, when available, full name,    3. Facilitate                (http://books.nap.edu/books/0309055326/ht
                                     laws, regulations, and          address or physical location, alternate contact       management of chronic        ml/index.html).
                                     conventions.                    person, primary phone number, and relevant health     conditions - 4. Improve
                                                                     status information for the purposes of the            efficiency - 5. Facilitate
                                                                     following:                                            self-health management




S.1.4.1   Patient's location within a Provide the patient's location Example: The patient census in a hospital setting                                                                                 E-Essential       R-Required
          facility                    information within a facility's
                                      premises.
S.1.4.2   Patient's residence related Provide the patient's residence                                                                                   Personal health information disclosure is E-Essential            R-Required
          to the provision and        information solely for                                                                                            required for pubic health purposes, see
          administration of services purposes related to the                                                                                            http://www.cdc.gov/mmwr/preview/mmwrht
                                      provision and administration                                                                                      ml/su5201a1.htm. -
                                      of services to the patient,
                                      patient transport, and as
                                      required for public health
                                      reporting.
S.1.4.3   Optimize patient bed        Enable management of                                                                                              Information on the recommended isolation O-Optional              M-Maybe
          arrangements                patient bed. Ensure that the                                                                                      of patients with certain infectious diseases
                                      patient's bed arrangements                                                                                        may be found at
                                      within the facility optimize                                                                                      http://www.cdc.gov/ncidod/sars/isolationquar
                                      care and minimize risks of                                                                                        antine.htm with a current list of possible
                                      exposure to contagious                                                                                            infectious agents at
                                      patients. The EHR-S will                                                                                          http://www.cdc.gov/ncidod/sars/executiveord
                                      enable the communication of                                                                                       er040403.htm. - Information on an
                                      bed usage with external                                                                                           instructional role in emergency situations has
                                      health entities in times of                                                                                       been developed by JCAHO and maybe found
                                      capacity overload to facilitate                                                                                   at
                                      efficient bed utilization.                                                                                        http://www.jcaho.org/about+us/public+polic
                                                                                                                                                        y+initiatives/emergency+preparedness.pdf.

S.1.5.0   Demographics and De-       Manage patient demographics                                                           1. Support delivery of       Patient demographics is an essential part of EF-Essential Future R-Required
          Identification             and identifying information                                                           effective healthcare - 4.    the patient record, which, by IOM definition
                                                                                                                           Improve efficiency - 6.      in their 1991 report that forms the basis of an
                                                                                                                           Ensure privacy,              EHR
                                                                                                                           confidentiality              (http://books.nap.edu/books/0309055326/ht
                                                                                                                                                        ml/index.html).




 Version 7.0                                                                                               page 24 of 71                                                                        Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                        DoD EHR - HL7 EHR Mapping                                                                             HL7 EHR-S Profile Coding
HL7       HL7                    HL7                               HL7                                                      HL7                         HL7                                        DoD EHR               DoD EHR
EHR       EHR                    EHR                               EHR                                                      EHR                         EHR                                        Constrainable      Implementable
ID        Function               Function                          Functional                                               Rationale                   Secondary                                  Functional Profile Functional Profile
          Name                   Statement                         Description                                                                          Citation                                   PRIORITY              REQUIRED
                                                                                                                                                                                                   CODING                CODING
                                                                                                                                                                                                   for Ambulatory - for Ambulatory -
                                                                                                                                                                                                   Outpatient       Outpatient
S.1.5.1   Patient demographics   Maintain, archive and update The minimum demographic data set must include                                                                                        E-Essential           R-Required
                                 demographic information in the data required by realm-specific laws governing
                                 accordance with realm-       health care transactions and reporting.
                                 specific recordkeeping
                                 requirements.

S.1.5.2   De-identified Data     Provide patient data in a         When an internal or external party requests patient                                  Deidentification of data requires removing EF-Essential Future R-Required
          Request management     fashion that meets local          data and that party requests de-identified data (or is                               patient demographic information to the point
                                 requirements for de-              not entitled to identify patient information, either                                 that the individual patient can not be
                                 identification.                   by law or custom), the EHR-S supplies the data in a                                  identified. Actual requirements for
                                                                   fashion that meets local requirements for de-                                        deidentification will vary based on location
                                                                   identification. The EHR-S maintains an audit trail                                   and specific need. In the US regulations for
                                                                   of these requests.                                                                   that are viewed as acceptable for complete
                                                                                                                                                        deidentification can be found at
                                                                                                                                                        http://privacyruleandresearch.nih.gov/pr_08.
                                                                                                                                                        asp#8a.

S.1.6.0   Scheduling             Provide the necessary data to     This includes relevant clinical or demographics          1. Support delivery of      IOM Rpt, page 10, "Electronic scheduling       EF-Essential Future R-Required
                                 a scheduling system for           information to prevent the scheduling of                 effective healthcare - 2.   systems for admissions, procedures and visits
                                 optimal efficiency in the         inappropriate procedures for the patient (e.g. X-Ray     Improve patient safety -    not only increase efficiency, but also provide
                                 scheduling of patient care, for   for pregnant women)                                      3. Facilitate               better service to patients (Everett, 2002;
                                 either the patient or a                                                                    management of chronic       Hancock and Walter, 1986; Woods, 2001) -
                                 resource/device.                                                                           conditions - 4. Improve     http://www.iom.edu/report.asp?id=14391
                                                                                                                            efficiency




 Version 7.0                                                                                               page 25 of 71                                                                      Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                     DoD EHR - HL7 EHR Mapping                                                         HL7 EHR-S Profile Coding
HL7       HL7                         HL7                                HL7                           HL7                        HL7                                        DoD EHR              DoD EHR
EHR       EHR                         EHR                                EHR                           EHR                        EHR                                        Constrainable      Implementable
ID        Function                    Function                           Functional                    Rationale                  Secondary                                  Functional Profile Functional Profile
          Name                        Statement                          Description                                              Citation                                   PRIORITY             REQUIRED
                                                                                                                                                                             CODING               CODING
                                                                                                                                                                             for Ambulatory - for Ambulatory -
                                                                                                                                                                             Outpatient       Outpatient
S.2       Measurement,
          Analysis, Research and
          Reports
S.2.1.0   Measurement, monitoring, Support measurement and                                             1. Support Delivery of     AHIMA Practice Brief: Data Quality            EF-Essential Future R-Required
          and analysis             monitoring of care for                                              Effective Healthcare - 2   Management Model:
                                   relevant purposes in the                                            Improve Patient Safety -   http://library.ahima.org/xpedio/groups/public
                                   EHRS.                                                               3 Facilitate               /documents/ahima/pub_bok1_000066.html
                                                                                                       management of chronic
                                                                                                       conditions - 4 Improve
                                                                                                       efficiency



S.2.1.1   Outcome Measures            Analyze outcomes of care                                                                                                               EF-Essential Future R-Required
                                      provided to populations, in
                                      facilities, by providers, and in
                                      communities.
S.2.1.2   Aspect of care indicators   Identify indicators that further                                                                                                       EF-Essential Future R-Required
                                      investigation is needed on
                                      aspects of care provided to
                                      populations, in facilities, by
                                      providers, and in
                                      communities
S.2.1.3   Performance and             Support the capture of                                                                                                                 EF-Essential Future R-Required
          accountability measures     quality, performance, and
                                      accountability measures to
                                      which
                                      providers/facilities/delivery
                                      systems/communities are held
                                      accountable including
                                      measures related to process,
                                      outcomes, and/or costs of care
                                      – may be used in pay for
                                      performance monitoring and
                                      adherence to best practice
                                      guidelines.




 Version 7.0                                                                                  page 26 of 71                                                            Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                  DoD EHR - HL7 EHR Mapping                                                                            HL7 EHR-S Profile Coding
HL7       HL7                 HL7                             HL7                                                     HL7                         HL7                                        DoD EHR              DoD EHR
EHR       EHR                 EHR                             EHR                                                     EHR                         EHR                                        Constrainable      Implementable
ID        Function            Function                        Functional                                              Rationale                   Secondary                                  Functional Profile Functional Profile
          Name                Statement                       Description                                                                         Citation                                   PRIORITY             REQUIRED
                                                                                                                                                                                             CODING               CODING
                                                                                                                                                                                             for Ambulatory - for Ambulatory -
                                                                                                                                                                                             Outpatient       Outpatient
S.2.2.0   Report Generation   Provide report generation      Using structured data and/or unstructured text in        1. Support Delivery of      “Claims and encounter data are used to        EF-Essential Future R-Required
                              features for the generation of the patient’s EHR, the EHR-S permits the creation        Effective Healthcare - 2    monitor and improve outcomes for numerous
                              standard and ad hoc reports. of standard and ad hoc reports for clinical,               Improve Patient Safety -    preventive services, including prenatal care,
                                                             administrative, and financial decision-making, and       3 Facilitate                childhood immunization, and cancer
                                                             for patient use. Reports may be required by              management of chronic       screenings.” p. 8 - Promoting Prevention
                                                             patients, regulators, accrediting agencies, payers,      conditions - 4 Improve      Through Information Technology: -
                                                             and/or providers/facilities/delivery systems; and, as    efficiency - 5 Facilitate   Assessment of Information Technology in
                                                             needed, linked with financial and other external         self-health management      Association of Health Center Affiliated
                                                             data sources (e.g. sources external to the EHR-S                                     Health Plans
                                                             and internal to the health care entity, or data                                      http://www.ahcahp.org/publications/Working
                                                             external to the entity). - - Such reports may include                                %20Papers/Final%20Report%20from%2020
                                                             patient-level reports (e.g., administratively required                               03%20AHCAHP%20IT%20Assessment.pdf -
                                                             patient assessment forms,
                                                             admission/transfer/discharge reports, operative and
                                                             procedure reports, consultation reports, drug
                                                             profiles, etc.), provider/facility/delivery system-
                                                             level reports, and population-level reports (e.g.
                                                             including reports on the effectiveness of clinical
                                                             pathways and other evidence-based practices,
                                                             tracking completeness of clinical documentation).




 Version 7.0                                                                                         page 27 of 71                                                                     Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                   DoD EHR - HL7 EHR Mapping                                                                              HL7 EHR-S Profile Coding
HL7       HL7                    HL7                           HL7                                                     HL7                         HL7                                          DoD EHR            DoD EHR
EHR       EHR                    EHR                           EHR                                                     EHR                         EHR                                          Constrainable      Implementable
ID        Function               Function                      Functional                                              Rationale                   Secondary                                    Functional Profile Functional Profile
          Name                   Statement                     Description                                                                         Citation                                     PRIORITY           REQUIRED
                                                                                                                                                                                                CODING             CODING
                                                                                                                                                                                                for Ambulatory - for Ambulatory -
                                                                                                                                                                                                Outpatient       Outpatient
S.3       Administrative and
          Financial


S.3.1.0   Encounter/Episode of   Manage and document the       Using data standards and technologies that support      1. Support Delivery of      AHIMA Practice Brief: Definition of the       E-Essential      R-Required
          Care Management -      health care needed and        interoperability, encounter management promotes         Effective Healthcare - 2    Health Record for Legal Purposes:
                                 delivered during an episode   patient-centered/oriented care and enables real         Improve Patient Safety -    http://library.ahima.org/xpedio/groups/public
                                 of care.                      time, immediate point of service, point of care by      3 Facilitate                /documents/ahima/pub_bok1_009223.html
                                                               facilitating efficient work flow and operations         management of chronic
                                                               performance to ensure the integrity of (1) the health   conditions - 4 Improve
                                                               record, (2) public health, financial and                efficiency - 5 Facilitate
                                                               administrative reporting, and (3) the healthcare        self-health management
                                                               delivery process. - - This support is necessary for
                                                               direct care functionality that relies on providing
                                                               user interaction and workflows, which are
                                                               configured according to clinical protocols and
                                                               business rules based on encounter specific values
                                                               such as care setting, encounter type (inpatient,
                                                               outpatient, home health, etc), provider type,
                                                               patient's EHR, health status, demographics, and the
                                                               initial purpose of the encounter.




 Version 7.0                                                                                          page 28 of 71                                                                       Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                    DoD EHR - HL7 EHR Mapping                                                             HL7 EHR-S Profile Coding
HL7       HL7                  HL7                              HL7                                                     HL7         HL7                                        DoD EHR            DoD EHR
EHR       EHR                  EHR                              EHR                                                     EHR         EHR                                        Constrainable      Implementable
ID        Function             Function                         Functional                                              Rationale   Secondary                                  Functional Profile Functional Profile
          Name                 Statement                        Description                                                         Citation                                   PRIORITY           REQUIRED
                                                                                                                                                                               CODING             CODING
                                                                                                                                                                               for Ambulatory - for Ambulatory -
                                                                                                                                                                               Outpatient       Outpatient
S.3.1.1   Specialized views    Provide specialized views and    Encounter management orchestrates electronic data                   Remarks by Tommy G. Thompson, Secretary EF-Essential Future R-Required
                               functionality based on the       interchange according to encounter-specific values,                 of HHS, NHII Conference 7/1/03: "Why is it
                               encounter-specific values,       clinical protocols and business rules. This function                that retailers such as L.L. Bean have been
                               clinical protocols and           "organizes" and "calls" functionalities described in                able to personalize my shopping experience
                               business rules                   other sections of the EHR Functional Outline and                    and yours - automatically providing the
                                                                depends on generic capabilities defined by the                      correct sizes and suggestions of other items
                                                                Information Infrastructure including support for                    based on what I bought last year - but my
                                                                security and privacy. - As an example, a mobile                     doctor and pharmacist cannot quickly refer
                                                                home health care worker using wireless laptop at                    to a list of my prescriptions or see when I
                                                                the patient's home would be presented with a home                   had my last physical?" -
                                                                health care specific workflow synchronized to the                   http://www.hhs.gov/news/speech/2003/03070
                                                                current patient's demographics and care plan and                    1.html - Key Capabilities of an Electronic
                                                                tailored to support the interventions appropriate for               Health Record System p. 9 -
                                                                this patient, including chronic disease management                  http://www.iom.edu/report.asp?id=14391 - -
                                                                protocols. The workflow would automatically or                      Standards Insight - An Analysis of Health
                                                                manually trigger electronic interchanges depending                  Information - Standards Development
                                                                on conditions arising during the encounter. - The                   Initiatives - July 2003 -
                                                                EHR would support bidirectional communications                      http://www.himss.org/content/files/Standards
                                                                with the case manager for adjustments to the care                   Insight/2003/07-2003.pdf -
                                                                plan; requests for e-prescriptions from the primary
                                                                care provider; scheduling a consult with a
                                                                specialist; permit the provider to assist the patient
                                                                with communications with other care givers; as
                                                                well as generate necessary prior authorization
S.3.1.2   Encounter specific   Provide assistance in            requests to the patient's health plan, management
                                                                Workflows, based on the encounter send the                          The CPR in Eleven Paperless Physicians'      O-Optional      M-Maybe
          functionality        assembling appropriate data,     settings, will assist in determining the appropriate                Offices -
                               supporting data collection and   data collection, import, export, extraction, linkages               http://www.himss.org/content/files/proceedin
                               processing output from the       and transformation. - As an example, the EHR-s                      gs/slides/sessions/ses048s.pdf -
                               encounter.                       would present a pediatrician with diagnostic and                    http://www.himss.org/content/files/proceedin
                                                                procedure codes specific to pediatrics, the patient's               gs/2000/sessions/ses048.pdf -
                                                                demographics, and the patient's health record.
                                                                Business rules in the EHR-S would automatically
                                                                collect necessary data from the patient's health
                                                                record and patient registry. As the provider enters
                                                                data into the EHR-S, triggered workflow processes
                                                                would access and populate appropriate transactions
                                                                and documents to, for example, populate an
                                                                eligibility verification transaction or query the
                                                                immunization registry.




