“Jericho / UT Austin Pilot”

Privacy with Dynamic Patient Review

August 27, 2013

Presented by:David Staggs, JD, CISSP

Jericho Systems Corporation

208/27/2013

Agenda• Administrative issues • Pilot scope• Pilot data flow • Review of previous demonstration• Report on current progress• Discussion• Pilot Timeline• Plan of Action• Announcement of “all hands meeting”

308/27/2013

Pilot Administrivia

• This pilot is a community led pilot– Limited support provided by the ONC

• Zachary May (ESAC)• Jeanne Burton (Security Risk Solutions)• Melissa Springer (HHS)

• In conjunction with DS4P bi-weekly return of an All Hands meeting• Access to DS4P Wiki, teleconference, and calendar • Meeting times: Tuesdays 11AM (ET)

– Dial In: +1-650-479-3208Access code: 662 197 169URL:https://siframework1.webex.com/siframework1/onstage/g.php?t=a&d=662197169

408/27/2013

Scope of the Pilot

1. Define the exchange of HL7 CDA-compliant PCD between a data custodian and a PCD repository that includes a report on the outcome of the request back to the healthcare consumer. 

2. Additional goal: use of identifiers that can uniquely identify the healthcare consumer and PCD repository used to report the outcome of the request back to the healthcare consumer by healthcare consumer’s provider and subsequent EHR custodians.

3. Stretch goal: mask and/or redact the clinical document based on PCD choices retrieved from the PCD repository.

4. Stretch goal: use of the PCD repository as a proxy allowing direct authentication by the healthcare consumer to the provider, subsequently reducing correlation errors.

508/27/2013

Pilot Data Flow

Custodian of Data being Provided at

Patient

PCD Repository2nd Requestor

1st Requestor

B

, = Clinical data

A,B =PCD data

= audit record

And Subsequent Custodian of Data being Provided at

608/27/2013

Previous Demonstration

1. Use Universal Client to send NwHIN messages– Patient Discovery (ITI-55), Query for Documents (ITI-38), and

Request Document (ITI-39) 

2. Demonstrate consent based on recipient and patient consent directive (retrieved from a PCD repository)– Show result of different policies: 1st requestor v. 2nd requestor

3. Demonstrate PCD applied by 1st requestor– 1st requestor retrieves document; 2nd requestor requests from 1st

requestor

4.  Demonstrate consent based on purpose of use– change policy from “allow treatment” to “allow research,” request

using “research” attribute both times

708/27/2013

Current Progress1. Edmonds Scientific development of data segmentation

functionality for identifying segments in clinical documents and redaction– Redaction demonstrated using Request Document (ITI-39). 

2. UT Austin demonstrate consent based on recipient and patient consent directive (retrieved from a PCD repository)– Patient Discovery (ITI-55), Query for Documents (ITI-38), and

Request Document

3. Conemaugh Health System demonstrate consent based on recipient and patient consent directive – Patient Discovery (ITI-55), Query for Documents (ITI-38), and

Request Document

07/30/2013 8

Healthcare Classification System(HCS)

08/27/2013 9

Document “Facts”

Doc

umen

t Orc

hest

ratio

nRules Engine

Document Transformer

Rule Generation

Packaging

Simplified View

PCD Constraints

Document

Clinical/Organizational Policies

Fact Administration

Rul

es

DocumentActions

Document, PCD (decomposed), and Org OID (FHIR ResourcesSupported)

Redacted/Annotated/Masked Document

Event Logging

HL7 FHIR ConnectathonFast Healthcare Interoperability Resources (FHIR) Resources:

– represent flexible granular clinical concepts– managed in isolation, or aggregated into complex

documents– a coherent solution for a range of interoperability problems– based on thorough requirements gathering, formal

analysis and extensive cross-mapping to other relevant standards

– based on simple XML, with an http-based RESTful protocol where each resource has predictable URL

A workflow management layer provides support for designing, procuring, and integrating solutions.

