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HITSP TC Presentation to Panel 121808 FINAL3

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HITSP TC Presentation to Panel 121808 FINAL3 Powered By Docstoc
					                            Document Number: HITSP 08 xxx
                                   Date: December 18, 2008




Report from the Technical Committees


Arlington, VA | December 18, 2008
Presented by:
Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS
HITSP Technical Committee Co-Chairs
                 enabling healthcare interoperability
                                                             0
              AHIC Use Cases 2008
   Provider          Consumer         Population
 Consultations                       Immunizations
                      Remote
and Transfers of                     and Response
                     Monitoring
     Care                             Management

                      Patient –
 Personalized                         Public Health
                   Provider Secure
  Healthcare                         Case Reporting
                     Messaging




                                                      1
Technical Committee Leadership
 Provider Perspective – 218 members
   – Allen Hobbs, PhD, Kaiser Permanente
   – Steve Hufnagel, PhD, DoD/Medical Health System (MHS)
   – Mike Lincoln, MD, Department of Veterans Affairs

 Consumer Perspective – 197 members
   – Mureen Allen, MD, FACP, ActiveHealth Management
   – Charles Parisot, EHR Association
   – Scott Robertson, PharmD, Kaiser Permanente




                                                            2
Technical Committee Leadership
  Population Perspective - 172 members
    – Floyd Eisenberg, MD, MPH, National Quality Forum
    – Anna Orlova, PhD, Public Health Data Standards Consortium

    – Eileen Koski, M. Phil, Quest Diagnostics Inc.

  Administrative and Financial Domain – 50 members
    – Don Bechtel, Siemens Medical Solutions
    – Durwin Day, Health Care Service Corporation
    – Deborah Belcher, GE Healthcare




                                                                  3
Technical Committee Leadership
  Security, Privacy & Infrastructure Domain - 172
   members
    – Glen Marshall, Grok-A-Lot, LLC
    – John Moehrke, GE Healthcare
    – Walter Suarez, MD, Institute for HIPAA/HIT Education and
      Research
  Care Management and Health Records Domain - 56
   members
    – Keith Boone, GE Healthcare
    – Corey Spears, McKesson Health Solutions


    Total Technical Committee Membership – 522 individuals



                                                                 4
          2009 Technical Committee Schedule

February 17-19          (Tuesday – Thursday)
  Washington, DC area
June 9-11               (Tuesday – Thursday)
  Washington, DC area
September 1-3           (Tuesday – Thursday)
  Chicago, IL
November 3-5            (Tuesday – Thursday)
  Phoenix, AZ


                                               5
Report from the Security, Privacy & Infrastructure
Domain Technical Committee

                   SPI-TC Report Topics:
  End-of-year summary of work for 2008
     – List of work items
     – List of revised constructs, to include editorial updates and
       technical changes

  Overview of 9 New constructs developed to support
   2008 use cases
  Activities planned for next year




                                                                      6
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
          End-of-year summary of work for 2008: Work Items

   Renamed from Security and Privacy Technical Committee to Security, Privacy and
    Infrastructure (SPI) Domain Technical Committee
   Inherited and became responsible for 11 pre-existing Infrastructure constructs
   During the year, the TC:
     – Completed minor revisions and updates to 7 S&P and 11 Infrastructure Constructs
     – Developed 9 new constructs
     – Formed Identity Credentials Management Work Group (WG tasks now complete)
     – Conducted webinars and outreach activities
     – Responded to NHIN clarification requests
     – Worked with Foundations Committee on Privacy and Security Matrices
     – Supported FHAs Security Strategy Subgroup
     – Supported National Governors Association (NGA) State Alliance for eHealth
     – Supported CCHIT through various means, including Cochair/Expert Panel participation


                                                                                             7
 Report from the Security, Privacy & Infrastructure
 Domain Technical Committee
End-of-year summary of work for 2008: Updates to Existing Constructs

  *T15 - Collect and Communicate               *TP13 - Manage Sharing of Documents
   Security Audit Trail
                                                T14 - Send Lab Result Message
  *T16 - Consistent Time
                                                *TP21 - Query for Existing Data
  *T17 - Secured Communication
   Channel                                      *TP22 - Patient ID Cross-Referencing

  C19 - Entity Identity Assertion              *T23 - Patient Demographics Query

  *TP20 - Access Control                       T24 – Pseudonymize

  *C26 - Nonrepudiation of Origin              C25 - Anonymize

  TP30 - Manage Consent Directives             *T29 - Notification of Document Availability
                                                *T31 - Document Reliable Interchange

  TN900 – S&P Technical Note                   *T33 - Transfer of Documents on Media
                                                C44 - Secure Web Connection
* Denotes updates requiring Panel Approval      *TP50 - Retrieve Form for Data Capture

                                                                                            8
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
                          Maintenance Updates:
     C26 - Nonrepudiation of Origin Component:
         Updated to reflect minor updates in underlying standard which was
          republished in October, 2008.
         Minor editorial changes for readability and clarity.
     TP13 - Manage Sharing of Documents: Updated reference to IHE XCA Standard
      to: Integrating the Healthcare Enterprise (IHE) IT Infrastructure Technical
      Framework (ITI-TF) Supplement 2008-2009, Cross-Community Access (XCA),
      Trial Implementation, October 10, 2008
     T15 - Collect and Communicate Security Audit Trail :
          Minor editorial changes
          Editorial updates for standards version change to IHE ITI-TF Revision 5.
          Updated quoted text from underlying standard that has been modified with
           the updated standard.
     T17 – Secured Communication Channel: Incorporated the updated version of the
      IHE ATNA standard to IHE ITI-TF Revision 5.0 and made minor editorial changes.



                                                                                       9
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
                           Maintenance Updates:
     TP21 - Query for Existing Data Transaction Package:
         Major update to reference the most recent version of the IHE QED
          Integration Profile supplement
         Additional updates to reflect changes in the underlying standard with respect
          to the technical actors that are referenced, the transactions that are used by
          the technical actors, and a further refinement of the HL7 V3.0 standard
     TP 22 – Patient ID Cross-Referencing:
         The use of HL7 2.3.1 for the Patient Identity Feed has been clarified.
         Changed the optionality for the technical actors: Patient Identifier Cross-
          Reference Manager, and Patient Identity Source in Section 2.1.2 Technical
          Actors.
         Provided specific standard reference for HL7 V2.3.1 and HL7 V2.5 in
          Selected Standards Table 2.3.2.
     T23 - Patient Demographics Query: Minor editorial changes.




                                                                                           10
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
                            Maintenance Updates:
     T29 - Notification of Document Availability:
          Updated name of the IHE NAV selected standard.
          Update the informative reference for IHE-ITI-TF to Revision 5.0.
     T31 – Document Reliable Interchange: Minor editorial changes in addition to:
         Updated the document to remove the mail option. This option is no longer
          specified by the underlying IHE XDR standard.
         Updated Table 2.1.2-1 Technical Actors to remove mail option, and updated
          Unified Modeling Language (UML) diagram to show only the ITI-41 Provide
          and Register Document Set-b Transaction.
     T33 - HITSP Transfer of Documents on Media: Minor editorial changes and
      changes resulting from Public Comment.
     TP50 - Retrieve Form for Data Capture Transaction Package :
      Edited to incorporate minor version updates of the underlying standard, IHE NAV.