 Version 7.0                                                                                           page 29 of 71                                                      Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                          DoD EHR - HL7 EHR Mapping                                                                           HL7 EHR-S Profile Coding
HL7       HL7                         HL7                             HL7                                                    HL7                         HL7                                        DoD EHR              DoD EHR
EHR       EHR                         EHR                             EHR                                                    EHR                         EHR                                        Constrainable      Implementable
ID        Function                    Function                        Functional                                             Rationale                   Secondary                                  Functional Profile Functional Profile
          Name                        Statement                       Description                                                                        Citation                                   PRIORITY             REQUIRED
                                                                                                                                                                                                    CODING               CODING
                                                                                                                                                                                                    for Ambulatory - for Ambulatory -
                                                                                                                                                                                                    Outpatient       Outpatient
S.3.1.3   Integration of clinical data Enable the inclusion of the    Maximizing the extent to which administrative and                                  Paperless Success: The Value of E-Medical E-Essential           R-Required
          with administrative and      patient's clinical data (for   financial data can be derived or developed from                                    Records -
          financial data               administrative or financial    clinical data will lessen provider reporting burdens                               http://www.himss.org/content/files/proceedin
                                       purposes) from one or more     and the time it takes to complete administrative and                               gs/2001/sessions/ses045.pdf -
                                       external repositories.         financial processes such as claim reimbursement.                                   http://www.himss.org/content/files/proceedin
                                                                      This will require a mapping of clinical                                            gs/2001/sessions/ses081.pdf - - "Having
                                                                      terminologies to various administrative and                                        clinical data represented with a standardized
                                                                      financial terminologies.                                                           terminology and in a machine-readable
                                                                                                                                                         format would reduce the significant data
                                                                                                                                                         collection burden at the provider level, as
                                                                                                                                                         well as the associated costs, and would likely
                                                                                                                                                         increase the accuracy of the data reported ."
                                                                                                                                                         IOM Key Capabilities of an Electronic
                                                                                                                                                         Health Record System , pg 14 (
                                                                                                                                                         http://www.iom.edu/report.asp?id=14391 )



S.3.1.4   Integrate device            Support device monitoring,      Promotes patient empowerment, self-determination                                   Recent examples of: device monitoring     EF-Essential Future R-Required
          monitoring and remote       and remote health services      and ability to maintain health status in the                                       (http://www.hi-
          health services such as     such as telehealth by           community. Promotes personal health, wellness                                      europe.info/files/2003/9974.htm); remote
          telehealth data             integrating records and data    and preventive care. For example, a diabetic                                       monitoring(http://www.devicelink.com/mddi
                                      collected by these means into   pregnant Mom can self-monitor her condition from                                   /archive/03/06/012.html); and telehealth
                                      the patient's EHR for care      her home and use web TV to report to her provider.                                 (http://www.mcg.edu/Telemedicine/Index.ht
                                      management, billing, and        The same TV-internet connectivity allows her to                                    ml) - -
                                      public health reporting         get dietary and other health promoting information
                                      purposes.                       to assist her with managing her high-risk
                                                                      pregnancy.

S.3.2.0   Information Access for      Support extraction,             Using data standards and technologies that support     1. Support delivery of      AHIMA Practice Brief: Definition of the       EF-Essential Future R-Required
          Supplemental Use            transformation and linkage of   interoperability, information access functionalities   effective healthcare - 2.   Health Record for Legal Purposes:
                                      information from structured     serve primary and secondary record use and             Improve patient safety -    http://library.ahima.org/xpedio/groups/public
                                      data and unstructured text in   reporting with continuous record availability and      3. Facilitate               /documents/ahima/pub_bok1_009223.html - -
                                      the patient's EHR for care      access that ensure the integrity of (1) the health     management of chronic       IOM Key Capabilities of an Electronic
                                      management, financial,          record, (2) public health, financial and               conditions - 4. Improve     Health Record System, p.14 -
                                      administrative, and public      administrative reporting, and (3) the healthcare       efficiency                  http://www.iom.edu/report.asp?id=14391 -
                                      health purposes.                delivery process.




 Version 7.0                                                                                                 page 30 of 71                                                                    Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                           DoD EHR - HL7 EHR Mapping                                                                HL7 EHR-S Profile Coding
HL7       HL7                        HL7                              HL7                                                        HL7         HL7                                         DoD EHR            DoD EHR
EHR       EHR                        EHR                              EHR                                                        EHR         EHR                                         Constrainable      Implementable
ID        Function                   Function                         Functional                                                 Rationale   Secondary                                   Functional Profile Functional Profile
          Name                       Statement                        Description                                                            Citation                                    PRIORITY           REQUIRED
                                                                                                                                                                                         CODING             CODING
                                                                                                                                                                                         for Ambulatory - for Ambulatory -
                                                                                                                                                                                         Outpatient       Outpatient
S.3.2.1   Rules-driven clinical      Make available all pertinent                                                                            Remarks by Tommy G. Thompson, Secretary E-Essential           R-Required
          coding assistance          patient information needed to                                                                           of HHS, NHII Conference 7/1/03: We need a
                                     support coding of diagnoses,                                                                            health information system that automatically
                                     procedures and outcomes.                                                                                gives health professionals access to the
                                                                                                                                             patient-specific medical knowledge required
                                                                                                                                             for diagnosis and treatment - the latest
                                                                                                                                             research results from medical journals, the
                                                                                                                                             most up-to-date guidelines, the appropriate
                                                                                                                                             public health notifications. Our doctors then
                                                                                                                                             will not have to depend on their great
                                                                                                                                             memories any more. -
                                                                                                                                             http://www.hhs.gov/news/speech/2003/03070
                                                                                                                                             1.html -

S.3.2.2   Rules-driven financial and Provide financial and            This function is a necessary precondition for the                      NHII03 Standards and Vocabulary Groups       E-Essential      R-Required
          administrative coding      administrative coding            EHR-S' capacity to support the development or                          A&B:
          assistance                 assistance based on the          derivation of administrative and financial                             http://aspe.hhs.gov/sp/nhii/Conference03/Sta
                                     structured data and              documentation, reporting and transactions. To a                        ndardsVocabA.ppt,
                                     unstructured text available in   certain extent that clinical data can be mapped to                     http://aspe.hhs.gov/sp/nhii/Conference03/Sta
                                     the encounter documentation.     administrative and financial data. However, where                      ndardsVocabB.PPT
                                                                      there is no map, the EHR-S must support the
                                                                      collection of required administrative and financial
                                                                      data that is not available from non-clinical sources.
                                                                      For example, the HIPAA 837 Professional claim
                                                                      requires the date of the last menstrual cycle for
                                                                      claims involving pregnancy. To support the
                                                                      generation of this transaction, the EHR-S would
                                                                      need to prompt the provider to enter this date when
                                                                      the patient is first determined to be pregnant. The
                                                                      EHR-S would need to make this information
                                                                      available to the billing process.

S.3.2.3   Integrate Cost           Enable the use of cost             The EHR-S could alert the provider or support the                      Medical Informatics for Better and Safer    EF-Essential Future R-Required
          management information - management information             provider's query regarding the most cost-effective                     Health Care.
                                   required to guide users and        services, referrals, devices etc to recommend to the                   http://www.ahrq.gov/data/informatics/inform
                                   workflows.                         patient based on the patient's health plan coverage                    atria.pdf
                                                                      rules. For example, help the provider recommend a
                                                                      specialist from the patient's preferred provider list. -
                                                                      - Note: The Direct care section needs to provide the
                                                                      functionality to guide users based on this
                                                                      information. - Example: alert the provider about co-
                                                                      pays, generic drugs, or other cost policies.




 Version 7.0                                                                                                   page 31 of 71                                                        Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                       DoD EHR - HL7 EHR Mapping                                                                        HL7 EHR-S Profile Coding
HL7       HL7                      HL7                            HL7                                                   HL7                        HL7                                        DoD EHR              DoD EHR
EHR       EHR                      EHR                            EHR                                                   EHR                        EHR                                        Constrainable      Implementable
ID        Function                 Function                       Functional                                            Rationale                  Secondary                                  Functional Profile Functional Profile
          Name                     Statement                      Description                                                                      Citation                                   PRIORITY             REQUIRED
                                                                                                                                                                                              CODING               CODING
                                                                                                                                                                                              for Ambulatory - for Ambulatory -
                                                                                                                                                                                              Outpatient       Outpatient
S.3.2.4   Formulary                Present relevant information The EHR-S could alert the provider or support the                                  Medical Informatics for Better and Safer      EF-Essential Future R-Required
          communication            at the point of care regarding provider's query regarding the most cost-effective                               Health Care.
                                   medication formulary.          prescriptions under the patient's health plan's                                  http://www.ahrq.gov/data/informatics/inform
                                                                  formulary.                                                                       atria.pdf
S.3.3.0   Administrative           Support the creation           STATEMENT: Support the creation (including            1. Support Delivery of     IOM Key Capabilities of an Electronic         E-Essential         R-Required
          Transaction Processing   (including using external data using external data sources, if necessary),           Effective Healthcare - -   Health Record System: "Use of
                                   sources, if necessary),        electronic interchange, and processing of             4. Improve efficiency -    communication and content standards is
                                   electronic interchange, and    transactions listed below that may be necessary for                              equally important in the billing and claims
                                   processing of transactions     encounter management during an episode of care. - -                              management area - close coupling of
                                   listed below that may be       The EHR system shall capture the patient health-                                 authorization and prior approvals can, in
                                   necessary for encounter        related information needed for administrative and                                some cases, eliminate delays and confusion.
                                   management during an           financial purposes including reimbursement. - -                                  Additionally, immediate validation of
                                   episode of care                Captures the episode and encounter information to                                insurance eligibility will add value for both
                                                                  pass to administrative or financial processes (e.g.                              providers and patients through improved
                                                                  triggers transmissions of charge transactions as by-                             access to services, more timely payments and
                                                                  product of on-line interaction including order entry,                            less
                                                                  order statusing, result entry, documentation entry,                              paperwork."http://www.iom.edu/report.asp?i
                                                                  medication administration charting.) - -                                         d=14391 - HIMSS Electronic Health Record
                                                                  Automatically retrieves information needed to                                    Definitional Model - Version 1.0 - - AHIMA
                                                                  verify coverage and medical necessity. - As a                                    Practice Brief: Definition of the Health
                                                                  byproduct of care delivery and documentation,                                    Record for Legal Purposes:
                                                                  captures and presents all patient information                                    http://library.ahima.org/xpedio/groups/public
                                                                  needed to support coding. Ideally performs coding                                /documents/ahima/pub_bok1_009223.html - -
                                                                  based on documentation. - - Clinically automated                                 AHIMA Practice Brief: Health Informatics
                                                                  revenue cycle - examples of reduced denials and                                  Standards and Information Transfer:
                                                                  error rates in claims. - - Clinical information                                  Exploring the HIM Role:
                                                                  needed for billing is available on the date of                                   http://library.ahima.org/xpedio/groups/public
                                                                  service. - - Physician and clinical teams do not                                 /documents/ahima/pub_bok1_000024.html - -
                                                                  perform additional data entry / tasks exclusively to                             AHIMA Practice Brief: Defining the
                                                                  support administrative or financial processes.                                   Designated Record Set:
                                                                                                                                                   http://library.ahima.org/xpedio/groups/public
                                                                                                                                                   /documents/ahima/pub_bok1_017122.html -




 Version 7.0                                                                                             page 32 of 71                                                                  Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                              DoD EHR - HL7 EHR Mapping                                                               HL7 EHR-S Profile Coding
HL7       HL7                          HL7                               HL7                                                       HL7         HL7                                         DoD EHR            DoD EHR
EHR       EHR                          EHR                               EHR                                                       EHR         EHR                                         Constrainable      Implementable
ID        Function                     Function                          Functional                                                Rationale   Secondary                                   Functional Profile Functional Profile
          Name                         Statement                         Description                                                           Citation                                    PRIORITY           REQUIRED
                                                                                                                                                                                           CODING             CODING
                                                                                                                                                                                           for Ambulatory - for Ambulatory -
                                                                                                                                                                                           Outpatient       Outpatient
S.3.3.1   Enrollment of patients      Enable enrollment of               Expedites determination of health insurance                           Enrolling and Retaining Low Income           EF-Essential Future R-Required
                                      uninsured patients into            coverage, thereby increasing patient access to care.                  families
                                      subsidized and unsubsidized        The EHR could alert the provider that uninsured                       http://cms.hhs.gov/schip/outreach/progress.p
                                      health plans, and enrollment       patients may be eligible for subsidized health                        df - To a Streamlined Approach to - Public
                                      of patients who are eligible       insurance or other health programs because they                       Health Insurance Enrollment -
                                      on the basis of health and/of      meet eligibility criteria based on demographics                       http://www.healtheapp.org/ -
                                      financial status in social         and/or health status. The EHR could be
                                      service and other programs,        automatically updated when such program's
                                      including clinical trials;         eligibility rules change. For examples, the EHR
                                                                         would notify the provider that the uninsured parents
                                                                         of a child enrolled in S-CHIP may now be eligible
                                                                         for a new subsidized health insurance program. The
                                                                         EHR could notify the provider of an uninsured
                                                                         pregnant patient about various programs that the
                                                                         patient may be eligible. The EHR could link to
                                                                         online enrollment forms that could be made
                                                                         available to the patient during the encounter. When
                                                                         enrollment is determined, the EHR would capture
                                                                         health coverage information needed for processing
                                                                         administrative and financial documentation, reports
                                                                         or transactions.



S.3.3.2   Eligibility verification and Enable eligibility verification   Automatically retrieves information needed to                         Immunization registries are having continual E-Essential       R-Required
          determination of             for health insurance and          support verification of coverage at the appropriate                   success in increasing vaccination rates of
          coverage;                    special programs, including       juncture in the encounter workflow. Improves                          children
                                       verification of benefits and      patient access to covered care and reduces claim                      (http://www.cdc.gov/mmwr/preview/mmwrh
                                       pre-determination of              denials. When eligibility is verified, the EHR-S                      tml/mm5001a2.htm). - - Electronic
                                       coverage;                         would capture eligibility information needed for                      determination of insurance coverage is a
                                                                         processing administrative and financial                               required HIPAA transaction in the US. See
                                                                         documentation, reports or transactions - updating or                  the 270/271 Implementation Guide available
                                                                         flagging any inconsistent data. In addition to health                 at http://www.wpc-
                                                                         insurance eligibility, this function would support                    edi.com/hipaa/HIPAA_40.asp. - -
                                                                         verification of registration in programs and
                                                                         registries, such as chronic care case management
                                                                         and immunization registries. An EHR-S would
                                                                         likely verify health insurance eligibility prior to the
                                                                         encounter, but would verify registration in case
                                                                         management or immunization registries during the
                                                                         encounter. -




 Version 7.0                                                                                                     page 33 of 71                                                        Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                           DoD EHR - HL7 EHR Mapping                                                             HL7 EHR-S Profile Coding
HL7       HL7                         HL7                              HL7                                                     HL7         HL7                                         DoD EHR            DoD EHR
EHR       EHR                         EHR                              EHR                                                     EHR         EHR                                         Constrainable      Implementable
ID        Function                    Function                         Functional                                              Rationale   Secondary                                   Functional Profile Functional Profile
          Name                        Statement                        Description                                                         Citation                                    PRIORITY           REQUIRED
                                                                                                                                                                                       CODING             CODING
                                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                                       Outpatient       Outpatient
S.3.3.3   Service authorizations      Requests, responses and          Automatically retrieves information needed to                       Plans reported that their electronic         O-Optional        M-Maybe
                                      appeals related to service       support verification of medical necessity and prior                 connections to various types of providers
                                      authorization, including prior   authorization of services at the appropriate juncture               enable numerous functions to be completed
                                      authorizations, referrals, and   in the encounter workflow. Improves timeliness of                   over the Internet, including claims
                                      pre-certification;               patient care and reduces claim denials.                             submission, online eligibility verification,
                                                                                                                                           and referral approvals. P.9 - Promoting
                                                                                                                                           Prevention Through Information
                                                                                                                                           Technology: Assessment of Information
                                                                                                                                           Technology in Association of Health Center
                                                                                                                                           Affiliated Health Plans
                                                                                                                                           http://www.ahcahp.org/publications/Working
                                                                                                                                           %20Papers/Final%20Report%20from%2020
                                                                                                                                           03%20AHCAHP%20IT%20Assessment.pdf

S.3.3.4   Support of service          Support health care              Automatically retrieves structured data, including                  Electronic transmission of clinical data for EF-Essential Future R-Required
          requests and claims;        attachments for submitting       lab, imaging and device monitoring data, and                        claims is a required HIPAA transaction in
                                      additional clinical              unstructured text based on rules or requests for                    the US that is under development. See
                                      information in support of        additional clinical information in support of service               http://www.hl7.org/library/committees/ca/hip
                                      service requests and claims;     requests or claims at the appropriate juncture in the               aa%20and%20claims%20attachments%20w
                                                                       encounter workflow                                                  hite%20paper%2020030920.pdf for details.


S.3.3.5   Claims and encounter      Support claims and encounter Automatically retrieves information needed to                             Electronic submission of claims data is a   E-Essential        R-Required
          reports for reimbursement reports for reimbursement    support claims and encounter reporting at the                             required HIPAA transaction in the US. See
                                                                 appropriate juncture in the encounter workflow.                           the 837 Implementation Guide available at
                                                                                                                                           http://www.wpc-
                                                                                                                                           edi.com/hipaa/HIPAA_40.asp. - - - -
S.3.3.6   Health service reports at   Support health service reports Clinicians do not perform additional data entry to                    IOM Key Capabilities of an Electronic       EF-Essential Future R-Required
          the conclusion of an        to public health entities, such support health management programs and                               Health Record System p. 14
          episode of care.            as notifiable condition         reporting.                                                           http://www.iom.edu/report.asp?id=14391 -
                                      reports, immunization, cancer                                                                        HIMSS Electronic Health Record
                                      registry and discharge data                                                                          Definitional Model - Version 1.0
                                      that a provider may be
                                      required to generate at the
                                      conclusion of an episode of
                                      care.

S.3.3.7   Receipt of clinical and     Provide the appropriate          Example of the use of information: prompts the                                                                  EF-Essential Future R-Required
          administrative responses    information from the receipt     provider about the receipt of an acknowledgement
          and acknowledgements        of clinical and administrative   and displays data relevant to the episode of care at
                                      responses and                    the appropriate juncture in the workflow
                                      acknowledgements for use by
                                      and guidance to EHR-S users




 Version 7.0                                                                                                  page 34 of 71                                                      Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                        DoD EHR - HL7 EHR Mapping                                                                            HL7 EHR-S Profile Coding
HL7       HL7                         HL7                               HL7                                                HL7                         HL7                                           DoD EHR            DoD EHR
EHR       EHR                         EHR                               EHR                                                EHR                         EHR                                           Constrainable      Implementable
ID        Function                    Function                          Functional                                         Rationale                   Secondary                                     Functional Profile Functional Profile
          Name                        Statement                         Description                                                                    Citation                                      PRIORITY           REQUIRED
                                                                                                                                                                                                     CODING             CODING
                                                                                                                                                                                                     for Ambulatory - for Ambulatory -
                                                                                                                                                                                                     Outpatient       Outpatient
S.3.4.0   Practitioner/Patient        Manage practitioner and                                                              1. Support delivery of      IOM Rpt, page 9, "Effective communication -
          Relationship                patient relationships.                                                               effective healthcare - 3.   among health care team members and with
                                                                                                                           Facilitate management       patients - is critical to the provision of
                                                                                                                           of chronic conditions -     quality health care (Bates and Gawande,
                                                                                                                           4. Improve efficiency       2003; Wanlass et. Al. 1992) -
                                                                                                                                                       http://www.iom.edu/report.asp?id=14391


S.3.4.1   Practitioner assignment     Enable practitioner          Example: In a care setting with multiple providers,                                                                               O-Optional        M-Maybe
                                      assignment based on business where the patient can only see certain kinds of
                                      and clinical practice rules  providers, (or an individual provider); allow the
                                                                   selection of only the appropriate providers (in
                                                                   conjunction with the provider registry).

S.3.4.2   Patient list management     Provide the ability to manage                                                                                                                                  E-Essential       R-Required
                                      patient lists assigned to a
                                      particular provider.

S.3.5.0   Patient to Other Persons    Facilitate access             Facilitate access to/propagation of information        1. Support Delivery of      An EHR used at a professional site should   O-Optional          M-Maybe
          Relationship                to/propagation of information between patient records where patients are related -   Effective Healthcare - 3    support personal health information
                                      between patient records                                                              Facilitate management       (http://www.connectingforhealth.org/resourc
                                      where patients are related                                                           of chronic conditions       es/phwg_final_report.pdf). - - Why Keeping
                                                                                                                                                       Family Health Records is a Good Idea -
                                                                                                                                                       http://www.health-
                                                                                                                                                       minder.com/articles/benefits.htm

S.3.5.1   Related by genealogy        Provide information of                                                                                                                                         O-Optional        M-Maybe
                                      Related by genealogy (blood
                                      relatives)
S.3.5.2   Related by insurance        Provide information of                                                                                                                                         O-Optional        M-Maybe
                                      Related by insurance
                                      (domestic partner, spouse,
                                      guarantor)
S.3.5.3   Related by living situation Provide information of                                                                                                                                         O-Optional        M-Maybe
                                      Related by living situation (in
                                      same household)
S.3.5.4   Related by other means      Provide information of                                                                                           Contact tracing is an essential and required O-Optional         M-Maybe
                                      Related by other means (e.g.                                                                                     feature of public health and has usefulness
                                      epidemiologic exposure)                                                                                          outside of public health when evaluating non-
                                                                                                                                                       reportable infectious disease or genetically
                                                                                                                                                       related conditions. -
                                                                                                                                                       (http://biotech.law.lsu.edu/Books/lbb/x578.ht
                                                                                                                                                       m)




 Version 7.0                                                                                              page 35 of 71                                                                      Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                              DoD EHR - HL7 EHR Mapping                                                                             HL7 EHR-S Profile Coding
HL7       HL7                          HL7                               HL7                                                    HL7                          HL7                                          DoD EHR            DoD EHR
EHR       EHR                          EHR                               EHR                                                    EHR                          EHR                                          Constrainable      Implementable
ID        Function                     Function                          Functional                                             Rationale                    Secondary                                    Functional Profile Functional Profile
          Name                         Statement                         Description                                                                         Citation                                     PRIORITY           REQUIRED
                                                                                                                                                                                                          CODING             CODING
                                                                                                                                                                                                          for Ambulatory - for Ambulatory -
                                                                                                                                                                                                          Outpatient       Outpatient
S.3.6.0   Acuity and Severity          Provide the capability to         Provide the capability to support and manage           1. Support Delivery of       An Integrated Analysis of Staffing and EF-Essential Future R-Required
                                       support and manage patient        patient acuity/severity of illness/risk adjustment -   Effective Healthcare - 2     Effects on Patient Outcomes
                                       acuity/severity of illness/risk                                                          Improve Patient Safety -     http://www.nursingworld.org/OJIN/KEYNO
                                       adjustment                                                                               - 4 Improve efficiency       TES/speech_3.htm


S.3.6.1                            Support and manage patient
          Patient acuity/severity of                                                                                                                                                                      EF-Essential Future R-Required
          illness/risk adjustment  acuity/severity of illness/risk
                                   adjustments.
S.3.6.2   Provider staff leveling  Adjust provider staffing levels                                                                                                                                        EF-Essential Future R-Required
          adjustment               in relation of patient
                                   acuity/severity and illness/risk
                                   status
S.3.7.0   Automated update for     Update EHR supportive                                                                        1. Support Delivery of                                                    EF-Essential Future R-Required
          EHR supportive content - content on an automated                                                                      Effective Healthcare -
          Update EHR supportive basis.                                                                                          2. Improve Patient
          content on an automated                                                                                               Safety - 3. Facilitate
          basis.                                                                                                                management of chronic
                                                                                                                                conditions - 4. Improve
                                                                                                                                efficiency - 5. Facilitate
                                                                                                                                self-health management


S.3.7.1   Clinical decision support Receive and validate                                                                                                     Nearly all plans (92 percent) reported having E-Essential       R-Required
          system guidelines updates formatted inbound                                                                                                        one or more IT databases that reference
                                    communications to facilitate                                                                                             clinical criteria, guidelines or protocols.
                                    updating of clinical decision                                                                                            While plans reported a variety of methods
                                    support system guidelines                                                                                                used to communicate clinical criteria,
                                                                                                                                                             guidelines and protocols to providers, e-mail
                                                                                                                                                             and electronic newsletters are seldom used
                                                                                                                                                             and only one of the most widely used
                                                                                                                                                             methods is related to IT. p 3 - Promoting
                                                                                                                                                             Prevention Through Information
                                                                                                                                                             Technology: Assessment of Information
                                                                                                                                                             Technology in Association of Health Center
                                                                                                                                                             Affiliated Health Plans
                                                                                                                                                             http://www.ahcahp.org/publications/Working
                                                                                                                                                             %20Papers/Final%20Report%20from%2020
                                                                                                                                                             03%20AHCAHP%20IT%20Assessment.pdf




 Version 7.0                                                                                                     page 36 of 71                                                                      Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                 DoD EHR - HL7 EHR Mapping                                           HL7 EHR-S Profile Coding
HL7       HL7                        HL7                             HL7                           HL7         HL7                                        DoD EHR             DoD EHR
EHR       EHR                        EHR                             EHR                           EHR         EHR                                        Constrainable      Implementable
ID        Function                   Function                        Functional                    Rationale   Secondary                                  Functional Profile Functional Profile
          Name                       Statement                       Description                               Citation                                   PRIORITY            REQUIRED
                                                                                                                                                          CODING              CODING
                                                                                                                                                          for Ambulatory - for Ambulatory -
                                                                                                                                                          Outpatient       Outpatient
S.3.7.2   Patient education material Receive and validate                                                      Patient Provider Communication Tools        E-Essential        R-Required
          Updates                    formatted inbound                                                         http://www.chcf.org/documents/ihealth/Patie
                                     communications to facilitate                                              ntProviderCommunicationTools.pdf - -
                                     updating of patient education                                             Informing Patients A Guide for Providing
                                     material                                                                  Patient Health Information -
                                                                                                               http://www.pubmedcentral.nih.gov/articleren
                                                                                                               der.fcgi?artid=61336 - - Promoting
                                                                                                               Prevention Through Information
                                                                                                               Technology: Assessment of Information
                                                                                                               Technology in Association of Health Center
                                                                                                               Affiliated Health Plans -
                                                                                                               http://www.ahcahp.org/publications/Working
                                                                                                               %20Papers/Final%20Report%20from%2020
                                                                                                               03%20AHCAHP%20IT%20Assessment.pdf

S.3.7.3   Physician continuing       Receive and validate                                                      Facility provided continuing education to    EF-Essential Future R-Required
          education information      formatted inbound                                                         professional staff is a recommended
          updates                    communications to facilitate                                              function. See http://dbapps.ama-
                                     updating of physician                                                     assn.org/iwcf/pf_online/pf_online?f_n=result
                                     continuing education                                                      Link&doc=policyfiles/HOD/H-
                                     information                                                               225.997.HTM&s_t=continuing+education&
                                                                                                               catg=AMA/CnB&catg= -
                                                                                                               AMA/CEJA&catg=AMA/HOD&&nth=1&&
                                                                                                               st_p=0&nth=7&)
S.3.7.4   Patient reminder           Receive and validate                                                      Plans reported using IT systems to support   E-Essential         R-Required
          information updates        formatted inbound                                                         numerous activities and processes, such as
                                     communications to facilitate                                              utilization management, disease
                                     updating of patient reminder                                              management and targeted mailings to
                                     information from external                                                 members. P. 3 Promoting Prevention
                                     sources such as Cancer or                                                 Through Information Technology:
                                     Immunization Registries                                                   Assessment of Information Technology in
                                                                                                               Association of Health Center Affiliated
                                                                                                               Health Plans
                                                                                                               http://www.ahcahp.org/publications/Working
                                                                                                               %20Papers/Final%20Report%20from%2020
                                                                                                               03%20AHCAHP%20IT%20Assessment.pdf -

S.3.7.5   Public health related      Receive and validate                                                      Public health response information changes EF-Essential Future R-Required
          updates                    formatted inbound                                                         continually and the ability to access the latest
                                     communications to facilitate                                              data by EHR users is essential
                                     updating of public health                                                 (http://www.cdc.gov/phin/components/PHIN
                                     reporting guidelines                                                      %20Brochure%20HAN%20.ppt). -




 Version 7.0                                                                              page 37 of 71                                              Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                        DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7       HL7                       HL7                            HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                       EHR                            EHR                                                     EHR                        EHR            Constrainable      Implementable
ID        Function                  Function                       Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
          Name                      Statement                      Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                     CODING             CODING
                                                                                                                                                                     for Ambulatory - for Ambulatory -
                                                                                                                                                                     Outpatient       Outpatient
I.1       INFORMATION
          INFRASTRUCTURE


I.1.1     Security



I.1.1.0   EHR Information Security Secure the EHR information. The EHRS is required to manage EHR information              1. Support delivery of                    E-Essential       R-Required
                                                               securely. For this, all EHRS applications must              effective healthcare 2.
                                                               ensure the authentication, authorization of entities        Improve patient safety 3
                                                               (e.g. user and applications) and control access to          Facilitate management
                                                               the EHR information.                                        of chronic conditions 4.
                                                                                                                           Improve efficiency 5.
                                                                                                                           Facilitate self-health
                                                                                                                           management 6. Ensure
                                                                                                                           privacy, confidentiality




I.1.1.1   Entity Authentication     Authenticate EHRS users        Both users and application are subject to               1. Support delivery of                    E-Essential       R-Required
                                    and/or entities before         authentication. EHRS application must provide           effective healthcare 2.
                                    allowing access to an EHRS. mechanisms for users and applications to be                Improve patient safety 3
                                                                   authenticated. Users will have to be authenticate       Facilitate management
                                                                   when they attempt to use the application, the           of chronic conditions 4.
                                                                   applications themselves must authenticate               Improve efficiency 5.
                                                                   themselves before accessing EHR information             Facilitate self-health
                                                                   managed by other application or remote EHR              management 6. Ensure
                                                                   Systems. Examples of entity authentication are: •       privacy, confidentiality
                                                                   Username/ password • Digital certificate • Secure
                                                                   token • Biometrics
I.1.1.2   Entity Authorization      Manage the sets of access-     Users of the EHRS will be allowed to use only the       1. Support delivery of                    E-Essential       R-Required
                                    control permissions granted to functions for which they authorized depending on        effective healthcare 2.
                                    EHRS-Users.                    their role, work assignment, location ,etc. Similarly   Improve patient safety 3
                                                                   applications will need to be authorized to access       Facilitate management
                                                                   certain types of EHR data. Financial applications       of chronic conditions 4.
                                                                   will be limited by their role in the types of EHR       Improve efficiency 5.
                                                                   data they may exchange. For example,                    Facilitate self-health
                                                                   authorization functions may control access to           management 6. Ensure
                                                                   EHRS: • Application modules • Application               privacy, confidentiality
                                                                   features • Data records