                                                                                         11
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
          Maintenance Updates: TP20: Access Control
 This Transaction Package has been updated with editorial and minor updates of a
 technical nature as follows:
  TN900 no longer has glossary or description of application of Security and Privacy
   constructs to HITSP Interoperability Specification‟s, so updated Table 1.4-1 with
   this information
  Provided further clarification on the standards for which the technical actors will be
   used
  Corrected the optionality of the technical actors to indicate that at least one of the
   Service User or Service Provider actors is required to be implemented
  Added high level overview narrative and Figure 2.1.3-1 to provide further details on
   the typical access control interactions between parties in the exchange of
   healthcare information
  Reorganized the section narrative to provide clarity by moving supplemental,
   supporting material from Section 2.1.3 into the appendix in Section 4.0
  Edited the narrative to improve readability and consistency
  Minor edits to the preconditions to improve readability
 •
                                                                                            12
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
Maintenance Updates: TP20: Access Control (continued)
    Selected Standards
      Moved the standard reference for OASIS WS-Federation from Table 2.3.2-1
       Selected Standards to Table 2.3.3-1Informative Reference Standards
      Updated the IHE ATNA profile reference to point to Revision 5.0 or later
  Informative References
      Added informative references to the OASIS XSPA SAML, OASIS XSPA WS-
       Trust, and OASIS XSPA XACML profiles as roadmapped references




                                                                                  13
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
                           New Constructs
      C62- Unstructured Document Component
      T63 - Emergency Message Distribution Element Transaction
      T64 - Identify Communication Recipients Transaction
      T66 - Retrieve Value Set Transaction
      T67 - Clinical Referral Request Transaction
      T81 - Retrieval of Medical Knowledge Transaction
      T85 - Administrative Transport to Health Plan Transaction
      C87 - Anonymize for PHCR Component
      C88 - Anonymize for IRM Component




                                                                   14
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
 New Construct: HITSP/C62 - Unstructured Document Component
   Key Capabilities: Provides the capture and storage of patient identifiable,
    unstructured document content, such as text, PDF, and images rendered in PDF.
   Selected Standard(s): Cross-Enterprise Sharing of Scanned Documents (XDS-
    SD) profile from the Integrating the Healthcare Enterprise (IHE) IT Infrastructure
    Technical Framework (ITI-TF).
   Used by:
    IS 3 V:3.1.2    Consumer Empowerment
    IS 4 V:1.2.2    Emergency Responder Electronic Health Record
    IS 5 V:1.1.2    Consumer Empowerment & Access to Clinical Information via Media
    IS 8 V:0.0.2    Personalized Healthcare
    IS 9 V:0.0.2    Consultation and Transfers of Care
    IS 10 V:0.0.2   Immunizations and Response Management
    IS 11 V:0.0.2   Public Health Case Reporting
    IS 12 V:0.0.2   Patient-Provider Secure Messaging



                                                                                         15
  Report from the Security, Privacy & Infrastructure
  Domain Technical Committee
New Construct: T63 Emergency Message Distribution Element Transaction

        Key Capabilities: A multicast notification message sent to an identified
         population (assume this is not to the general public, but to specifically identified
         populations, such as emergency departments).


        Selected Standard(s): Emergency Data Exchange Language (EDXL)
         Distribution Element (DE) v1.0


        Used by:
         IS 4 V:1.2.2  Emergency Responder Electronic Health Record
         IS 10 V:0.0.2 Immunizations and Response Management
         IS 11 V:0.0.2 Public Health Case Reporting




                                                                                                16
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
New Construct: T64 - Identify Communication Recipients Transaction
     Key Capabilities: Identification of communication recipients and the
      subsequent purpose of delivery of alerts and bi-directional communications
      (e.g., public health agencies notifying a specific group of service providers
      about an event.) The method and criteria by which individuals are added to a
      directory is a policy decision, which is out of scope for this construct.
     Selected Standard(s): Integrating the Healthcare Enterprise (IHE) Personnel
      White Pages profile which provides access to basic directory information for
      identifying one or more recipients.
     Used by:
      IS 4 V:1.2.2    Emergency Responder Electronic Health Record
      IS 8 V:0.0.2    Personalized Healthcare
      IS 9 V:0.0.2    Consultation and Transfers of Care
      IS 10 V:0.0.2   Immunizations and Response Management
      IS 11 V:0.0.2   Public Health Case Reporting




                                                                                      17
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
     New Construct: HITSP/T66 - Retrieve Value Set Transaction

     Key Capabilities: Used to transform human or computer vocabularies. For
      example, it can be used to convert the initial capture of a human-readable concept
      into a computer vocabulary captured in a document or message that will be
      communicated. It may also be used in the reverse, to take computer vocabulary
      and convert to human-readable form.
     Selected Standard(s):
      - Health Level Seven (HL7) Common Terminology Services (CTS) Release 1
      - IHE ITI-TF Supplement 2008-2009 Sharing Value Sets (SVS) Integration Profile

     Used by:
      IS 4 V:1.2.2    Emergency Responder Electronic Health Record
      IS 8 V:0.0.2    Personalized Healthcare
      IS 9 V:0.0.2    Consultation and Transfers of Care
      IS 10 V:0.0.2   Immunizations and Response Management
      IS 11 V:0.0.2   Public Health Case Reporting

                                                                                           18
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
 New Construct: HITSP/T67 – Clinical Referral Request Transaction

     Key Capabilities: Used to transport the provider to provider
      (clinical) referral request interaction.
     Selected Standard(s): Integrating the Healthcare Enterprise (IHE)
      Document-based Referral Request (DRR) profile which is used to
      bundle a referral request document with other relevant clinical
      documents of interest and optionally to send a trigger message to
      the receiving provider system.
     Used by:
      IS 4 V:1.2.2   Emergency Responder Electronic Health Record
      IS 9 V:0.0.2   Consultation and Transfers of Care




                                                                          19
 Report from the Security, Privacy & Infrastructure
 Domain Technical Committee
New Construct: HITSP/T81 - Retrieval of Medical Knowledge Transaction

      Key Capabilities: Enables the request and receipt of additional knowledge about a
       medical concept based on specific context parameters. This transaction does not
       prescribe the knowledge content of the message returned but provides the
       specifications for the query for and receipt of additional knowledge.
      Selected Standard(s): Health Level 7 (HL7) Context-Aware Information Retrieval
       (Infobutton) Specification: URL Implementation Guide.
      Used by:
       IS 3 V:3.1.2    Consumer Empowerment
       IS 5 V:1.1.2    Consumer Empowerment & Access to Clinical Information via Media
       IS 8 V:0.0.2    Personalized Healthcare
       IS 10 V:0.0.2   Immunizations and Response Management
       IS 11 V:0.0.2   Public Health Case Reporting




                                                                                           20
 Report from the Security, Privacy & Infrastructure
 Domain Technical Committee
New Construct:T85 - Administrative Transport to Health Plan Transaction

       Key Capabilities: The transport for administrative transactions between a
        provider and a health plan. Examples include a pharmacy obtaining health
        plan eligibility, and a physician requesting referral or authorization information
        from a health plan.
       Selected Standard(s): CAQH Phase II CORE #270 Connectivity Rule
        v2.0.0, which addresses the message envelope metadata, the message
        envelope standards, and the submitter authentication standards for
        administrative transactions, as well as communications-level errors, and
        acknowledgements.
       Used by:
        IS 4 V:1.2.2    Emergency Responder Electronic Health Record
        IS 8 V:0.0.2    Personalized Healthcare
        IS 9 V:0.0.2    Consultation and Transfers of Care
        IS 77 V:0.0.2   Remote Monitoring