  Version 7.0                                                                                             page 38 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                            DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7         HL7                        HL7                              HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                        EHR                              EHR                                                    EHR                        EHR            Constrainable      Implementable
ID          Function                   Function                         Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
            Name                       Statement                        Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                         CODING             CODING
                                                                                                                                                                         for Ambulatory - for Ambulatory -
                                                                                                                                                                         Outpatient       Outpatient
I.1.1.2.1   Role-Based authorization Authorize access to EHRS           The role of a user is in regards to authorization to   1. Support delivery of                    E-Essential       R-Required
                                     functions and/or data based        access any subject. Examples of EHRS-User roles        effective healthcare 2.
                                     on an entity's role.               include: nurse, dietician, administrator, legal        Improve patient safety 3
                                                                        guardian, and auditor. Similarly the role of an        Facilitate management
                                                                        application will determine what types of               of chronic conditions 4.
                                                                        information in may query, access, or view when         Improve efficiency 5.
                                                                        interoperating with complementary applications in      Facilitate self-health
                                                                        the EHRS.                                              management 6. Ensure
                                                                                                                               privacy, confidentiality




I.1.1.2.2   User-Based authorization Override existing role-based       For example, a doctor may typically be allowed to      1. Support delivery of                    E-Essential       R-Required
                                     and/or context-based               view any patient's record in the Emergency             effective healthcare 2.
                                     authorizations. User-based         Department, except when a patient is also a blood-     Improve patient safety 3
                                     authorizations restrict or         relative.                                              Facilitate management
                                     allow an EHRS-user’s access                                                               of chronic conditions 4.
                                     to a patient’s record                                                                     Improve efficiency 5.
                                     (regardless of the user’s role).                                                          Facilitate self-health
                                                                                                                               management 6. Ensure
                                                                                                                               privacy, confidentiality




  Version 7.0                                                                                                  page 39 of 71                                          Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                        DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7         HL7                    HL7                             HL7                                                      HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                    EHR                             EHR                                                      EHR                        EHR            Constrainable      Implementable
ID          Function               Function                        Functional                                               Rationale                  Secondary      Functional Profile Functional Profile
            Name                   Statement                       Description                                                                         Citation       PRIORITY           REQUIRED
                                                                                                                                                                      CODING             CODING
                                                                                                                                                                      for Ambulatory - for Ambulatory -
                                                                                                                                                                      Outpatient       Outpatient
I.1.1.2.3   Context-Based          Context-based Authorization–    The EHRS must support a set of policies to ensure        1. Support delivery of                    E-Essential       R-Required
            authorization          Authorize access to EHRS        that the users can access the information they need      effective healthcare 2.
                                   functions and/or data based     and they must reference for complete and correct         Improve patient safety 3
                                   on geographic, time-related,    clinical decision. Context-based authorization           Facilitate management
                                   assignment-related, consent-    extends Role and User-based Authorization by             of chronic conditions 4.
                                   related, or other healthcare-   overlaying business rules and policies to the user       Improve efficiency 5.
                                   related contexts (and           and role. For example, • A nurse may be able to          Facilitate self-health
                                   according to specific care-     access the EHR’s of patients in the maternity            management 6. Ensure
                                   setting profiles).              department but not in the neurosurgery department.       privacy, confidentiality
                                                                   • A doctor may be able to access a patient’s EHR
                                                                   before his shift ends, but not after his shift ends. •
                                                                   A dietician may be able to access those parts of a
                                                                   patient’s EHR that impact food-selection, but not
                                                                   other parts of that patient’s EHR. • A physician
                                                                   may not be permitted to access parts of a patient’s
                                                                   EHR that pertain to a civil or criminal matter. • An
                                                                   EHRS-User may only use a patient’s data in a
                                                                   manner consistent with the patient’s (explicit or
                                                                   implied) consent. • A physician may be able to
                                                                   access a given patient’s EHR while providing
                                                                   healthcare, but not while conducting research. • A
                                                                   physician may restrict a patient’s access to the
                                                                   patient’s EHR if the physician believes such access
                                                                   may be harmful to the patient (for example, a
I.1.1.4     Secure Data Exchange   Send and receive EHR data       suicidalthe personal nature patient).
                                                                   Due to or hypochondriac of the data, Electronic          1. Support delivery of                    E-Essential       R-Required
                                   securely.                       Health Record information requires security and          effective healthcare 2.
                                                                   privacy considerations that exceed typical               Improve patient safety 3
                                                                   electronic data security standards.                      Facilitate management
                                                                                                                            of chronic conditions 4.
                                                                                                                            Improve efficiency 5.
                                                                                                                            Facilitate self-health
                                                                                                                            management 6. Ensure
                                                                                                                            privacy, confidentiality




  Version 7.0                                                                                              page 40 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                        DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7         HL7                   HL7                              HL7                                                      HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                   EHR                              EHR                                                      EHR                        EHR            Constrainable      Implementable
ID          Function              Function                         Functional                                               Rationale                  Secondary      Functional Profile Functional Profile
            Name                  Statement                        Description                                                                         Citation       PRIORITY           REQUIRED
                                                                                                                                                                      CODING             CODING
                                                                                                                                                                      for Ambulatory - for Ambulatory -
                                                                                                                                                                      Outpatient       Outpatient
I.1.1.4.1   Data Obfuscation      Obscure electronically-          Since the EHRS applications cannot control               1. Support delivery of                    EF-Essential Future R-Required
                                  exchanged EHR data to            security of the transmission methods, applications       effective healthcare 2.
                                  inhibit unauthorized data-       must obfuscate the data sent to application within       Improve patient safety 3
                                  access (according to             the EHRS and particularly to remote entities.            Facilitate management
                                  applicable healthcare-specific                                                            of chronic conditions 4.
                                  rules and relevant standards).                                                            Improve efficiency 5.
                                                                                                                            Facilitate self-health
                                                                                                                            management 6. Ensure
                                                                                                                            privacy, confidentiality


I.1.1.4.2   Secure Data Routing   Route electronically-            EHRS application need to ensure that they are            1. Support delivery of                    E-Essential        R-Required
                                  exchanged EHR data only          exchanging EHR information with the entities             effective healthcare 2.
                                  to/from known, registered,       (applications, institutions, directories) they expect.   Improve patient safety 3
                                  and authenticated                This function depends on Entity Lookup,                  Facilitate management
                                  destinations/sources             Authorization, and Authentication to be available        of chronic conditions 4.
                                  (according to applicable         in the system. For example, a physician practice         Improve efficiency 5.
                                  healthcare-specific rules and    management application in the EHRS, might send           Facilitate self-health
                                  relevant standards).             claim attachment information to an external entity.      management 6. Ensure
                                                                   For this, the application must use a secure routing      privacy, confidentiality
                                                                   method which ensures that both the sender and
                                                                   receiving sides are authorized to engage in the
                                                                   information exchange.

I.1.1.4.3   Non-repudiation       Limit an EHRS-User’s ability     In general terms, the term "non-repudiation" crypto-     1. Support delivery of                    EF-Essential Future R-Required
                                  to deny (repudiate) an           technically means: In authentication, a service that     effective healthcare 2.
                                  electronic data-exchange         provides proof of the integrity and origin of data,      Improve patient safety 3
                                  originated or authorized by      both in an unforgeable relationship, which can be        Facilitate management
                                  that user.                       verified by any third party at any time; or, In          of chronic conditions 4.
                                                                   authentication, an authentication that with high         Improve efficiency 5.
                                                                   assurance can be asserted to be genuine, and that        Facilitate self-health
                                                                   can not subsequently be refuted. In the electronic       management 6. Ensure
                                                                   commerce environment, the technical meaning of           privacy, confidentiality
                                                                   the term "non-repudiation" either shifts the onus of
                                                                   proof from the recipient to the alleged signatory or
                                                                   entirely denies the signatory the right to repudiate a
                                                                   digital signature. That is, if a digital signature is
                                                                   verified so as to identify the owner of the private
                                                                   key that was used to create the digital signature in
                                                                   question then it is that person who has the onus of
                                                                   proving that it is not their digital signature. Hence,
                                                                   there is a shift in the burden of proof. This crypto-
                                                                   technical position does not correspond with what
                                                                   occurs in the paper-based environment.




  Version 7.0                                                                                              page 41 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                         DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7         HL7                     HL7                             HL7                                                      HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                     EHR                             EHR                                                      EHR                        EHR            Constrainable      Implementable
ID          Function                Function                        Functional                                               Rationale                  Secondary      Functional Profile Functional Profile
            Name                    Statement                       Description                                                                         Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.1.4.4   Data-Exchange Privacy   Limit EHR data                  Communicating the EHR or parts of it to third            1. Support delivery of                    EF-Essential Future R-Required
                                    communications to those         parties that have a legal or other legitimate interest   effective healthcare 2.
                                    explicitly (or implicitly)      in the record should have explicit and documented        Improve patient safety 3
                                    authorized by the subject-of-   authorization by the patient. Including a clear          Facilitate management
                                    care or to those that have a    understanding by the third party that the                of chronic conditions 4.
                                    legal (or other legitimate)     information will only be used for the stated             Improve efficiency 5.
                                    need.                           purpose.                                                 Facilitate self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality


I.1.1.5     Patient Privacy         Protect the patient’s privacy   Functionality allows for compliance with personal, 1. Support delivery of                          E-Essential        R-Required
                                    according to personal, local,   local, and national rules.                         effective healthcare 2.
                                    and national rules.                                                                Improve patient safety 3
                                                                                                                       Facilitate management
                                                                                                                       of chronic conditions 4.
                                                                                                                       Improve efficiency 5.
                                                                                                                       Facilitate self-health
                                                                                                                       management 6. Ensure
                                                                                                                       privacy, confidentiality




  Version 7.0                                                                                               page 42 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                               DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7         HL7                         HL7                                HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                         EHR                                EHR                                                     EHR                        EHR            Constrainable      Implementable
ID          Function                    Function                           Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
            Name                        Statement                          Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                             CODING             CODING
                                                                                                                                                                             for Ambulatory - for Ambulatory -
                                                                                                                                                                             Outpatient       Outpatient
I.1.1.5.1   Personal patient-privacy    Protect personal privacy           The electronic health record will allow for the         1. Support delivery of                    EF-Essential Future R-Required
            rules                       according to best-practice         assignment, removal, and tracking of anonymous,         effective healthcare 2.
                                        standards.                         de-identified, alias, and restricted access status of   Improve patient safety 3
                                                                           protected health information. For example: • Make       Facilitate management
                                                                           anonymize, de-identify, or apply alias to EHR data      of chronic conditions 4.
                                                                           provided for public health, clinical research, and      Improve efficiency 5.
                                                                           population health initiatives. Re-identify specific     Facilitate self-health
                                                                           data in special cases (e.g., disease-outbreak           management 6. Ensure
                                                                           detection). • Include or exclude a subject-of-care’s    privacy, confidentiality
                                                                           data for specific purposes (such as for research or
                                                                           public health initiatives). An example of "best-
                                                                           practice standard" would be the HIPAA Privacy
                                                                           Rule which requires that covered providers
                                                                           communicate only the minimum necessary
                                                                           information about a patient for payment or
                                                                           operations. With respect to HIPAA transactions, a
                                                                           covered provider may only transmit situational data
                                                                           elements when these are required by a condition
                                                                           stated in the transaction implementation guide. In
                                                                           addition, a covered provider can only communicate
                                                                           the minimum necessary information needed for
                                                                           operations purposes such as quality-related health
                                                                           care activities or fraud and abuse detection.



I.1.1.5.2   Local and National patient- Support mechanisms for             The electronic health record will allow for the         1. Support delivery of                    EF-Essential Future R-Required
            privacy rules               implementing (codifying),          compliance with realm-specific privacy rules. An        effective healthcare 2.
                                        validating, and displaying         example of such rule is the HIPAA Privacy Rule          Improve patient safety 3
                                        local and national (realm-)        which gives patients the right to request               Facilitate management
                                        specific privacy rules. The        suppression of their health care information under      of chronic conditions 4.
                                        rules defining patient privacy     circumstances such as domestic violence. If the         Improve efficiency 5.
                                        requirements will be codified      provider agrees to do this, then the provider must      Facilitate self-health
                                        in the EHRS. These rules will      ensure that the patient's protected health              management 6. Ensure
                                        be used by EHRS applications       information is not disclosed per this agreement.        privacy, confidentiality
                                        to ensure that the privacy         Some states have more stringent laws that preempt
                                        level defined for the patient is   HIPAA. For example, in some states, patients, who
                                        maintained (for example, at        are minors, have a right to suppress protected
                                        the jurisdictional,                health information related to sensitive services such
                                        organizational, or patient-        as treatment for reproductive health, mental health,
                                        specified level).                  and substance abuse.




  Version 7.0                                                                                                     page 43 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                      DoD EHR - HL7 EHR Mapping                                           HL7 EHR-S Profile Coding
HL7         HL7                     HL7                           HL7                                               HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                     EHR                           EHR                                               EHR                        EHR            Constrainable      Implementable
ID          Function                Function                      Functional                                        Rationale                  Secondary      Functional Profile Functional Profile
            Name                    Statement                     Description                                                                  Citation       PRIORITY           REQUIRED
                                                                                                                                                              CODING             CODING
                                                                                                                                                              for Ambulatory - for Ambulatory -
                                                                                                                                                              Outpatient       Outpatient
I.1.1.5.3   Advisement of Patient   Record that the patient was   The EHRS will allow for the dispensing and        1. Support delivery of                    EF-Essential Future R-Required
            Privacy Rights          informed of current privacy   tracking of patient education regarding current   effective healthcare 2.
                                    policies practices.           privacy policies and procedures.                  Improve patient safety 3
                                                                                                                    Facilitate management
                                                                                                                    of chronic conditions 4.
                                                                                                                    Improve efficiency 5.
                                                                                                                    Facilitate self-health
                                                                                                                    management 6. Ensure
                                                                                                                    privacy, confidentiality




  Version 7.0                                                                                           page 44 of 71                                      Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                       DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7       HL7                     HL7                              HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                     EHR                              EHR                                                     EHR                        EHR            Constrainable      Implementable
ID        Function                Function                         Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
          Name                    Statement                        Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                     CODING             CODING
                                                                                                                                                                     for Ambulatory - for Ambulatory -
                                                                                                                                                                     Outpatient       Outpatient
I.1.2     Health Record
          Information &
          Management
I.1.2.0   EHR Information         Manage the EHR information Electronic Health Record information will be                  1. Support delivery of                    E-Essential       R-Required
          Management (Record      across EHRS applications   available on a variety of EHRS applications. The              effective healthcare 2.
          Management)                                        EHRS must provide the ability for users to access             Improve patient safety 3
                                                             this information, to manage it, to control access to          Facilitate management
                                                             it, and to audit the use and access of data.                  of chronic conditions 4.
                                                                                                                           Improve efficiency 5.
                                                                                                                           Facilitate self-health
                                                                                                                           management 6. Ensure
                                                                                                                           privacy, confidentiality




I.1.2.1   Information Integrity   Ensure that clinical             An important aspect of maintaining a legally sound      1. Support delivery of                    E-Essential       R-Required
                                  information is valid according   health record is securing the record to prevent loss,   effective healthcare 2.
                                  to the healthcare-specific       tampering, or unauthorized use. The integrity of the    Improve patient safety 3
                                  business rules.                  health record may be questioned in a legal              Facilitate management
                                                                   proceeding if concerns are raised about the security    of chronic conditions 4.
                                                                   of paper-based or electronic records. The Rules of      Improve efficiency 5.
                                                                   Evidence require an organization to have policies       Facilitate self-health
                                                                   and procedures in place to protect against              management 6. Ensure
                                                                   alterations, tampering, and loss. Systems and           privacy, confidentiality
                                                                   procedures should also be in place to prevent loss
                                                                   (such as tracking and sign-out procedures), secure
                                                                   record storage areas or systems, and limit access to
                                                                   only authorized users. For example, • Entered data
                                                                   must be validated based on system edit rules and
                                                                   valid code sets. These may be field specific (i.e.
                                                                   valid list of values), intra-record (i.e. date
                                                                   deceased) date of birth), or they may extend across
                                                                   multiple related records (i.e. test order must exist
                                                                   before test results can be recorded). • Healthcare
                                                                   documents must not be altered as dictated by the
                                                                   “Uniform Rules of Evidence” and the ”Federal
                                                                   Rules of Evidence”. • Translations between
                                                                   numbering systems and written languages must not
                                                                   result in substantive document alterations.




  Version 7.0                                                                                             page 45 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                    DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7       HL7                    HL7                             HL7                                                   HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                    EHR                             EHR                                                   EHR                        EHR            Constrainable      Implementable
ID        Function               Function                        Functional                                            Rationale                  Secondary      Functional Profile Functional Profile
          Name                   Statement                       Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                 CODING             CODING
                                                                                                                                                                 for Ambulatory - for Ambulatory -
                                                                                                                                                                 Outpatient       Outpatient
I.1.2.2   Document Retention     Retain all clinical documents   Each healthcare provider should develop a             1. Support delivery of                    E-Essential        R-Required
                                 (including complex standards-   retention schedule for patient health information     effective healthcare 2.
                                 based clinical documents) for   that meets the needs of its patients, physicians,     Improve patient safety 3
                                 the policy-designated or        researchers, and other legitimate users, and          Facilitate management
                                 legally-designated time         complies with legal, regulatory, and accreditation    of chronic conditions 4.
                                 period.                         requirements. EHRS applications must conform to       Improve efficiency 5.
                                                                 the current rules.                                    Facilitate self-health
                                                                                                                       management 6. Ensure
                                                                                                                       privacy, confidentiality




I.1.2.3   Inbound Documents      Retain inbound documents as An important aspect of maintaining a legally sound        1. Support delivery of                    EF-Essential Future R-Required
                                 received (unaltered).       health record is securing the record to prevent loss,     effective healthcare 2.
                                                             tampering, or unauthorized use. The integrity of the      Improve patient safety 3
                                                             health record may be questioned in a legal                Facilitate management
                                                             proceeding if concerns are raised about the security      of chronic conditions 4.
                                                             of the electronic health record. Therefore when           Improve efficiency 5.
                                                             clinical documents are exchanged by EHRS                  Facilitate self-health
                                                             applications, the receiving application is expected       management 6. Ensure
                                                             to retain inbound documents unchanged.                    privacy, confidentiality




I.1.2.4   Document Attestation   Support electronic attestation The purpose of authentication is to show authorship    1. Support delivery of                    E-Essential        R-Required
                                 of documents.                  and assign responsibility for an act, event,           effective healthcare 2.
                                                                condition, opinion, or diagnosis. Every entry in the   Improve patient safety 3
                                                                health record must be authenticated by the author      Facilitate management
                                                                and should not be made or signed by someone other      of chronic conditions 4.
                                                                than the author. This includes all types of entries    Improve efficiency 5.
                                                                such as narrative/progress notes, assessments, flow    Facilitate self-health
                                                                sheets, orders, etc., whether in paper or electronic   management 6. Ensure
                                                                format. For example, digital signatures may be used    privacy, confidentiality
                                                                to implement document attestation for EHR.




  Version 7.0                                                                                          page 46 of 71                                          Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                          DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7         HL7                     HL7                               HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                     EHR                               EHR                                                    EHR                        EHR            Constrainable      Implementable
ID          Function                Function                          Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
            Name                    Statement                         Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.2.4.1   Retention of Document   Retain the signature of           For example, retain a digital signature that was       1. Support delivery of                    EF-Essential Future R-Required
            Attestation             attestation (or certificate of    included with an inbound clinical document.            effective healthcare 2.
                                    authenticity) associated with                                                            Improve patient safety 3
                                    an incoming or outgoing                                                                  Facilitate management
                                    document.                                                                                of chronic conditions 4.
                                                                                                                             Improve efficiency 5.
                                                                                                                             Facilitate self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality




I.1.2.5     Confidentiality         Promote patient                   This section deals with the enforcements of the        1. Support delivery of                    E-Essential        R-Required
                                    confidentiality by enforcing      privacy rules. Patients may be harmed if their         effective healthcare 2.
                                    the privacy rules that apply to   privacy is invaded (including unauthorized access      Improve patient safety 3
                                    various parts of the EHR.         to Electronic Healthcare Records), or if the patient   Facilitate management
                                                                      a part of their records that they must not access or   of chronic conditions 4.
                                                                      view.                                                  Improve efficiency 5.
                                                                                                                             Facilitate self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality




  Version 7.0                                                                                                page 47 of 71                                          Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                           DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7         HL7                       HL7                              HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                       EHR                              EHR                                                     EHR                        EHR            Constrainable      Implementable
ID          Function                  Function                         Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
            Name                      Statement                        Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                         CODING             CODING
                                                                                                                                                                         for Ambulatory - for Ambulatory -
                                                                                                                                                                         Outpatient       Outpatient
I.1.2.5.1   Protection of Patient     Provide the mechanisms to        The EHRS must provide EHR confidentiality-              1. Support delivery of                    E-Essential       R-Required
            Privacy                   implement adherence to the       controls that minimize each type of harm. This          effective healthcare 2.
                                      patient privacy rules codified   function requires that the EHRS implement               Improve patient safety 3
                                      in the EHR Information           mechanisms to protect the confidentiality of the        Facilitate management
                                      Security subsection of the       Electronic Health Record in a consistent way by         of chronic conditions 4.
                                      Information Infrastructure       enforcing rules and policies defined by the best-       Improve efficiency 5.
                                      section of this document.        practice standards and governmental organization.       Facilitate self-health
                                                                       EHR Information Security controls differ for            management 6. Ensure
                                                                       various care-settings. The EHR Information              privacy, confidentiality
                                                                       Security subsection of the Information
                                                                       Infrastructure section of this document details those
                                                                       controls. For example, to comply with HIPAA
                                                                       Privacy Rule requirement that a covered provider
                                                                       only transmit situational data that is required under
                                                                       certain conditions, the provider or its billing
                                                                       service/clearinghouse, must have edits in place in
                                                                       the systems that process transactions that ensure
                                                                       this requirement is met. In order to support
                                                                       administrative and financial reporting in Section
                                                                       6.3.0.0, the EHR must collect data necessary for the
                                                                       transaction processing systems to support this
                                                                       requirement. Consider also a patient who is
                                                                       suffering physical abuse by a guardian. If the
                                                                       guardian reads certain portions of the provider's
                                                                       notes, the patient might be further endangered.
I.1.2.5.2   Restrict Patient Access   Enable a healthcare              Although patient mightthe right to view much of
                                                                       Finally, a a patient has not even confide in the        1. Support delivery of                    E-Essential       R-Required
                                      professional to restrict a       his/her Electronic Healthcare Record, a healthcare      effective healthcare 2.
                                      patient’s access to EHR data     provider sometimes needs to prevent a patient (or       Improve patient safety 3
                                      that is potentially harmful to   guardian) from viewing parts of the record.             Facilitate management
                                      the patient/subject-of-care.     Consider, for example, a patient receiving              of chronic conditions 4.
                                                                       psychiatric care: the patient might harm himself (or    Improve efficiency 5.
                                                                       others) if he reads the doctor's evaluation of his      Facilitate self-health
                                                                       condition. Furthermore, reading the doctor's            management 6. Ensure
                                                                       therapy-plan might actually cause the plan to fail.     privacy, confidentiality




  Version 7.0                                                                                                 page 48 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                           DoD EHR - HL7 EHR Mapping                                               HL7 EHR-S Profile Coding
HL7         HL7                      HL7                               HL7                                                   HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                      EHR                               EHR                                                   EHR                        EHR            Constrainable      Implementable
ID          Function                 Function                          Functional                                            Rationale                  Secondary      Functional Profile Functional Profile
            Name                     Statement                         Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.2.6     Audit trail              Track changes to EHR data to      Most information systems benefit from the quality     1. Support delivery of                    E-Essential       R-Required
                                     verify enforcement of             control offered by an audit trail. All systems that   effective healthcare 2.
                                     business, security, and access-   are backed up, for example, also note the date and    Improve patient safety 3
                                     control rules.                    time of the backup in an audit log. Healthcare-       Facilitate management
                                                                       related information systems, however, have many       of chronic conditions 4.
                                                                       additional events and controls that must be audited   Improve efficiency 5.
                                                                       (tracked) due to the sensitive (personal) nature of   Facilitate self-health
                                                                       the healthcare data itself. For example: HIPAA        management 6. Ensure
                                                                       Security Rule Section 164.308(a)(1)(i) Security       privacy, confidentiality
                                                                       Management Process requires Information System
                                                                       Activity Review, which means to "Implement
                                                                       procedures to regularly review records of
                                                                       information system activity, such as audit logs,
                                                                       access reports, and security incident tracking
                                                                       reports."

I.1.2.6.1   Amendment history        Track amendments to clinical Once an clinical document receives a mark of               1. Support delivery of                    E-Essential       R-Required
                                     documents.                   attestation by a healthcare provider, (e.g., a             effective healthcare 2.
                                                                  signature), it becomes a legal document and must           Improve patient safety 3
                                                                  be preserved in an unaltered fashion. Sometimes,           Facilitate management
                                                                  however, corrections or amendments need to be              of chronic conditions 4.
                                                                  made to the document. In these cases, the EHRS             Improve efficiency 5.
                                                                  must keep track of the corrections or amendments           Facilitate self-health
                                                                  such that the integrity of the original (signed)           management 6. Ensure
                                                                  document is still preserved.                               privacy, confidentiality




I.1.2.6.2   Information Lifecycle    Track who, when, and by        The EHRS application must be able to record              1. Support delivery of                    E-Essential       R-Required
            Alteration-Event audit   which system an EHR record information required to determine who altered                effective healthcare 2.
                                     was created, updated,          EHR related information in that application.             Improve patient safety 3
                                     translated or (if local policy                                                          Facilitate management
                                     permits) deleted.                                                                       of chronic conditions 4.
                                                                                                                             Improve efficiency 5.
                                                                                                                             Facilitate self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality




  Version 7.0                                                                                                page 49 of 71                                          Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                         DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7         HL7                     HL7                             HL7                                                      HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                     EHR                             EHR                                                      EHR                        EHR            Constrainable      Implementable
ID          Function                Function                        Functional                                               Rationale                  Secondary      Functional Profile Functional Profile
            Name                    Statement                       Description                                                                         Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.2.6.3   Information Lifecycle   Track who, when, and by    The EHRS application must be able to record                   1. Support delivery of                    E-Essential       R-Required
            Access-Event audit      which system an EHR record information required to determine who viewed or               effective healthcare 2.
                                    was viewed or extracted.   extracted EHR related information from that                   Improve patient safety 3
                                                               application.                                                  Facilitate management
                                                                                                                             of chronic conditions 4.
                                                                                                                             Improve efficiency 5.
                                                                                                                             Facilitate self-health
                                                                                                                             management 6. Ensure
                                                                                                                             privacy, confidentiality




I.1.2.6.4   Record audit            Generate an audit report for Differing care-settings benefit from being able to          1. Support delivery of                    E-Essential       R-Required
                                    an EHR record (or for a set of identity the various people or systems that viewed        effective healthcare 2.
                                    EHR records).                  or altered a patient's (or set of patient's) EHR's. For   Improve patient safety 3
                                                                   example, a judge might want to know how many              Facilitate management
                                                                   patients a given healthcare provider treated while        of chronic conditions 4.
                                                                   the provider's license was suspended. Similarly, in       Improve efficiency 5.
                                                                   some cases a report detailing all those who               Facilitate self-health
                                                                   modified or viewed a certain patient record might         management 6. Ensure
                                                                   be needed.                                                privacy, confidentiality




  Version 7.0                                                                                               page 50 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                       DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7         HL7                    HL7                             HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                    EHR                             EHR                                                    EHR                        EHR            Constrainable      Implementable
ID          Function               Function                        Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
            Name                   Statement                       Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                    CODING             CODING
                                                                                                                                                                    for Ambulatory - for Ambulatory -
                                                                                                                                                                    Outpatient       Outpatient
I.1.2.6.5   Security audit         Track and summarize             Often, clinical information is considered to be        1. Support delivery of                    E-Essential        R-Required
                                   attempts by unauthorized        sensitive to the subject-of-care and therefore must    effective healthcare 2.
                                   users to access EHR             be secured. (An example of a care-setting where        Improve patient safety 3
                                   information.                    clinical information may not necessarily be            Facilitate management
                                                                   sensitive to the subject-of-care is veterinary         of chronic conditions 4.
                                                                   medicine.) In addition to actually securing the EHR    Improve efficiency 5.
                                                                   data itself, an EHRS must also be able to prove that   Facilitate self-health
                                                                   it secured the EHR data. A security audit trail can    management 6. Ensure
                                                                   help provide such proof. In large healthcare           privacy, confidentiality
                                                                   settings, EHRS' typically log not only accesses to
                                                                   sensitive EHR data, but attempts to access EHR
                                                                   data by unauthorized users. The level of auditing
                                                                   (detail) required can range anywhere from a local
                                                                   policy to a national standard -- as appropriate to
                                                                   each care-setting. Tracking the attempts of
                                                                   unauthorized users to access sensitive EHR
                                                                   information will enable healthcare organizations to
                                                                   identify the staff members who are not following
                                                                   the local patient privacy rules.

I.1.2.6.6   Information-Exchange   Retain any information          If EHR information is exchanged between EHRS           1. Support delivery of                    EF-Essential Future R-Required
            audit                  exchange details along with     application for viewing or other purposes, the         effective healthcare 2.
                                   any amendment history sent      receiving application must log information about       Improve patient safety 3
                                   with clinical documents by an   the sender and the nature, history, and content of     Facilitate management
                                   external clinical or EHR        the information exchanged in the transaction If any    of chronic conditions 4.
                                   system.                         translations are necessary (.e.g. vocabulary lookup)   Improve efficiency 5.
                                                                   then a record of the transformation must be created    Facilitate self-health
                                                                   by the receiving application. For example, in          management 6. Ensure
                                                                   addition to receiving an EHR from an external          privacy, confidentiality
                                                                   system, receive the amendment history for that
                                                                   record, the identity of the originating system, and
                                                                   details about the receiving system’s reception event
                                                                   (including, when and by whom the EHR and its
                                                                   audit trail were received).