                                                                                             21
 Report from the Security, Privacy & Infrastructure
 Domain Technical Committee
New Construct: HITSP/C87 -Anonymize for PHCR Component
      Key Capabilities: Provides specific instructions for anonymizing data that
       was created as part of routine clinical care data delivery in preparation for
       repurposing data for public health case reporting. This construct defines the
       Component specification that provides the ability to anonymize patient
       identifiable information.
      Selected Standard(s): International Organization for Standardization (ISO)
       Health Informatics - Pseudonymisation, Unpublished Technical Specification
       # 25237
      Used by:
       IS 11 V:0.0.2 Public Health Case Reporting




                                                                                       22
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
New Construct: HITSP/C88 - Anonymize for IRM Component
     Key Capabilities: Provides the ability to anonymize patient identifiable
      information for Immunization and Response Management. It provides specific
      instruction for anonymizing data that was created as part of routine clinical
      care delivery in preparation for repurposing the data .
     Selected Standard(s): International Organization for Standardization (ISO)
      Health Informatics - Pseudonymisation, Unpublished Technical Specification #
      25237
     Used by:
      IS 10 V:0.0.2 Immunizations and Response Management




                                                                                      23
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
                     Activities Planned for Next Year
    TN900: Significant restructuring of the document is being undertaken to:
      – Improve overall readability,
      – Decrease emphasis on initial 3 use cases
      – Include additional clarification resulting from user community feedback

    TP20: Access Control
      – Provides greater clarity of previously specified OASIS standards and explains when
        standards should be used
      – Specifies profiles for SAML, WsTrust, etc (Initial draft of XSPA due in May)
      – TP20 will be a focus of a HITSP demo at HIMSS 2009

    TP30: Manage Consent Directives
      – Workgroup will be discussing transaction package upgrade based in part on the resolution of
        identified gaps
      – Work with SDO to update HL7 Confidentiality codes, and ontology of roles




                                                                                                  24
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
         Activities Planned for Next Year (continued)
    C19: Entity Identity Assertion Component
      – Update to support Level of Assurance

    T24: Pseudonymize Transaction
      – update to support provider and organizational pseudonyms

    2009 Use Case / Gaps / Extensions work




                                                                   25
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
                               Conclusion
    We continue to make progress on Privacy and Security interoperability
     standards, working within the multiplicity of jurisdictional constrained
     policies.
    New Use-Cases were well satisfied through re-use of existing SPI
     constructs.
    Look forward to practical feedback from NHIN experience with SPI
     constructs.
    Need to continue to expand our membership and expand the base of
     „active‟ members.




                                                                                26
Report from the Care Management & Health Records
Domain Technical Committee


  Year end work summary
     – List of CM&HR constructs
     – Overview of new construct organization

  Continued activities planned for the coming year




                                                      27
Report from the Care Management & Health Records
Domain Technical Committee
   New/Modified Care Management and Health Records Constructs

 C76 - Case Report Pre-Populate             C48 - Encounter Document
 C83 - CDA and CCD Content Modules          TP89 - Sharing Imaging Results
 C75 – Healthcare Associated Infection      C84 - Consultation, History and Physical
  Report                                      Document
 C74 - Remote Monitoring Observation        C32 - Summary Documents Using CCD
  (RMON)
                                             C78 - Immunization Content
 C80 - Clinical Document & Message
  Terminology                                C72 – Immunization Message
 C90 - Clinical Genomic Decision            C70 - Immunization Query and Response
  Support




 TN901 – Technical Note for Clinical
  Documents


                                                                                         28
Report from the Care Management & Health Records
Domain Technical Committee
                             Reference Constructs
    C80: Clinical Document and Message Terminology
      – Clinical based terminologies and code sets for CM&HR constructs
      – Terminologies/code sets for message or document based constructs
      – Contains references and locations for contained terminologies
      – Contains constrained code sets where applicable for certain use cases

    C83: CDA Content Modules
      – Defines content modules for clinical document based HITSP constructs

    TN901: Technical Notes for Clinical Documents
      – Describes the organization of CM&HR constructs as they relate to C80 and C83




                                                                                       29
New Construct Organization




                             30
Report from the Care Management & Health Records
Domain Technical Committee
                           New/Modified Constructs
    C76: Case Report Pre-Populate
      – Supports data mapping for public health case reports
      – Currently focused on data attributes that are universal or pertain to drug safety reporting

    C75: Healthcare Associated Infection Report
      – construct defining the electronic submission of Healthcare Associated Infection (HAI) reports
        to the National Healthcare Safety Network (NHSN) of the Centers for Disease Control and
        Prevention (CDC)

    C74: Remote Monitoring Observation Document
      – Describes content for clinical content collected by remote healthcare monitoring devices
    C90: Family History Decision Support for Genetic Risk Analysis
      – Defines communication of genetic and family history information for the purposes of clinical
        genomic decision support
    TP89: Sharing Imaging Results
      – Previously TP49 – Sharing Radiology Results, expanded to include cardiology images




                                                                                                        31
Report from the Care Management & Health Records
Domain Technical Committee
                          New/Modified Constructs
    C48: Encounter Document Using IHE Medical Summary
      – Supports the process of communication patient encounter data (excluding lab and radiology)
      – Modifications include constraints for referral and discharge summary

    C84: Consult and History and Physical Note
      – Support consult notes and history and physical notes.

    C32: Summary Documents Using CCD
      – Defines document content summarizing a consumers medical status for the purpose of
        exchange




                                                                                                     32
Report from the Care Management & Health Records
Domain Technical Committee
                         New/Modified Constructs
    C78: Immunization Document
     – immunization data content to be exchanged between healthcare entities

    C72: Immunization Message
     – Defines the method to communicate updates to a patient‟s vaccination record

    C70: Immunization Query and Response
     – Specifies a message mechanism to query for immunization data as well as response
       messages




                                                                                          33
Report from the Care Management & Health Records
Domain Technical Committee
                               Continued Activities
    C83: CDA Content Modules
      – Add CDA content modules from previously existing CDA based constructs not yet transitioned from
        the new organization. C38
      – Increase consistency and readability of existing content modules

    C80: Clinical Document and Messaging Terminology
      – Add vocabulary from previously existing constructs not yet transitioned to new organization
      – Add additional code and value sets based on continuing industry developments and feedback

    C35: Lab Terminology
      – Move terminologies into C80 and update dependent constructs/IS (C36, C37, IS01, IS02, IS05)

    C38: Patient Level Quality Data Document Using IHE Medical Summary
      – Merge into C48 (requires update to IS06)

    TN901: Technical Notes for Clinical Documents
      – Improve understandability



                                                                                                          34
Report from the Care Management & Health Records
Domain Technical Committee
                           Conclusion
  Re-organization of constructs to use generalized modules will
   promote re-use and consistency.
  Continue to re-use and modify existing constructs where possible to
   meet new use case requirements and add new constructs where
   required.
  Continued expansion and refinement of existing constructs to fill
   gaps or specific areas of interest.
  Continue to have a great amount of work and looking for additional
   members to assist.




                                                                        35
Report from the Administrative and Financial Domain
Technical Committee
 Completed editorial changes
     – T40 - Patient Health Plan Generic Eligibility Verification
       Transaction

  Completed new construct
     – T68 - Patient Health Plan Authorization Request and Response
       Transaction
     – T79 - Pharmacy to Health Plan Authorization Request and
       Response Transaction

  Reviewed proposed 2009 Use Cases
  Long Term - Develop a Technical Note document for
   Administrative and Financial Domain TN902

                                                                    36
Report from the Administrative and Financial Domain
Technical Committee
 Construct Work
                                                                               2007 Use
                                                 2008 Use Cases
 HITSP                                                                           Case
                    TITLE
 Doc #                              RMON         PHC     CTC                   E-EHR
                                          PPSM                    IRM   PHCR
                                     IS77        IS08    IS09                   IS04

         Patient Health Plan
  T40    Eligibility Verification    x           x       x                        x
         Transaction

         Patient Health Plan
         Authorization Request
  T68                                x            x          x                    x
         and Response
         Transaction
         Pharmacy to Health Plan
  T79    Authorization Request       x                       x
         and Response



                                                                                          37
Report from the Administrative and Financial Domain
Technical Committee

Existing Constructs Modified to Meet New Use Case Requirements



 Doc            Construct                          Change Description
  #
T40    Patient Health Plan        • Updates to support service/procedure specific inquiry
       Eligibility Verification   and response
       Transaction                • Replaced CORE Phase 1 rules with new CORE
                                  Phase 2 rules
                                  • Renamed to remove word “Generic” in the name




                                                                                            38
Report from the Administrative and Financial Domain
Technical Committee

 New Construct Development Work

     New Construct                       Construct Description                      Selected Standards
 T68 – Patient Health Plan Used by a healthcare provider (other than a retail  ASC X12 278 v4010A
 Authorization Request and pharmacy) to request approval from a health plan to
 Response                  authorize certain healthcare services, when
                           required by the patient‟s health plan contract. The
                           health plan responds to the healthcare provider
                           authorization request.
 T79 – Pharmacy to Health Used by a retail pharmacy to request approval from       NCPDP
 Plan Authorization Request a health plan to authorize certain healthcare          Telecommunication
 and Response Transaction services, when required by the patient‟s health plan     Standard Implementation
                            contract. The health plan responds to the healthcare
                            provider authorization request.                        Guide version 5.1




                                                                                                             39
Report from the Administrative and Financial Domain
Technical Committee

  Current Work Plan
 Project/task                                            Target date
 Draft Administrative and Financial Technical Note 902   02/15/2009
 Preliminary Interest in Proposed 2009 Use Cases –       Ongoing
    - Prior Authorization
    - Scheduling
    - Medications
    - Maternal & Child Health
    - Long Term Care


 Support Provider Perspective Com. on ER-EHR HAVE In Progress


                                                                       40
Report from the Population Perspective Technical
Committee

  Immunization and Response
  Public Health Case Reporting
  Planned Updates:
     –Biosurveillance IS02
     –Quality IS06




                                                   41
Report from the Population Perspective Technical
Committee: Immunization and Response




                                                   42
Report from the Population Perspective Technical Committee:
Immunization and Response – Privacy & Security
TP 20   HITSP Access Control Transaction Package

TP 22   HITSP Patient ID Cross-Referencing Transaction Package

TP 30   HITSP Manage Consent Directives Transaction Package

T 15    HITSP Collect and Communicate Security Audit Trail Transaction

T 17    HITSP Secured Communication Channel Transaction

T 23    HITSP Patient Demographics Query Transaction

T 24    HITSP Pseudonymize Transaction

C 19    HITSP Entity Identity Assertion Component

C 26    HITSP Nonrepudiation of Origin Component

C 88    Anonymize Immunizations and Response Management Data Component




                                                                         43
Report from the Population Perspective Technical Committee:
Immunization and Response – Infrastructure
TP 13   HITSP Manage Sharing of Documents Transaction Package

T 16    HITSP Consistent Time Transaction

T 29    HITSP Notification of Document Availability Transaction

T 31    Document Reliable Interchange

T 33    HITSP Transfer of Documents on Media Transaction

T 63    Emergency Message Distribution Element Transaction

T 64    Identify Communication Recipients Transaction

T 66    Retrieve Value Set Transaction

T 81    Retrieval of Medical Knowledge Transaction

C 62    Unstructured Document Component

C 82    Emergency Common Alerting Protocol Component




                                                                  44
Report from the Population Perspective Technical Committee:
Immunization and Response – Content
TP 21   HITSP Query for Existing Data Transaction Package

T 66    Retrieve Value Set Transaction

C 70    Immunization Query and Response

C 72    Immunization Message Component

C 78    Immunization Document Component

C 80    Clinical Document and Message Terminology Component

C 83    CDA Content Modules Component




                                                              45
Report from the Population Perspective Technical Committee:
Immunization and Response (IS10) – Roadmap


1. Harmonize Immunization Alerts (and Public Health Alerts) with structured
   messaging standards
2. Evaluate Supply Chain Management (Scenario 2) – Deferred in IS10 v1.0
3. Evaluate Countermeasure and Response Administration – Deferred in IS10 v1.0
4. Review next steps for Clinical Decision Support – CMHR
    1. Vaccine Forecast
    2. Communication of immunization schedules
    3. Prioritization notices
    4. Alerts




                                                                              46
Report from the Population Perspective Technical
Committee: Public Health Case Reporting




                                                   47
Report from the Population Perspective Technical Committee:
Public Health Case Reporting – Privacy & Security
TP 20   HITSP Access Control Transaction Package

TP 22   HITSP Patient ID Cross-Referencing Transaction Package

TP 30   HITSP Manage Consent Directives Transaction Package

T 15    HITSP Collect and Communicate Security Audit Trail Transaction

T 17    HITSP Secured Communication Channel Transaction

T 23    HITSP Patient Demographics Query Transaction

T 24    HITSP Pseudonymize Transaction

T 66    Retrieve Value Set Transaction

C 19    HITSP Entity Identity Assertion Component

C 26    HITSP Nonrepudiation of Origin Component

C 87    Anonymize Public Health Case Reporting Data Component




                                                                         48
Report from the Population Perspective Technical Committee:
Public Health Case Reporting – Infrastructure

 TP 13   HITSP Manage Sharing of Documents Transaction Package
 TP 50   HITSP Retrieve Form for Data Capture Transaction Package
 T 16    HITSP Consistent Time Transaction
 T 29    HITSP Notification of Document Availability Transaction
 T 31    Document Reliable Interchange
 T 33    HITSP Transfer of Documents on Media Transaction
 T 63    Emergency Message Distribution Element Transaction
 T 64    Identify Communication Recipients Transaction
 T 81    Retrieval of Medical Knowledge Transaction
 C 62    Unstructured Document Component
 C 82    Emergency Common Alerting Protocol Component
 C 83    CDA Content Modules Component




                                                                    49
Report from the Population Perspective Technical Committee:
Public Health Case Reporting – Content

 TP 21   HITSP Query for Existing Data Transaction Package
 T 14    HITSP Send Laboratory Result Message Transaction
 C 32    HITSP Summary Documents Using HL7 Continuity of Care Document (CCD) Component
 C 35    HITSP Lab Result Terminology Component
 C 36    HITSP Lab Result Message Component
 C 37    HITSP Lab Report Document Component
 C 48    HITSP Encounter Document Using IHE Medical Summary (XDS-MS) Component
 C 75    Healthcare Associated Infection (HAI) Report Component
 C 76    Case Report Pre-Populate Component
 C 80    Clinical Document and Message Terminology Component
 C 83    CDA Content Modules Component