  Version 7.0                                                                                            page 51 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                           DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7         HL7                        HL7                            HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                        EHR                            EHR                                                     EHR                        EHR            Constrainable      Implementable
ID          Function                   Function                       Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
            Name                       Statement                      Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                        CODING             CODING
                                                                                                                                                                        for Ambulatory - for Ambulatory -
                                                                                                                                                                        Outpatient       Outpatient
I.1.2.6.7   Business-Rule audit        Audit compliance of (and       Clinical decision-support rules and administrative      1. Support delivery of                    EF-Essential Future R-Required
                                       overrides to) decision-support (business) decision-support rules are designed to       effective healthcare 2.
                                       business rules.                help the healthcare provider make good, timely,         Improve patient safety 3
                                                                      efficient, and cost-effective medical and workflow-     Facilitate management
                                                                      related decisions. An audit trail provides evidence     of chronic conditions 4.
                                                                      of the healthcare provider's adherence with those       Improve efficiency 5.
                                                                      various rules. Since each healthcare setting requires   Facilitate self-health
                                                                      differing sets of rules, corresponding audit trail      management 6. Ensure
                                                                      requirements will be different for each setting. For    privacy, confidentiality
                                                                      example, in a large hospital a doctor might be
                                                                      expected to deliver control of a patient to another
                                                                      doctor before leaving the hospital when her shift is
                                                                      finished. An corresponding audit trail would
                                                                      indicate whether this rule was followed. A small
                                                                      healthcare practice might have no such rule (and no
                                                                      need for a corresponding audit trail).



I.1.2.7     Data Archival and Storage Persist long-term EHR          The EHRS application must provide facilities to          1. Support delivery of                    E-Essential        R-Required
                                      information according to best- achieve clinical (EHR-related) information.              effective healthcare 2.
                                      practice standards.            Example of best-practices standards: HIPAA               Improve patient safety 3
                                                                     Security Rule Section 164.308(a)(7)(i)                   Facilitate management
                                                                     Administrative Safeguards - Data Backup Plan             of chronic conditions 4.
                                                                     (Required): "Establish and implement procedures          Improve efficiency 5.
                                                                     to create and maintain retrievable exact copies of       Facilitate self-health
                                                                     electronic protected health information."                management 6. Ensure
                                                                                                                              privacy, confidentiality




  Version 7.0                                                                                                page 52 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                        DoD EHR - HL7 EHR Mapping                                                  HL7 EHR-S Profile Coding
HL7         HL7                  HL7                               HL7                                                       HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                  EHR                               EHR                                                       EHR                        EHR            Constrainable      Implementable
ID          Function             Function                          Functional                                                Rationale                  Secondary      Functional Profile Functional Profile
            Name                 Statement                         Description                                                                          Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.2.7.1   Persisted EHR data   Archive and retrieve              Paper-based healthcare records are difficult to           1. Support delivery of                    E-Essential       R-Required
                                 information to/from diverse       view. An electronic implementation of a paper-            effective healthcare 2.
                                 technology storage devices        based system can be just as cumbersome to view.           Improve patient safety 3
                                 based on availability             Therefore, in order for the electronic version of a       Facilitate management
                                 requirements for specific data    healthcare records to prove beneficial, the EHR           of chronic conditions 4.
                                 (according to clinical or         must be archived and retrieved in a semantically          Improve efficiency 5.
                                 administrative business rules).   intelligent and useful manner. A database of              Facilitate self-health
                                                                   clinical and administrative business rules will help      management 6. Ensure
                                                                   present Electronic Health Records to the various          privacy, confidentiality
                                                                   EHR-viewers in efficient and intelligent ways --
                                                                   fulfilling the promise of enhanced access. As
                                                                   technology changes, the means by which the stored
                                                                   data is presented can also change, taking advantage
                                                                   of the particular strengths of each new device. This
                                                                   function requires that information no longer needed
                                                                   by operational EHRS application is persisted
                                                                   (either for ever or for a pre-defined period of time)
                                                                   using appropriate technology and policies to
                                                                   support the business requirements of the EHR. The
                                                                   EHRS must be able to retrieve and allow users to
                                                                   view persisted EHR data.



I.1.2.7.2   Retrospective EHR    Access EHR data                   The EHRS will be able to reconstruct the patient          1. Support delivery of                    E-Essential       R-Required
                                 chronologically, archived for     record in its totality across time and across             effective healthcare 2.
                                 the lifetime of the subject-of-   providers. The EHRS applications will present a           Improve patient safety 3
                                 care. Timestamp notable           view of this data to the clinicians. When Electronic      Facilitate management
                                 healthcare-related points in      Health Records are organized in chronological             of chronic conditions 4.
                                 time (such as time of arrival,    order, a healthcare provider can more easily locate       Improve efficiency 5.
                                 time of record-review, time of    significant healthcare events and begin to construct      Facilitate self-health
                                 physical examination, or time     a basis on which to make informed medical                 management 6. Ensure
                                 of elopement).                    decisions. A provider will typically desire to view a     privacy, confidentiality
                                                                   list of previous visits and the reasons for those
                                                                   visits in reverse (i.e., latest first) chronological
                                                                   order. By capturing timestamps of notable
                                                                   healthcare-related events (such as time of arrival,
                                                                   time of record-review, or time of physical
                                                                   examination), a healthcare provider can quickly
                                                                   determine when a patient's last visit occurred, when
                                                                   he last reviewed a patient's record, or how long it
                                                                   has been since the patient's last physical
                                                                   examination. For example, chronological lists of
                                                                   previous visits and the reasons for visits, the ability
                                                                   to review progress notes easily in reverse
                                                                   chronological (latest first) order.



  Version 7.0                                                                                              page 53 of 71                                            Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                           DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7         HL7                        HL7                             HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                        EHR                             EHR                                                     EHR                        EHR            Constrainable      Implementable
ID          Function                   Function                        Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
            Name                       Statement                       Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                         CODING             CODING
                                                                                                                                                                         for Ambulatory - for Ambulatory -
                                                                                                                                                                         Outpatient       Outpatient
I.1.2.7.3   (Legally proscribed) Data Archive (and make                Different care-settings often require differing         1. Support delivery of                    E-Essential       R-Required
            Retention                 accessible) the EHR for the      periods of EHR retention (after which the data has      effective healthcare 2.
                                      period of time required by       little or no value). Since the cost and speed of        Improve patient safety 3
                                      law (typically five years from   various data storage technologies also varies,          Facilitate management
                                      the time the care was            archival of EHR data can be managed (balanced) in       of chronic conditions 4.
                                      rendered).                       such a way as to minimize costs while still meeting     Improve efficiency 5.
                                                                       data access needs.                                      Facilitate self-health
                                                                                                                               management 6. Ensure
                                                                                                                               privacy, confidentiality




I.1.2.7.4   Data Availability          Make clinical information      Not only must clinical information be available for      1. Support delivery of                    E-Essential       R-Required
                                       readily available (as required recall, in certain care-settings the data must also be   effective healthcare 2.
                                       by a clinical care setting).   available within a proscribed period of time. For        Improve patient safety 3
                                                                      example, if the EHRS fails to present a report that      Facilitate management
                                                                      it has received from a laboratory in a timely            of chronic conditions 4.
                                                                      fashion, the patient may die. Depending on the care      Improve efficiency 5.
                                                                      setting, the EHRS must make all or some of the           Facilitate self-health
                                                                      EHR information available when, where, and how           management 6. Ensure
                                                                      the users need it.                                       privacy, confidentiality




  Version 7.0                                                                                                 page 54 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                         DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7       HL7                       HL7                              HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                       EHR                              EHR                                                     EHR                        EHR            Constrainable      Implementable
ID        Function                  Function                         Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
          Name                      Statement                        Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.3     Unique Identity,
          Registry, and Directory
          Services
I.1.3.0   Chain of Custody          Track specimens,                 Chain of Custody is necessary for laboratory            1. Support delivery of                    EF-Essential Future R-Required
                                    pharmaceuticals, and other       evidence involving the subset of cases that, for        effective healthcare 2.
                                    materials from the subject-of-   example, include: criminal, family court, protective    Improve patient safety 3
                                    care to the receiving party as   services, insurance fraud, and liability cases. Chain   Facilitate management
                                    required by business rules.      of custody support can be accomplished either by        of chronic conditions 4.
                                                                     supplying necessary information to an external          Improve efficiency 5.
                                                                     system that is responsible for tracking chain of        Facilitate self-health
                                                                     custody, or by supporting chain of custody within       management 6. Ensure
                                                                     the EHRS. Chain of custody functions within an          privacy, confidentiality
                                                                     EHRS will be necessary for those organizations
                                                                     that use local office laboratories that lack formal
                                                                     laboratory information management systems.




  Version 7.0                                                                                               page 55 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                          DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7       HL7                        HL7                              HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                        EHR                              EHR                                                     EHR                        EHR            Constrainable      Implementable
ID        Function                   Function                         Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
          Name                       Statement                        Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                        CODING             CODING
                                                                                                                                                                        for Ambulatory - for Ambulatory -
                                                                                                                                                                        Outpatient       Outpatient
I.1.4     Support for Health
          Informatics and
          Terminology Standards

I.1.4.0   Unique Identity, Registry, Identify and/or lookup           These functions are critical to successfully            1. Support delivery of                    EF-Essential Future R-Required
          and Directory              subjects-of-care, providers,     managing the security, interoperability and the         effective healthcare 2.
                                     payers, employers, material      consistently of the EHR data across the EHR-            Improve patient safety 3
                                     resources, and references to     System.                                                 Facilitate management
                                     various parts of the EHR                                                                 of chronic conditions 4.
                                     (hosted locally and/or                                                                   Improve efficiency 5.
                                     remotely).                                                                               Facilitate self-health
                                                                                                                              management 6. Ensure
                                                                                                                              privacy, confidentiality




I.1.4.1   Inter-registry             Obscure electronically-          This function recognizes that the EHRS will rely on     1. Support delivery of                    EF-Essential Future R-Required
          communication              exchanged EHR data to            an set of infrastructure services, directories, and     effective healthcare 2.
                                     inhibit unauthorized data-       registries organized hierarchically. Additionally,      Improve patient safety 3
                                     access (according to             this function assumes that the EHR Systems will         Facilitate management
                                     applicable healthcare-specific   need to communicate with each other. For example:       of chronic conditions 4.
                                     rules and relevant standards).   if a patient is treated at the primary care physician   Improve efficiency 5.
                                                                      for a chronic condition but becomes ill while           Facilitate self-health
                                                                      visiting a different region, the new provider will      management 6. Ensure
                                                                      lookup the patient and in, the background, the          privacy, confidentiality
                                                                      EHRS at the remote site will have to interrogate a
                                                                      local, regional, and even a nation registry to find
                                                                      the match. With the patient identify, the remote
                                                                      EHRS will interrogate the primary care physician's
                                                                      EHRS for information relevant to the new episode
                                                                      of care, in conformance with the applicable patient
                                                                      privacy and confidentiality rules. An example of
                                                                      using a local registry would be that of an EHRS
                                                                      application sending a query message to the Hospital
                                                                      Information System to retrieve a patient
                                                                      demographics.




  Version 7.0                                                                                                page 56 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                          DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7       HL7                        HL7                              HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                        EHR                              EHR                                                     EHR                        EHR            Constrainable      Implementable
ID        Function                   Function                         Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
          Name                       Statement                        Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                        CODING             CODING
                                                                                                                                                                        for Ambulatory - for Ambulatory -
                                                                                                                                                                        Outpatient       Outpatient
I.1.4.2   Entity Identity Lookup for The EHRS applications must       In order to create a correct and complete Electronic    1. Support delivery of                    EF-Essential Future R-Required
          Clinical Functions         be able to utilize a registry    Health Record, the EHRS applications must ensure        effective healthcare 2.
                                     service to uniquely identify     that they are consistently referencing Subjects of      Improve patient safety 3
                                     and retrieve information for     Care (patients, clients) and Providers. This function   Facilitate management
                                     existing records of healthcare   requires that EHRS Applications transparently           of chronic conditions 4.
                                     delivery stakeholders: •         invoke algorithms for uniquely identifying a certain    Improve efficiency 5.
                                     Subjects of care • Providers     Subject of Care or a Provider. This way, the            Facilitate self-health
                                                                      applications will be able to retrieve patient           management 6. Ensure
                                                                      demographic, provider identity and certification        privacy, confidentiality
                                                                      information, etc.

I.1.4.3   Entity Identity Lookup for The EHRS applications must       In order to support financial functions, the EHRS       1. Support delivery of                    EF-Essential Future R-Required
          Financial Functions        be able to utilize a registry    application must be able to retrieve information        effective healthcare 2.
                                     service to uniquely identify     about payors. Note that updating financial              Improve patient safety 3
                                     and retrieve information for     stakeholder registry records is not in the scope of     Facilitate management
                                     existing records of financial    the EHRS. EHRS application will be enabled only         of chronic conditions 4.
                                     stakeholders: • Payors           to lookup this information not update it. An            Improve efficiency 5.
                                     (Insurers) • Employers           example of lookup would be looking up Payor             Facilitate self-health
                                                                      information for determining the eligibility of a        management 6. Ensure
                                                                      Subject of Care.                                        privacy, confidentiality




I.1.4.4   Entity Identity         Limit EHR data                      The ability to update the contents of identity          1. Support delivery of                    EF-Essential Future R-Required
          Management for Clinical communications to those             directories ( for Subject of Care and Providers)        effective healthcare 2.
          Functions               explicitly (or implicitly)          ensures that the information in those directories       Improve patient safety 3
                                  authorized by the subject-of-       stays current over time. EHRS applications must be      Facilitate management
                                  care or to those that have a        able to update the information, if needed. Examples     of chronic conditions 4.
                                  legal (or other legitimate)         of identity management operations are: update           Improve efficiency 5.
                                  need.                               existing record, link registry records for same         Facilitate self-health
                                                                      patient, unlink registry records previously linked in   management 6. Ensure
                                                                      error, delete record, etc. The EHRS must also           privacy, confidentiality
                                                                      handle the update notifications from the registry to
                                                                      those application who registered interest in a
                                                                      certain record.




  Version 7.0                                                                                                page 57 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                        DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7       HL7                    HL7                                HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                    EHR                                EHR                                                     EHR                        EHR            Constrainable      Implementable
ID        Function               Function                           Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
          Name                   Statement                          Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                      CODING             CODING
                                                                                                                                                                      for Ambulatory - for Ambulatory -
                                                                                                                                                                      Outpatient       Outpatient
I.1.4.5   Entity Access Lookup   Verify and enforce access          This is a fundamental function of EHRS                  1. Support delivery of                    E-Essential        R-Required
                                 control (authentication and        applications. These applications are expected to use    effective healthcare 2.
                                 authorization) permissions to      algorithms for uniquely identifying entities (users,    Improve patient safety 3
                                 EHR information for end-           applications, etc.) when they attempt to access         Facilitate management
                                 users, applications, sites, etc.   EHR data. To ensure the access control, the EHRS        of chronic conditions 4.
                                                                    applications will perform an identity lookup of         Improve efficiency 5.
                                                                    users or application for any operations that require    Facilitate self-health
                                                                    it (authentication, access control, secure routing,     management 6. Ensure
                                                                    querying, etc.).                                        privacy, confidentiality




I.1.4.6   EHR Key Directory      The EHRS must maintain and         As EHR information will be persisted across EHRS        1. Support delivery of                    E-Essential        R-Required
                                 use a directory of keys which      applications and archives, a directory of pointers to   effective healthcare 2.
                                 link related records across the    the various parts of the EHR will be required in        Improve patient safety 3
                                 applications that constitute       order to retrieve the entire record or selected parts   Facilitate management
                                 the EHR. This directory will       of the EHR.                                             of chronic conditions 4.
                                 be necessary to access the                                                                 Improve efficiency 5.
                                 various components of the                                                                  Facilitate self-health
                                 EHR across local (e.g. Master                                                              management 6. Ensure
                                 Patient Index), regional,                                                                  privacy, confidentiality
                                 jurisdictional, national, or
                                 international boundaries.