                                                                                         50
Report from the Population Perspective Technical Committee:
Public Health Case Reporting (IS11) – Roadmap
1. Complete notifiable diseases data set
    •   Coordinate Council of State and Territorial Epidemiologists (CSTE), CDC, HITSP
    •   Align with other HITSP data sets, e.g., Biosurveillance, Quality, etc.
2. Harmonize Public Health Alerts (and Immunization Alerts) with structured
   messaging standards
3. Align Patient Safety Reporting with AHRQ Common Formats
    •   Case Report Pre-populate Component <C76>
    •   Clinical Document and Message Terminology Component <C80>
    •   CDA and CCD Content Modules Component <C83>
4. Identify management strategy for non-EHR data required for Patient Safety
   Reporting in Case Report Pre-populate Component <C76>
    •   HITSP (Internal Review Taskforce) – Unaccounted data attribute
5. Update Pseudonymize Transaction <T24>
    •   Practitioner and Organizational Provider Pseudonymization
6. Review next steps for Clinical Decision Support – CMHR


                                                                                         51
Report from the Population Perspective Technical Committee:
Biosurveillance (IS02) – Roadmap




1. Perform maintenance update IS02




                                                          52
Report from the Population Perspective Technical Committee:
Quality (IS06) – Roadmap
1. Configure 3 measure sets for EHR consumption and electronic reporting with
   schematron rule testing (Stroke, Venous Thromboembolism <VTE> and
   Emergency Department <ED>)
2. Update IS06 Maintenance Release
    •   Pseudonymization <T24> update for Practitioner and Organizational Provider
    •   Determine applicability of 2008 constructs to fill gaps for notification
         • Emergency Message Distribution Element Transaction <T63> [Communication
            Protocol]
         • Unstructured Document Component <C62> [Patient specific alert]
         • Emergency Common Alerting Protocol Component <C82> [Generic alert]
         • Retrieval of Medical Knowledge <T81> [Info-button]




                                                                                 53
Report from the Population Perspective Technical Committee:
Quality (IS06) – Roadmap Continued
3. New Construct Considerations to fill Gaps
    •   Specification of Measure and Value Sets
         Health Quality Measures Format <HQMF>
    •   Creation of Patient-Level Data Export (Consider QRDA)
         • Update Patient-Level Quality Document <C38>
         • Update Patient-Level Quality Message <C34>
         • Quality Measure Document Component (Aggregate Report)
         • Case Review Document (Validation with Provider)
4. Review next steps for Clinical Decision Support – CMHR
5. Update Data Set – HITEP II results (July 2009)
    •   Expanded Quality Data Set and Workflow maps




                                                                   54
Report from the Consumer Perspective Technical
Committee

   IS 03 & 05 Consumer Access to Clinical
    Information (gap resolutions update)
   IS 12 Patient-Provider Secure Messaging
    (PPSM)
   IS 77 Remote Monitoring (RMON)




                                                 55
Report from the Consumer Perspective Technical
Committee

  IS03 & IS05
     –Transitioned to the 2008 template
     –Updated both IS‟s to address the following
      gaps:
                 Advance Directives component
                Access to Consumer-Friendly Presentation of
               Medical Information




                                                              56
Report from the Consumer Perspective Technical
Committee – IS03/05

  Advance Directives
     – C62: Unstructured document
     – Facilitates the upload of a scanned version of an advance
       directive into a PHR
     – This represents a partial resolution of the identified gap

  Consumer-Friendly Clinical Information / translations
     – T81: Retrieval of Medical Knowledge
     – Enables consumers to obtain information about clinical term /
       subject from a knowledge resource




                                                                       57
Report from the Consumer Perspective Technical
Committee – IS03/05

  T81: Retrieval of Medical Knowledge Transaction (new)
     – References: HL7 v 3.0 Context-Aware Information Retrieval
       Specification: URL Implementation Guide
     – Based on the “Infobutton” concept




                                                                   58
Report from the Consumer Perspective Technical
Committee – IS03/05
IS03/05 Data Requirements (DRs)

     DR01 Demographic data                 DR67 Allergies/Medication Allergies
     DR02 Patient clinical summary         DR68 Structured information request
     DR03 Clinical History                 DR69 Context-aware Information
                                             Retrieval Message
     DR04 Personal Genetic/Genomic
      Information.                          DR70 Information Source
                                             identification data
     DR05 Family Genetic/Genomic
      Information                           DR71 Change request data
     DR08 Unstructured Data:               DR73 Provider Identification
     DR27 Message Routing and              DR74 Access Control Lists
      Content/Envelope/Metadata of the
      secure message                        DR75 Access log summary
     DR29 Read/delivery confirmation       DR100 Lab Report Document
     DR66 Diagnosis Codes




                                                                                   59
Report from the Consumer Perspective Technical
Committee – IS03/05
IS03/05 Information Exchange Requirements (IERs)

    IER 1   Provide authorization and consent      IER 43 Send/Receive accept patient
    IER 3   Create audit log entry                 IER 61 Provide and Register Document Set
    IER 5   Verify entity identity                 IER 63 Request additional patient data
    IER 8   Generate a delivery-receipt            IER 68 Identify PHR
    IER 10 Identify patient                        IER 69 Authorize release of information
    IER 11 Identify provider based on patient      IER 72 Send/receive audit log
     preference
                                                    IER 73 Request/receive provider
    IER 18 Send/receive clinical document           information
    IER 21 Receive updated clinical information    IER 74 Access/Select provider information
    IER 23 Request/provide additional              IER 75 Designate provider permissions
     information
                                                    IER 76 Request modification to clinical data
    IER 28 Download historical health data
                                                    IER 77 Identification of information sources
    IER 38 Query/retrieve document set
    IER 42 Request/receive medical concept                   = IS03 only
     knowledge
                                                              = IS05 only


                                                                                                    60
Report from the Consumer Perspective Technical
Committee

  IS 12: Patient-Provider Secure Messaging
   (PPSM)
     – Simple in concept
                   Exchange a document

     – Complex in realization
                   Three design alternatives
                   Workflow variants
                   Security requirements
                   Patient identity management
                   Linked to Clinical Decision Support
                   Many Cognitive Processes
                   Internal & Workflow operations


                                                         61
Report from the Consumer Perspective Technical
Committee - IS12 PPSM

  PPSM Architectural Variants

                                       Third variant
                                       selected as
                                       foundation.

                                       First two
                                       variants are
                                       supported as
                                       simplified
                                       implementations



                                                       62
Report from the Consumer Perspective Technical
Committee - IS12 PPSM

  C62 Unstructured Document
     – The “body” of the secure message
     – Care Management & Health Records
                   Primary Author
                   Input from CPTC and other committees

     – Compatible with other HITSP CDA documents
     – Supports a wide variety of content
                   Simple/unstructured text
                   Scanned Documents
                   PDFs
                   Structured Documents


                                                          63
Report from the Consumer Perspective Technical
Committee - IS12 PPSM

  T31 Document Reliable Interchange
     –the means to move the message content from
      the sender to the receiver
     –Security, Privacy & Infrastructure
                 Primary Author

     –Point-to-point exchange
                 No document repository required




                                                   64
Report from the Consumer Perspective Technical
Committee - IS12 PPSM

 PPSM Data Requirements
      DR17 Decision Support Data
      DR27 Message Routing and Content/
      Envelope/ Metadata
      DR28 Secure Message Integrity
      DR29 Read/Delivery Confirmation



                                                 65
Report from the Consumer Perspective Technical
Committee - IS12 PPSM
 PPSM Information Exchange Requirements
       IER01    Provide authorization and consent
       IER02    Send data over secured communication channel
       IER03    Create audit log entry
       IER05    Verify entity identity
                                                                   = Security/Privacy
       IER07    Verify message integrity
                                                                   = Message en route
       IER08    Generate a delivery-receipt
       IER09    Generate a read-receipt
       IER10    Identify patient
       IER30    Compose message
       IER31    Provide message routing/description information
       IER32    Request message
       IER33    Send/receive message
       IER34    Retrieve message „envelope‟ data
       IER35    Store Message into PHR




                                                                                        66
Report from the Consumer Perspective Technical
Committee

  IS77: Remote Monitoring (RMON)
     – Access to remote monitoring information within an EHR or PHR
     – Clinician monitoring information captured remotely in an ambulatory
       setting
     – Measurements such as physiological, diagnostic, medication tracking,
       and patient sensor monitoring (e.g. activities of daily living)
     – Enables management of chronic health problems and initial
       management of new conditions
     – A component of maintaining wellness for the aging population
     – Devices designed for use by the patient or a patient caregiver
     – Communication of interoperable ambulatory remote monitoring
       information to the EHR and the PHR
     – Not the communication/process by which data are captured and
       transmitted from the device


                                                                              67
 Report from the Consumer Perspective Technical
 Committee – IS77 RMON
High Level Diagram                          Business Actors may be combined:
                                            e.g. RM Mgt Syst & EHR
                              System Data
                                            or RM Mgt Syst & PHR
         Interface #1         Exchange #2     Significant reuse of existing & new
                                              constructs in SDE‟s # 3, 4, 5, 6 and 7

Device                     Device              Remote
                        Intermediary          Monitoring         System Data
                                             Mgmt System         Exchange #3

                            System Data
                            Exchange #6                             System Data
                                                                    Exchange #4

                    System Data               Health Info
                    Exchange #7                                      System Data
                                              Exchange
                                                                     Exchange #5

                           PHR                                       EHR System
                          System

                                                                                   68
Report from the Consumer Perspective Technical
Committee – IS77 RMON

  Challenges
     – Convergence to a single interface between Device
       Intermediaries (used either in Homes or in Care
       Delivery Organizations) and Remote Monitoring Mgmt
       Systems
     – Request to IHE and Continua for harmonization
     – Tight schedule synchronization
                   IEEE standards
                   Continua Implementation Guidelines
                   IHE Implementation Guides
                   HITSP IS completion




                                                        69
Report from the Consumer Perspective Technical
Committee – IS77 RMON
RMON Data Requirements (DRs)
    DR06 Health Plan Eligibility         DR81 Physiological measurement
     Information                           data - Blood Pressure Monitor
    DR30 Identification/Remote           DR87 Physiological measurement
     Monitoring Registration Data          data - Implantable Cardioverter
                                           Defibrillator (ICD) Monitoring
    DR35 Free Text Notes
                                          DR89 Physiological measurement
    DR36 Care Coordination Notes .        data - Oxygen Saturation (Pulse
                                           Oximeter)
    DR37 Alerts, Alarms and Notices
                                          DR91 Physiological measurement
    DR38 Health plan authorization        data - Temperature (Thermometer)
    DR39 Remote Monitoring Services      DR92 Physiological measurement
     Order                                 data - Weight (Weighing Scale)
    DR40 Structured Treatment Plan       DR97 Device and measurement
    DR74 Access control lists             descriptive data – Generic Device
                                           Data
    DR80 Physiological measurement
     data - Blood Glucose Meter           See IS77 RMON Device Roadmap for
                                           additional DR‟s



                                                                               70
Report from the Consumer Perspective Technical
Committee – IS77 RMON
 RMON Information Exchange Requirements
       IER01    Provide authorization and consent
       IER02    Send data over secured communication channel
       IER03    Create audit log entry
       IER04    Synchronize system time
                                                                 = Security/Privacy
       IER05    Verify Entity Identity
                                                                 = SDE #2
       IER10    Identify patient
       IER14    Send/receive health plan eligibility
       IER15    Send/receive health plan authorization
       IER18    Send/receive clinical document
       IER24    Send/receive structured treatment plan
       IER36    Send/receive remote monitoring service order:
       IER38    Query/retrieve document set
       IER39    Send/receive device observation data
       IER61    Provide and register document set




                                                                                      71
Report from the Consumer Perspective Technical
Committee – IS77 RMON
    Send/receive device observation data : From Device Intermediary to Remote
     Monitoring Mgt System
      – Shall support conventional networks (e.g., POTS, Cable, DSL, GPRS, CDMA).
      – Must support “always on” (e.g., Internet) and “intermittent” connections (e.g.,
        POTS)
      – Shall support conventional Device Intermediaries (e.g., Cell Phone, PC, Set Top
        Boxes, PDA)
      – Device data values shall not be modified, a sufficient data integrity (i.e., must not
        be altered or destroyed either by attack or accident while in transmission)
      – A tamper-resistant audit log file should record security-relevant actions
      – A mechanism must be provided to synchronize clocks with the Remote Monitoring
        Mgmt System
      – Sufficient Security/Privacy based on a reasonable level of risk
      – Transport sessions must be initiated from within the home or from the patient-side
        device
      – Message size should be reasonable (but not minimized more than lossless
        compression) due to bandwidth limitation and/or transmission cost


                                                                                                72
Report from the Consumer Perspective Technical
Committee – IS77 RMON
  HITSP/IS77 [current release]
     – IHE, Continua, and HITSP have achieved consensus on most system data exchanges
     – Work needed on System Data Exchange #2, Device Intermediary to the Remote Monitoring
       System
     – For Consumer Grade and Clinical Grade applications, the IEEE 11073 PHD nomenclature
       provides semantic interoperability and has been concluded as the resolution of the data
       requirements for the devices being addressed in this release of the IS77 document.

  HITSP/IS77 future – extended clinical-grade device
   nomenclature drawn from :
     – ISO/IEEE 11073-10101:2004(E) – Health Informatics – Point-of-care medical device
       communication Part 10101: Nomenclature, First Edition
     – IHE Patient Care Device Technical Framework Supplement 2008-2009 – Rosetta
       Terminology Mapping (RTM) – Defines observation identifiers and co-constraints such as
       units-of-measure, enumerations, external measurement site identifiers and instrumentation
       hierarchy which also defines IEEE 11073 to UCUM Units-Of-Measure Mapping
     – Ultimately all new terms used in IS77 will be merged into ISO/IEEE 11073-10101 base
       nomenclature standards.