I.1.4.7   Clinical Registries    Access and submit update           Clinical registries provide an aggregate view or        1. Support delivery of                    EF-Essential Future R-Required
                                 request to local,                  anonymize EHR information with a certain                effective healthcare 2.
                                 jurisdictional, national, and      specialization. For example: immunization, disease,     Improve patient safety 3
                                 international registries.          tumor, organ donor, or blood bank registries. EHRS      Facilitate management
                                                                    applications must be able to lookup and update          of chronic conditions 4.
                                                                    these registries according to the applicable rules      Improve efficiency 5.
                                                                    and best-practices.                                     Facilitate self-health
                                                                                                                            management 6. Ensure
                                                                                                                            privacy, confidentiality




  Version 7.0                                                                                              page 58 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                       DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7       HL7                     HL7                              HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                     EHR                              EHR                                                     EHR                        EHR            Constrainable      Implementable
ID        Function                Function                         Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
          Name                    Statement                        Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                     CODING             CODING
                                                                                                                                                                     for Ambulatory - for Ambulatory -
                                                                                                                                                                     Outpatient       Outpatient
I.1.4.8   Resource and Location   The EHRS applications will       These registries will manage care unit identifiers,     1. Support delivery of                    EF-Essential Future R-Required
          Lookup                  be able to look up directories   point of care devices that contribute information to    effective healthcare 2.
                                  containing location              the EHR, and other relevant resources. For              Improve patient safety 3
                                  information, device, and other   instance: if a new care unit is added in the location   Facilitate management
                                  resources relevant to the        master file, the applications that use patient          of chronic conditions 4.
                                  EHR.                             location must update their list of available care       Improve efficiency 5.
                                                                   units. Therefore, EHRS applications must be able        Facilitate self-health
                                                                   to receive notification when these directories have     management 6. Ensure
                                                                   been updated.                                           privacy, confidentiality




  Version 7.0                                                                                             page 59 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                    DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7       HL7                     HL7                            HL7                                                   HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                     EHR                            EHR                                                   EHR                        EHR            Constrainable      Implementable
ID        Function                Function                       Functional                                            Rationale                  Secondary      Functional Profile Functional Profile
          Name                    Statement                      Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                 CODING             CODING
                                                                                                                                                                 for Ambulatory - for Ambulatory -
                                                                                                                                                                 Outpatient       Outpatient
I.1.5     Interoperability




I.1.5.0   Vocabulary Functions    The EHRS must use              The EHRS will provide centralized vocabulary          1. Support delivery of                    E-Essential       R-Required
                                  consistent, codified medical   services which may be used by all the applications    effective healthcare 2.
                                  terminology to eliminate       in the EHRS. This way the EHRS ensure that coded      Improve patient safety 3
                                  ambiguity, confusion, and      terminologies are applied consistently across         Facilitate management
                                  ensure data correctness and    applications. Additionally, this function ensures a   of chronic conditions 4.
                                  interoperability.                                                                    Improve efficiency 5.
                                                                                                                       Facilitate self-health
                                                                                                                       management




I.1.5.1   Standard Vocabulary     The EHR should comply with EHRS applications need to support a consistent set        1. Support delivery of                    E-Essential       R-Required
                                  the Healthcare industry        of terminology. For example: LOINC, SNOMED,           effective healthcare 2.
                                  standards for transactions and ICD9, CPT4.                                           Improve patient safety 3
                                  terminology coding, therefore                                                        Facilitate management
                                  the EHRS applications must                                                           of chronic conditions 4.
                                  support consistent a                                                                 Improve efficiency 5.
                                  terminology model                                                                    Facilitate self-health
                                                                                                                       management 6. Ensure
                                                                                                                       privacy, confidentiality


I.1.5.2   Consistent Vocabulary   The EHRS will support a       EHRS applications need to support a consistent set 1. Support delivery of                        E-Essential       R-Required
                                  consistent terminology model. of transactions and terminology. Exam HL7, X12N, effective healthcare 2.
                                                                HIPAA.                                             Improve patient safety 3
                                                                                                                   Facilitate management
                                                                                                                   of chronic conditions 4.
                                                                                                                   Improve efficiency 5.
                                                                                                                   Facilitate self-health
                                                                                                                   management 6. Ensure
                                                                                                                   privacy, confidentiality




  Version 7.0                                                                                         page 60 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                          DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7       HL7                       HL7                               HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                       EHR                               EHR                                                    EHR                        EHR            Constrainable      Implementable
ID        Function                  Function                          Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
          Name                      Statement                         Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.5.3   Mapping for local terms   Support the ability to map        This function would be implemented by an EHRS          1. Support delivery of                    E-Essential       R-Required
                                    from local terminology to         application which uses a local terminology; that       effective healthcare 2.
                                    standard terminology.             terminology must be related to a standard              Improve patient safety 3
                                                                      terminology. For Example: If local terminology         Facilitate management
                                                                      specifies a descriptive string for referring to        of chronic conditions 4.
                                                                      "Ionized Calcium" that application must be able to     Improve efficiency 5.
                                                                      replace the local code with a standard, for instance   Facilitate self-health
                                                                      LOINC, when creating EHR documentation for             management 6. Ensure
                                                                      archival or exchange.                                  privacy, confidentiality




I.1.5.4   Code Set Maintenance      Accommodate updates and           The EHRS needs to provide master files,                1. Support delivery of                    E-Essential       R-Required
                                    changes to terminology as the     vocabulary services or other mechanisms such that      effective healthcare 2.
                                    source terminology undergoes      code sets and vocabularies used for the EHR may        Improve patient safety 3
                                    its natural update process        be maintained across application boundaries.           Facilitate management
                                    (new codes, retired codes,        Additionally, if the code sets are changes, those      of chronic conditions 4.
                                    redirected codes). These          changes should be reflected in all the relevant        Improve efficiency 5.
                                    changes in terminology need       applications. For examples, if a new critical care     Facilitate self-health
                                    to be propagated to all the       unit is opened, the code used for that location        management 6. Ensure
                                    clinical reference sets           should be present in the hospital master files and     privacy, confidentiality
                                    (templates, custom                the new care unit should appear as an option in the
                                    formularies), etc. This           Hospital Information System and all the clinical
                                    functionality will also help      application that operate in the new location,
                                    when there is a desire to share
                                    standard templates (since, for
                                    instance, it would be hard to
                                    share templates without a
                                    shared terminology).




  Version 7.0                                                                                                page 61 of 71                                          Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                            DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7       HL7                   HL7                     HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                   EHR                     EHR                                                    EHR                        EHR            Constrainable      Implementable
ID        Function              Function                Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
          Name                  Statement               Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                         CODING             CODING
                                                                                                                                                         for Ambulatory - for Ambulatory -
                                                                                                                                                         Outpatient       Outpatient
I.1.5.5   Code Set Versioning   The EHRS will support   Version control allows for multiple sets/versions of   1. Support delivery of                    E-Essential       R-Required
                                version control for     the same terminology to exist and be distinctly        effective healthcare 2.
                                terminology.            recognized over time. Terminology versioning           Improve patient safety 3
                                                        supports retrospective analysis and research, as       Facilitate management
                                                        well as interoperability with systems that comply      of chronic conditions 4.
                                                        with different releases of the standard.               Improve efficiency 5.
                                                                                                               Facilitate self-health
                                                                                                               management 6. Ensure
                                                                                                               privacy, confidentiality




  Version 7.0                                                                                 page 62 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                         DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7       HL7                        HL7                              HL7                                                   HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                        EHR                              EHR                                                   EHR                        EHR            Constrainable      Implementable
ID        Function                   Function                         Functional                                            Rationale                  Secondary      Functional Profile Functional Profile
          Name                       Statement                        Description                                                                      Citation       PRIORITY           REQUIRED
                                                                                                                                                                      CODING             CODING
                                                                                                                                                                      for Ambulatory - for Ambulatory -
                                                                                                                                                                      Outpatient       Outpatient
I.1.6     Manage Business
          Rules


I.1.6.0   Interoperability           EHRS application must be     These functions are critical to the successful            1. Support delivery of                    E-Essential        R-Required
                                     able to automate health      operation of the EHRS.                                    effective healthcare 2.
                                     delivery processes and                                                                 Improve patient safety 3
                                     seamlessly exchange clinical                                                           Facilitate management
                                     (EHR) information.                                                                     of chronic conditions 4.
                                                                                                                            Improve efficiency 5.
                                                                                                                            Facilitate self-health
                                                                                                                            management 6. Ensure
                                                                                                                            privacy, confidentiality




I.1.6.1   Interaction-model -based   The EHRS applications must       This function requires that the EHRS application      1. Support delivery of                    EF-Essential Future R-Required
          exchange                   be able to exchange              support a variety of interaction models depending     effective healthcare 2.
                                     information with authorized      on type of interoperability required. This function   Improve patient safety 3
                                     entities using the appropriate   recognizes that an application must undergo several   Facilitate management
                                     interaction model:               state changes to complete the information exchange    of chronic conditions 4.
                                                                      with another application and that interoperability    Improve efficiency 5.
                                                                      needs will determine the standard to be used and      Facilitate self-health
                                                                      the interaction mode. For instance, messaging is      management 6. Ensure
                                                                      effective for many near-real time, asynchronous       privacy, confidentiality
                                                                      data exchange scenarios but that same mode of
                                                                      interaction may not be applied if the end-user is
                                                                      requesting an immediate response from a remote
                                                                      application. Additionally, even in the case where
                                                                      store-and-forward, message-oriented
                                                                      interoperability is used, the applications may need
                                                                      to support the appropriate interaction mode. For
                                                                      example: Unsolicited Event Notifications,
                                                                      Query/Response, Query for display, Unsolicited
                                                                      summary, structured/discrete, and unstructured
                                                                      clinical documents. .




  Version 7.0                                                                                              page 63 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                    DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7       HL7                HL7                               HL7                                                      HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                EHR                               EHR                                                      EHR                        EHR            Constrainable      Implementable
ID        Function           Function                          Functional                                               Rationale                  Secondary      Functional Profile Functional Profile
          Name               Statement                         Description                                                                         Citation       PRIORITY           REQUIRED
                                                                                                                                                                  CODING             CODING
                                                                                                                                                                  for Ambulatory - for Ambulatory -
                                                                                                                                                                  Outpatient       Outpatient
I.1.6.2   Chain of Trust     The EHRS must adhere to           This function requires that there is an overall          1. Support delivery of                    E-Essential       R-Required
                             documented procedures for         coordination of regarding what information is            effective healthcare 2.
                             executing chain of trust          exchange between EHRS entities and how that              Improve patient safety 3
                             agreements (in which the          exchange is expected to . The policies applied in at     Facilitate management
                             parties agree to electronically   different locations must be consistent or compatible     of chronic conditions 4.
                             exchange data and protect the     with each other in order to ensure that the              Improve efficiency 5.
                             integrity and confidentiality     information is protected when it crosses entity          Facilitate self-health
                             of the data exchanged).           boundaries within the EHRS or with entities              management 6. Ensure
                                                               outside the EHRS.                                        privacy, confidentiality




I.1.6.3   Standard-based     The EHRS applications must        This function identifies the dependency between          1. Support delivery of                    E-Essential       R-Required
          Interoperability   use standard-based                EHRS applications and EHRS infrastructure                effective healthcare 2.
                             information exchange              services or complementary application. The               Improve patient safety 3
                             methods to interact with local    infrastructure services are those crucial to             Facilitate management
                             or remote application             application's ability to operate seamlessly with         of chronic conditions 4.
                             registries, and directories.      complementary application. In turn these services        Improve efficiency 5.
                                                               may be local or remote and require that the              Facilitate self-health
                                                               applications use a common messaging or                   management 6. Ensure
                                                               programming interfaces to interoperate.                  privacy, confidentiality
                                                               Interoperability with EHR Infrastructure services
                                                               such as directories, registries, etc. must be standard
                                                               based and EHRS applications must be capable to
                                                               use these interfaces. For example: an application
                                                               may use standard-based messaging (HL7 V3) to
                                                               look a patient's identity in a regional registry but
                                                               the same application might use CCOW in order to
                                                               synchronize the patient context with other EHRS
                                                               applications displayed on the same workstation.




  Version 7.0                                                                                          page 64 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                          DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7         HL7                       HL7                             HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                       EHR                             EHR                                                    EHR                        EHR            Constrainable      Implementable
ID          Function                  Function                        Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
            Name                      Statement                       Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.6.3.1   Standard-based messaging An EHRS application must be      When EHRS applications exchange information            1. Support delivery of                    E-Essential        R-Required
                                     able to exchange standard-       (notifications, clinical summaries, documents, etc.)   effective healthcare 2.
                                     conformant message payloads      they must rely on uniform standards and semantics.     Improve patient safety 3
                                     and transport with               For instance, HL7 Messages for exchanging clinical     Facilitate management
                                     complementary applications       observations, queries, and event notifications, CDA    of chronic conditions 4.
                                     and infrastructure services      (Clinical Document Architecture) for summary           Improve efficiency 5.
                                     (directory, vocabulary, etc.)    information and signed clinical documents, X12N        Facilitate self-health
                                                                      for billing.                                           management 6. Ensure
                                                                                                                             privacy, confidentiality




I.1.6.3.2   Standard-based            An EHRS application must be     Similar to standard-based messaging, standard-         1. Support delivery of                    E-Essential        R-Required
            application integration   able to integrate with          based application integration requires that the        effective healthcare 2.
                                      complementary applications      EHRS application use standardized programming          Improve patient safety 3
                                      and infrastructure services     interfaces, where applicable. For example: CCOW        Facilitate management
                                      (directory, vocabulary, etc.)   for visual integration, WfMC for workflow              of chronic conditions 4.
                                      using standard-based            integration, etc.                                      Improve efficiency 5.
                                      application programming                                                                Facilitate self-health
                                      interfaces (API). E.g. CCOW                                                            management 6. Ensure
                                                                                                                             privacy, confidentiality




I.1.6.3.3   Vocabulary lookup and     The EHRS must support           This function assumes that applications in the         1. Support delivery of                    EF-Essential Future R-Required
            mapping                   semantic interoperability       EHRS are using different standardized or local         effective healthcare 2.
                                      between EHRS application by     vocabulary. In order to address the semantic           Improve patient safety 3
                                      enabling lookup of              differences across these applications, vocabulary      Facilitate management
                                      vocabulary mappings between     lookup (to map local codes to standard codes) and      of chronic conditions 4.
                                      local and standard              mappings (to map one set of codes to another) the      Improve efficiency 5.
                                      vocabularies as defined by      EHRS infrastructure will provide vocabulary            Facilitate self-health
                                      data exchange standards.        lookup and mapping (as a common service or             management 6. Ensure
                                                                      distributed across applications).                      privacy, confidentiality




  Version 7.0                                                                                               page 65 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                          DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7         HL7                    HL7                                HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR         EHR                    EHR                                EHR                                                    EHR                        EHR            Constrainable      Implementable
ID          Function               Function                           Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
            Name                   Statement                          Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                       CODING             CODING
                                                                                                                                                                       for Ambulatory - for Ambulatory -
                                                                                                                                                                       Outpatient       Outpatient
I.1.6.3.4   External Information   The EHRS must be able to           This function identifies the dependency between        1. Support delivery of                    EF-Essential Future R-Required
            Exchange               transmit messages to               EHRS applications and external applications and        effective healthcare 2.
                                   authorized third parties using     services. These external services/application may      Improve patient safety 3
                                   standard-based methods.            be offered by peer organizations or a intended to be   Facilitate management
                                                                      shared across institutions. An example of External     of chronic conditions 4.
                                                                      Information Exchange between peer institutions         Improve efficiency 5.
                                                                      would be a patient referral. an example of using a     Facilitate self-health
                                                                      shared service would be eligibility lookup.            management 6. Ensure
                                                                                                                             privacy, confidentiality




I.1.6.3.5   Internal Information   Applications that comprise an      This function requires that EHRS application use       1. Support delivery of                    E-Essential        R-Required
            Exchange               EHRS will cooperate                the necessary standard-based methods to                effective healthcare 2.
                                   seamlessly and support data        communicate with complementary applications and        Improve patient safety 3
                                   integration and consolidated       services in such a way that the EHR can operate        Facilitate management
                                   access across the system.          seamlessly. Initially, EHRS applications will          of chronic conditions 4.
                                                                      exchange information with complementary                Improve efficiency 5.
                                                                      applications. For instance, in order to determine      Facilitate self-health
                                                                      drug interactions the EHRS might need that a           management 6. Ensure
                                                                      laboratory information system be integrated with       privacy, confidentiality
                                                                      the a pharmacy information system.