                                                                                                   73
    T73 - Aggregate Device Information Communication
              [Construct Release Planned for Mid-2009]

    Concept
–     Allows a system (such as a home hub, a cell phone, a set top box, a
      monitoring station) to report device observations through a local or
      remote connection to an information management system
    Standards Selection Work
–     The Tier 2 analysis has resulted in two alternatives for SDE#2
      transport:
        One approach is based on the use of the IHE DEC Integration Profile (HL7 V2.x).
         This approach is widely used today within Hospitals to connect clusters of devices
         to EHRs
        The other approach is based on the use of IEEE Device Specialization conveyed
         as a document (ASN1 encoded with MDER or XER)) by HITSP T31 (IHE-XDR).
         This approach is primarily targeted at home monitoring
        HITSP has obtained convergence on one approach by IHE & Continua for June
         2009 (Transport and message structure).
–     Data Vocabulary standards selected using IEEE 11073 Device
      Specializations nomenclature


                                                                                       74
 C74 - Remote Monitoring Observation Document

 Concept
 – Specifies the medical information collected by remote health monitoring devices,
   based upon HL7 CDA
 – Measurements captured by devices; notes, summaries, and other kinds of
   narrative information that may be added by caregivers or by the users
 – Graphs that may be added by intermediary devices that represent trends of
   users‟ health
 – Example systems include PHRs, EHRs, Practice Management Applications and
   other stakeholders

 Selected Standards
 – Implementation Guide for CDA Release 2.0 Personal Health Monitoring Report
   (PHMR)
        Uses SNOMED CT nomenclature mapped to IEEE 11073 nomenclature used in
         HITSP/T73 for data vocabulary


                                                                                 75
Report from the Consumer Perspective Technical
Committee - Strategy for IS77 and IER39 (i.e. T73/SDE#2)
  HITSP 2009 Work for IER39
     – IHE, Continua and HITSP TC‟s are highly motivated to work together
     – IHE and Continua have signed an MOU
     – To converge on a single solution for System Data Exchange #2,
       additional work will be needed to achieve consensus. IHE, Continua
       and HITSP will make their best effort to complete this work by June
       2009
     – In the event that this does not happen, it is recommended that HITSP
       convene an interim cross-organizational team of HITSP TC members
       to review the progress, collect information (e.g., industry survey of
       manufacturers/consumers of RMON Device Intermediary), and
       provide a recommendation to the HITSP Board.
            We used a similar approach to achieve consensus with regards
             to CCD

  HITSP RMON Device Road Map


                                                                               76
    Report from the Consumer Perspective Technical
    Committee – IS77 RMON Device Roadmap
     AHIC March 2008 Remote Monitoring Use Case                                     IS77-Dec 2008           IS77- Dec 2009
Physiological Measurement Data Types and Devices (Examples
      provided below are not comprehensive)

     Blood Glucose [DR80]                                                               Yes                       2008
     Blood Pressure [DR81]                                                              Yes                       2008
     Brain Activity (e.g., Ambulatory EEG) [DR82]                                                                   No
     Cholesterol [DR83]                                                                                            Yes
     Esophageal pH [DR84]                                                                                           No
     Heart Rate [DR85]                                                                  Yes                       2008
     Heart Rhythm (e.g., AECG, Holter Monitor, Cardiac Implants) [DR86]                             Yes (1-3 Channel ECG and rhythm)
                                                                                                    No (Cardiac Implants, Holter Monitor)
     Implantable Cardioverter Defibrillator (ICD) Monitoring (e.g., Intercardiac                                    No
      Pressure, Intrathoracic Fluid, EGM Waveforms) [DR87]
     Lung Function [e.g., FEV1 (forced expiratory in 1 sec), FVC (forced vital                                     Yes
      capacity), PEV(peak expiratory volume), PEFR (peak expiratory flow
      rate)], i.e. Spirometry measures [DR88]
     Oxygen Saturation [DR89]                                                           Yes                       2008
     Respiration Rhythm [DR90]                                                                     Yes (Respiration rate through ECG)
     Temperature [DR91]                                                                 Yes                       2008
     Weight [DR92]                                                                     Yes                        2008



                                                                                                                                            77
Report from the Consumer Perspective Technical
Committee – IS77 RMON Device Roadmap
 AHIC March 2008 Remote Monitoring Use Case            IS77-Dec 2008          IS77- Dec 2009
 Medication Management and Administration
      Data and Device Types:
 Electronic Pillbox – Patient Alerts and Medication                                Yes
 Administration Tracking [DR93]
 Medication Pumps – Medication Administration                          Yes (Reporting Pump activity)
 [DR94]                                                                   No (Pump Programming)
 Medication Infusion Devices – Medication                              Yes (Reporting Infusion Pump
 Administration [DR95]                                                                activity)
                                                                       No (Infusion Pump Programming)
 Patient Sensor Monitoring Data: [DR96]
 ADL Biosensors and Detection Devices                                              Yes
 Emergency Alerting, Global Positioning System                           Yes (Emergency alerting)
 (GPS)
 Fall Detection                                                              Yes (Simple fall)
 Pedometer (Steps Moved)                                                           Yes
 Sleep Actigraphy                                                              Yes (Simple)

                                                                                                        78
Report from the Consumer Perspective Technical
Committee – IS77 RMON Device Roadmap
 AHIC March 2008 Remote Monitoring Use Case              IS77-Dec 2008   IS77- Dec 2009
 Measurement Metadata – Device/Device
     Intermediary-Generated: [DR97]
 Device Identification Information                           Yes             2008
 Patient Identification Data                                 Yes             2008
 Device Type                                                 Yes             2008
 Device Setting Information                                                  Yes
 Date/Time of Measurement                                    Yes             2008
 Data Source (Device-generated vs. Patient-entered)                          Yes
 Measurement Characteristics (Raw vs. Summary Data)                          Yes
 Measurement Scale/Units                                     Yes             2008
 Device Calibration/Programming Data                         Yes             2008

 Error Details: [DR98]
 Device Malfunction                                          Yes             2008
 User Error During Measurement                                               Yes
 Measurement Cancelled by Patient (Stopped                   Yes             2008
 measurement process or marked measurement as invalid)


                                                                                          79
Report from the Consumer Perspective Technical
Committee – IS77 RMON Device Roadmap

 AHIC March 2008 Remote Monitoring Use Case        IS77-Dec 2008           IS77- Dec 2009
 Patient-Entered Measurement Descriptive data:
       [DR99]
 Measurement-Instance Specific Details (e.g.,                                    Yes
 patient-entered accompanying the measurement
 such as stress level, position)
 Measurement Error Details                                                       Yes
 Alerts, Alarms and Notices [DR37]
 Normal Range                                                                    Yes
 Normal Range for Patient                                         Yes (potential for remote patient-
                                                                          specific setting of normal
                                                                                    ranges)
 Alert (Low Value, High Value, Change in Trend)                                  Yes




                                                                                                        80
Report from the Provider Perspective Technical
Committee
 IS0-8 Personalized Health Care
 Use case Scenario's
    Clinical Assessment. A family health history is gathered from or by the
     consumer in an interoperable form to be used by consumers and clinicians.
     This information is accessed by clinicians and used in conjunction with
     personal medical history, current health status, and personal preferences to
     develop a diagnostic plan.
    Genetic Testing, Reporting, and Clinical Management. A medical
     testing laboratory performs genetic or genomic testing after it receives
     genetic/genomic test orders and any accompanying information necessary
     for the testing in an interoperable form. The testing laboratory performs the
     tests, develops the patient report, and transmits this information back to
     authorized providers. Clinicians utilize this new diagnostic information for
     the management of their patients. Both clinicians and consumers have
     access to this information via the PHR.

                                                                                     81
Report from the Provider Perspective Technical
Committee

 Current Status
  IRT review passed; all formatting and
   tables updated to latest standards
  Gaps identified
  Submitting for Panel Approval




                                                 82
Report from the Provider Perspective Technical
Committee: Identified Constructs

  HITSP/C19 - Entity Identity Assertion
  HITSP/C32 - Summary Documents Using HL7 Continuity of Care
   Document (CCD)
  HITSP/C36 - Lab Result Message Component
  HITSP/C37 - Lab Report Document
  HITSP/C48 - Encounter Document Using IHE Medical Summary
   (XDS-MS)




                                                                83
Report from the Provider Perspective Technical
Committee: Identified Constructs

  HITSP/C62 Unstructured Document Component
  HITSP/C69 - Generic Order Component
  HITSP/C80 - Clinical Document and Message Terminology
   Component
  HITSP/C84 - Consult and History and Physical Note Component
  HITSP/C90 – Clinical Genomic Decision Support Component




                                                                 84
Report from the Provider Perspective Technical
Committee: Identified Constructs

  HITSP/T15 - Collect and Communicate Security Audit Trail
  HITSP/T16 - Consistent Time
  HITSP/T17 - Secured Communication Channel
  HITSP/T23 - Patient Demographics Query
  HITSP/T29 - Notification of Document Availability
  HITSP/T31 - Document Reliable Interchange
  HITSP/T33 - Transfer of Documents on Media
  HITSP/T40 - Patient Generic Health Plan Eligibility Verification
   Transaction

                                                                      85
Report from the Provider Perspective Technical
Committee: Identified Constructs

  HITSP/T68 - Health Plan Authorization/Referral Request and
   Response
  HITSP/T85 – Administrative Transport to Health Plan
  HITSP/TP13 - Manage Sharing of Documents
  HITSP/TP20 - Access Control
  HITSP/TP22 - Patient ID Cross-Referencing
  HITSP/TP30 - Manage Consent Directives
  HITSP/TP89 – Sharing Imaging Results


                                                                86
Report from the Provider Perspective Technical
Committee

 Gaps Identified
  Ability to receive report including analysis of risk from a
   Genetic Clinical Decision Support System

  Ability to send and receive updated Genomic Test
   Orders and Clarification of Orders

  C36 is necessary but not sufficient to communicate
   genomic lab results. More detailed implementation
   guidance is necessary to satisfy the requirements.




                                                                 87
Report from the Provider Perspective Technical
Committee

  Next Steps
  Address Clinical Decision Support and
   Family History
  Introduce W3C Standards pertinent to Life
   Sciences and Interoperability for
   Personalized Health Care



                                                 88
Report from the Provider Perspective Technical
Committee



   Personalized Health Care

    Integration into Clinical Practice
  Intervention Development and Review
      Expansion of the             Health Information
       Science Base                   Technology

                   Adapted from DHHS:
      “PHC, Opportunities, Pathways, Resources,” 2007



                                                        89
Report from the Provider Perspective Technical
Committee – Emergency Responder EHR




                                                 90
Report from the Provider Perspective Technical
Committee – Emergency Responder EHR




                                                 91
Report from the Provider Perspective Technical
Committee – Emergency Responder EHR




                                                 92
Report from the Provider Perspective Technical
Committee – Emergency Responder EHR
    What we added
     – C82 Emergency Common Alerting Protocol
     – C47 Resource Utilization Message Component
     – C62 Unstructured Document
     – T40 Patient Generic Health Plan Eligibility Verification Transaction
     – T63 Emergency Message Distribution Element Transaction
     – T64 Identify Communication Recipients
     – T66 - Retrieve Value Set
     – T67 - Clinical Referral Request Transport
     – T68 Patient Health Plan Authorization Request and Response Transaction
     – T85 Administrative Transport to Health Plan
     – Harmonized Information Exchange (IERs) and Data Requirements (DRs)
     – UML Component data flow diagrams


                                                                              93
Report from the Provider Perspective Technical
Committee – Emergency Responder EHR

 The NEMSIS chaired work group will report back to the TC in 2009 on:
    – Finding a method of assigning and adopting unique identifiers for
      both incidents and patients so data from heterogeneous systems
      can be linked
    – Exploring common approaches of delivering third party incident
      information such as telematics data to the ECS and other
      emergency responders
    – Reaching agreement between healthcare and other emergency
      responders on a common terminology (“Managed List”) for incident
      types
    – Harmonizing the data taxonomies of hospital, EMS, and other
      emergency responders to the extent necessary to implement the
      ER-EHR

                                                                          94
Report from the Provider Perspective Technical
Committee – Emergency Responder EHR

  There are additional gap area projects, which are:
   – Decision Support Tools – pending HITSP wide solution
   – Core Services – watch industry
   – Situation Awareness Messaging – Need construct for
     Oasis SA
   – Resource Management messaging – Need construct for
     Oasis RM
   – Emergency Contact Registry (ECON) - working through
     IHE
   – Life critical monitoring – will build upon IS 77 Remote
     Monitoring

                                                         95
Report from the Provider Perspective Technical
Committee

  Consultations and Transfers of Care
   (CTC) based upon
     –Consultation and Transfers of Care Detailed
      Use Case, March 21, 2008
     –TN900, Security and Privacy Technical Note
     –TN901, Technical Note for Clinical
      Documents



                                                    96
Report from the Provider Perspective Technical
Committee

  CTC covers:
    –Consultations: information exchange supporting
    consult request, performance and resulting
    –Transfers of care: information exchange for
    request and actual transfer

  For both consults and transfers
    –Supports information exchange to verify
    eligibility and authorization for services.

                                                   97
Report from the Provider Perspective Technical
Committee

 Summary of CTC/IS09 constructs
   –Lab-related (C35, C36, C37, T14)
   –Document-related (C32, C48 , C62, C84, T29, T31, T33, TP13,
   TP22)
   –Radiology-related (C41, TP89)
   –Security/infrastructure-related (T15, T16, T17, T85, TP20)
   –Eligibility/referral-related (T40, T67, T68, T79)
   –Entity/identity-related (C19, T23, TP22)




                                                                  98
Report from the Provider Perspective Technical
Committee

 CTC progress report
   –As of our last report in September …
       oWe were finishing IS09 draft for public comment
       oAddressing a few last minute gaps and issues
       oGetting ready for public comment




                                                          99
Report from the Provider Perspective Technical
Committee

 CTC present status:
   –Public comment was vigorous, intensively
   reviewed, and mostly incorporated in present
   document
   –IRT review passed; all formatting and tables
   updated to latest standards
   –Gaps identified (mostly requiring external work)



                                                       100
Report from the Provider Perspective Technical
Committee

 Public Comment Details
   –CTC draft completed on Sept 22, 2008
   –Public comment period Sept 29 – Oct 24th
   –86 Comment received and reviewed
       o40 accepted, all implemented
       o30 accepted with modification, all implemented
       o15 rejected (not implemented)
       o1 gap (need to develop registries for DR5 and
       IER18)

                                                         101
Report from the Provider Perspective Technical
Committee

 CTC IRT Review and Results
   –Sent to IRT on Nov 18, 2008
   –Steve Hufnagel and David Tao revised
   component diagrams
   –IRT revealed cut-paste errors and naming
   revision issues that had not been detected
       oDemonstrates need for more robust tooling in
       future efforts


                                                       102
Report from the Provider Perspective Technical
Committee

 Remaining Gaps
   –Some important clinical data lack a HITSP construct
   (e.g., ECG)
   –Functional status instruments need CDA constructs
   –Nursing documentation (may need CDA work plus more
   definition of professional standards)
   –Identifying provider/facilities by patient preferences is an
   area needing 2009 work
   –Decision support needs more field work, standards
   creations, and cross-TC engagement to incorporate
                                                               103

				
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