I.1.6.3.6   Recipient Addressing   When exchanging                    This function requires that an application sending     1. Support delivery of                    EF-Essential Future R-Required
                                   information with another           EHR-relevant information use the entity registries     effective healthcare 2.
                                   application, an EHRS               to ensure that the information is sent to the          Improve patient safety 3
                                   application must be able to        authorized receiver. Similarly, the receiver of the    Facilitate management
                                   interact with entity directories   data must ensure that the sender is a valid,           of chronic conditions 4.
                                   to determine the recipients’       authoritative source of information. This function     Improve efficiency 5.
                                   address profile.                   requires that a conformant EHRS application be         Facilitate self-health
                                                                      able to access entity registries and use that          management 6. Ensure
                                                                      information for addressing information                 privacy, confidentiality
                                                                      transmission and validating inbound transmissions.




  Version 7.0                                                                                               page 66 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                      DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7       HL7                   HL7                               HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                   EHR                               EHR                                                    EHR                        EHR            Constrainable      Implementable
ID        Function              Function                          Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
          Name                  Statement                         Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                   CODING             CODING
                                                                                                                                                                   for Ambulatory - for Ambulatory -
                                                                                                                                                                   Outpatient       Outpatient
I.1.6.4   Synchronization       The EHRS applications must        The EHRS is assumed to consist of a set of             1. Support delivery of                    E-Essential        R-Required
                                be able to interact with entity   application; each application manages a subset of      effective healthcare 2.
                                directories to link data          the EHR information. Therefore it is important that    Improve patient safety 3
                                received from other               through various interoperability mechanisms, the       Facilitate management
                                applications to existing entity   EHRS maintains all the relevant information            of chronic conditions 4.
                                records. Disparate systems        regarding the health record in synchrony. For          Improve efficiency 5.
                                will be synchronized to keep      example, if an MRI is ordered by a physician, a set    Facilitate self-health
                                all the parts of the record       of diagnostic images and a radiology report will be    management 6. Ensure
                                current.                          created. The patient demographics, the order for       privacy, confidentiality
                                                                  MRI, the diagnostic images associated with the
                                                                  order, and the report associated with the study must
                                                                  all be in synch in order for the clinicians to view
                                                                  the complete EHR information.

I.1.6.5   EHR Data Extraction   The EHRS must be able to          Using certain EHRS applications, clinicians must       1. Support delivery of                    EF-Essential Future R-Required
                                extract data in accordance        be able to access and aggregate the distributed        effective healthcare 2.
                                with analysis and reporting       information that correspond to the Electronic          Improve patient safety 3
                                requirements. The data may        Health Record or Records which are needed for          Facilitate management
                                reside on more that one           viewing, reporting, etc. EHRS application must be      of chronic conditions 4.
                                application and it may be pre-    able to support data extraction operations whether     Improve efficiency 5.
                                processed (e.g. de-identified)    the extract requires the application's own local       Facilitate self-health
                                before transmission. Data         information or an aggregation of information from      management 6. Ensure
                                extractions could be to           more than one application. If the data required by     privacy, confidentiality
                                retrospective EHR data or to      the end-user resides on other application, the EHRS
                                report public health              application responsible for data extraction must
                                information.                      query the other applications and display the
                                                                  information.

I.1.6.6   Clinical Documents    EHR s must be able to import A significant part of the EHR consists of summary           1. Support delivery of                    EF-Essential Future R-Required
                                and export complex standards- reports and complex clinical documents. Therefore          effective healthcare 2.
                                based clinical documents.     the EHRS must support the effective exchange of            Improve patient safety 3
                                                              such documents as atomic units of information.             Facilitate management
                                                              EHRS applications must be able to create and               of chronic conditions 4.
                                                              import clinical documents when needed.                     Improve efficiency 5.
                                                                                                                         Facilitate self-health
                                                                                                                         management 6. Ensure
                                                                                                                         privacy, confidentiality




  Version 7.0                                                                                           page 67 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                        DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7       HL7                       HL7                             HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                       EHR                             EHR                                                     EHR                        EHR            Constrainable      Implementable
ID        Function                  Function                        Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
          Name                      Statement                       Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                      CODING             CODING
                                                                                                                                                                      for Ambulatory - for Ambulatory -
                                                                                                                                                                      Outpatient       Outpatient
I.1.7     Workflow




I.1.7.0   Business Rules           Control system behavior via      Business Rules Administrative Functions include         1. Support delivery of                    E-Essential       R-Required
          Administrative Functions business rules. Example of       both the management of the business rules and the       effective healthcare 2.
                                   business rules that control      implementation functions that use business rules to     Improve patient safety 3
                                   system behavior are: decision    control system behavior. The implementation             Facilitate management
                                   support, diagnostic support,     functions can be invoked from necessary points          of chronic conditions 4.
                                   workflow control, access         within EHRS applications. Examples of                   Improve efficiency 5.
                                   privileges, and system and       implementation functions include: decision              Facilitate self-health
                                   user defaults and preferences.   support, diagnostic support, workflow control,          management 6. Ensure
                                                                    access privileges, and system and user defaults and     privacy, confidentiality
                                                                    preferences.

I.1.7.1   Maintain Business Rules   Provide the ability for         This function supports creating, updating, and          1. Support delivery of                    E-Essential       R-Required
                                    authorized EHRS-Users to        deleting (or disabling) business rules by authorized    effective healthcare 2.
                                    create, update and delete       users. Business rules versioning is also supported      Improve patient safety 3
                                    business rules including        by this function. Business rule versioning is           Facilitate management
                                    institutional preferences.      necessary to trace an action that was recommended       of chronic conditions 4.
                                                                    based on a business rule, to the exact version of the   Improve efficiency 5.
                                                                    business rule that was in place at the time the         Facilitate self-health
                                                                    recommendation was issued. Providers and                management 6. Ensure
                                                                    institutions need the ability to customize decision     privacy, confidentiality
                                                                    support components such as triggers, rules or
                                                                    algorithms, and the wording of alerts and advice, to
                                                                    meet local requirements and preferences. These
                                                                    local customizations must be supported and
                                                                    maintained as changes occur in the underlying
                                                                    systems and knowledge-bases.




  Version 7.0                                                                                              page 68 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                       DoD EHR - HL7 EHR Mapping                                                 HL7 EHR-S Profile Coding
HL7       HL7                       HL7                            HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                       EHR                            EHR                                                     EHR                        EHR            Constrainable      Implementable
ID        Function                  Function                       Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
          Name                      Statement                      Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                                     CODING             CODING
                                                                                                                                                                     for Ambulatory - for Ambulatory -
                                                                                                                                                                     Outpatient       Outpatient
I.1.7.2   Implement/apply business Enable usage of business        The implementation function is invoked by               1. Support delivery of                    E-Essential       R-Required
          rules                    rules by EHRS Supportive        applications throughout the EHRS to apply the           effective healthcare 2.
                                   functions.                      business rules that have been defined. For example:     Improve patient safety 3
                                                                   • When creating or updating a patient record with       Facilitate management
                                                                   symptoms, the diagnostic support function may use       of chronic conditions 4.
                                                                   this implementation function to determine if            Improve efficiency 5.
                                                                   business rules exist to suggest diagnosis based on      Facilitate self-health
                                                                   the combination of symptoms (flu-like symptoms          management 6. Ensure
                                                                   combined with widened mediastinum suggesting            privacy, confidentiality
                                                                   anthrax). • When creating a vaccination record the
                                                                   work flow process may use this implementation
                                                                   function to determine if business rules exist to send
                                                                   an update to an immunization registry. • When
                                                                   diagnosing a patient as pregnant, the decision
                                                                   support function may use this implementation
                                                                   function to determine if business rules exist to
                                                                   classify the patient as high risk due to factors such
                                                                   as age, health status, and prior pregnancy
                                                                   outcomes.

I.1.7.3   Override business rule    Support override of business   The override function allows authorized users to        1. Support delivery of                    E-Essential       R-Required
                                    rules by authorized EHRS-      dismiss a or bypass a recommendation for action         effective healthcare 2.
                                    Users.                         that was generated on the basis of business rules.      Improve patient safety 3
                                                                   Override may also be used to reset user preferences     Facilitate management
                                                                   or defaults.                                            of chronic conditions 4.
                                                                                                                           Improve efficiency 5.
                                                                                                                           Facilitate self-health
                                                                                                                           management 6. Ensure
                                                                                                                           privacy, confidentiality




I.1.7.4   Audit business rule usage Audit usage and override of    The EHRS will maintain a record of business rules       1. Support delivery of                    E-Essential       R-Required
                                    business rules (refer to       that are created, updated and disabled. In addition,    effective healthcare 2.
                                    section 3.2.5).                the EHRS will track the business rule that was used     Improve patient safety 3
                                                                   to issue a recommendation or guidance as well as        Facilitate management
                                                                   the disposition of the business rule (if it was         of chronic conditions 4.
                                                                   followed or bypassed).                                  Improve efficiency 5.
                                                                                                                           Facilitate self-health
                                                                                                                           management 6. Ensure
                                                                                                                           privacy, confidentiality




  Version 7.0                                                                                             page 69 of 71                                           Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                                       DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7       HL7                     HL7                              HL7                                                    HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR                     EHR                              EHR                                                    EHR                        EHR            Constrainable      Implementable
ID        Function                Function                         Functional                                             Rationale                  Secondary      Functional Profile Functional Profile
          Name                    Statement                        Description                                                                       Citation       PRIORITY           REQUIRED
                                                                                                                                                                    CODING             CODING
                                                                                                                                                                    for Ambulatory - for Ambulatory -
                                                                                                                                                                    Outpatient       Outpatient
I.1.8.0   Workflow                Support Workflow                 Work flow functions include both the management        1. Support delivery of                    E-Essential        R-Required
                                  Management. Distribute           and setup of work queues, personnel, and system        effective healthcare 2.
                                  workflow-related EHRS            interfaces as well as the implementation functions     Improve patient safety 3
                                  information (according to        that use work flow related business rules to direct    Facilitate management
                                  established business rules)      tasks to queues. The implementation functions can      of chronic conditions 4.
                                  within the EHRS and to/from      be invoked from necessary points within EHRS           Improve efficiency 5.
                                  external parties.                applications. Note that workflow definitions and       Facilitate self-health
                                                                   management may be implemented by a designated          management 6. Ensure
                                                                   application or distributed across EHRS                 privacy, confidentiality
                                                                   applications.

I.1.8.1   Task Distribution       Support workflow task-           This function supports creating, updating and          1. Support delivery of                    EF-Essential Future R-Required
                                  management and task-             disabling work queues, assignees, system               effective healthcare 2.
                                  distribution systems             destinations, work flow algorithms, and links          Improve patient safety 3
                                  (including serial tasks and      between work flow components and business rules        Facilitate management
                                  parallel tasks).                 (maintained by the business rules functions).          of chronic conditions 4.
                                                                   Examples of links include: queues to                   Improve efficiency 5.
                                                                   recipients/roles, business rules to work flow          Facilitate self-health
                                                                   algorithms and distribution paths, and escalation      management 6. Ensure
                                                                   and redirection rules to roles/users. Work flow        privacy, confidentiality
                                                                   algorithms include the routing of tasks down single
                                                                   dependent paths or multiple independent paths. For
                                                                   example: • Serial tasks - An initial X-ray may be
                                                                   required prior to ordering an MRI. • Parallel tasks-
                                                                   When a patient is in the process of being admitted
                                                                   for scheduled surgery, the registration department
                                                                   may be asked for last-minute insurance coverage
                                                                   verification, while the lab may simultaneously be
                                                                   asked whether pre-admission lab work has been
                                                                   completed.

I.1.8.2   System-triggered Task   Support workflow                 This function specifies that task routing can be       1. Support delivery of                    EF-Essential Future R-Required
          Routing                 notifications and task routing   based on the type of diagnosis or other system         effective healthcare 2.
                                  based on system triggers such    triggers. Diagnosis based routing uses business        Improve patient safety 3
                                  as diagnosis assignments.        rules (maintained by the business rules functions)     Facilitate management
                                                                   to determine the routing path that should be           of chronic conditions 4.
                                                                   followed. For example: • Updates to clinical           Improve efficiency 5.
                                                                   registries (cancer is detected), blood banks (HIV is   Facilitate self-health
                                                                   detected), or donor banks (kidney is available). •     management 6. Ensure
                                                                   Notifications to social service agencies               privacy, confidentiality
                                                                   (Alzheimer's disease is detected or child abuse is
                                                                   suspected). • Updates to immunization registry
                                                                   (patient receives vaccination).




  Version 7.0                                                                                             page 70 of 71                                          Version Date: 23 February 2004
 DoD EHR - For Public Distribution                                              DoD EHR - HL7 EHR Mapping                                                HL7 EHR-S Profile Coding
HL7       HL7             HL7                            HL7                                                     HL7                        HL7            DoD EHR            DoD EHR
EHR       EHR             EHR                            EHR                                                     EHR                        EHR            Constrainable      Implementable
ID        Function        Function                       Functional                                              Rationale                  Secondary      Functional Profile Functional Profile
          Name            Statement                      Description                                                                        Citation       PRIORITY           REQUIRED
                                                                                                                                                           CODING             CODING
                                                                                                                                                           for Ambulatory - for Ambulatory -
                                                                                                                                                           Outpatient       Outpatient
I.1.8.3   Workflow task   Support workflow task-         This set of work flow tasks are invoked to direct       1. Support delivery of                    EF-Essential Future R-Required
          assignment      assignments, task-escalations, tasks to the correct work queue to support initial      effective healthcare 2.
                          and task-redirections.         assignment, escalation of work not completed in a       Improve patient safety 3
                                                         timely manner, and redirection of tasks. Work Flow      Facilitate management
                                                         utilizes business rules (maintained by the business     of chronic conditions 4.
                                                         rules functions) to determine the routing of a task.    Improve efficiency 5.
                                                         Examples of task routing include: • Assigning a         Facilitate self-health
                                                         documents-checking task before discharging a            management 6. Ensure
                                                         patient (according to length-of-stay business rules).   privacy, confidentiality
                                                         For example, a patient staying in a hospital for
                                                         more than 24 hours cannot be discharged unless
                                                         that patient's medical history and physical
                                                         examination have been documented. • Assigning an
                                                         insurance-verification task when a patient is
                                                         admitted. • Escalating a task to a supervisor when
                                                         that task was not completed within the business
                                                         rule -specified time frame. • Redirecting a task
                                                         when an employee becomes unavailable or over-
                                                         tasked (as defined by business rules).




  Version 7.0                                                                                   page 71 of 71                                           Version Date: 23 February 2004

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:2
posted:12/1/2011
language:English
pages:71