08/27/2013 10

1108/27/2013

FHIR Demonstration

Health Level Seven (HL7)

27TH Annual Plenary & Working Group Meetings

September 21-22, 2013 Hyatt Regency Cambridge (Boston)

HCS – Security Labeling Services

DS4P Use Cases – Share All, Share Partial, Breakglass

VA/DoD iEHR Use Cases

1208/27/2013

Discussion

• Open forum for discussing questions:o Problems with the Universal Client?o Problems with communicating use of the PCD repositoryo Problems with use of OpenATNA Audit Message Viewero Problems with how PCD is changed and the affects o Unexpected benefits/problems

1308/27/2013

Pilot Timeline

• General Timeline, conditioned on agreement of stakeholders

14

Plan of Action

• Upon agreement of the participants the POA is: • Identify the elements available from previous DS4P pilots• Scope level of effort, decide on extended scenario• Determine first draft of functional requirements• Review standards available for returning information on requests• Determine any gaps or extensions required in standards• Stand up information holders and requestors• Create XDS.b repository holding PCD• Identify remaining pieces, create test procedures • Document and update IG with results of our experience

08/27/2013

15

Announcement

• DS4P “All Hands Meeting:”

When: Wed, August 28, 11:00am – 12:30pm (ET)

Where: Dial-in 1-650-479-3208

Access code: 661 315 448

WebEx URL

(https://siframe work1.webex.com /siframework1/o nstage/g.php?t= a&d=661315448)

08/27/2013

1608/27/2013

Backup Slides

DS4P Standards Material• Location of DS4P Standards Inventory:

http://wiki.siframework.org/Data+Segmentation+-+Standards+Inventory

• Location of DS4P Standards Mapping Issues:http://wiki.siframework.org/file/view/Copy%20of%20DataMappingsIssues%2005102012.xlsx/333681710/Copy%20of%20DataMappingsIssues%2005102012.xlsx

• General Standards Source List:http://wiki.siframework.org/file/view/General%20SI%20Framework%20Standards%20Analysis.xlsx/297940330/General%20SI%20Framework%20Standards%20Analysis.xlsx

• Standards Crosswalk Analysis http://wiki.siframework.org/Data+Segmentation+for+Privacy+Standards+and+Harmonization (at bottom of page, exportable)

• Implementation Guidancehttp://wiki.siframework.org/file/view/Data%20Segmentation%20Implementation%20Guidance_consensus_v1_0_4.pdf/416474106/Data%20Segmentation%20Implementation%20Guidance_consensus_v1_0_4.pdf

08/27/2013 17

1808/27/2013

DS4P References

• Use Case: http://wiki.siframework.org/Data+Segmentation+for+Privacy+Use+Cases

• Implementation Guide: http://wiki.siframework.org/Data+Segmentation+for+Privacy+IG+Consensus

• Pilots Wiki Page: http://wiki.siframework.org/Data+Segmentation+for+Privacy+RI+and+Pilots+Sub-Workgroup

1908/27/2013

Pilot Data Flow

Custodian of Data being Provided at

Patient

PCD Repository2nd Requestor

1st Requestor

B

, = Clinical data

A,B =PCD data

= audit record

And Subsequent Custodian of Data being Provided at

2008/27/2013

Pilot Data Flow

Custodian of Data being Provided at

Patient

PCD Repository2nd Requestor

1st Requestor

Clinical exchange #

Clinical exchange #

B

, = Clinical data

A,B =PCD data

= audit record

And Subsequent Custodian of Data being Provided at Fetch PCD Fetch

PCD

Send auditSend audit

2108/27/2013

Pilot Data Flow (1)

Custodian of Data being Provided at

Patient

PCD Repository2nd Requestor

1st Requestor

, = Clinical data

A,B =PCD data

= audit record

2208/27/2013

Pilot Data Flow (2)

Custodian of Data being Provided at

Patient

PCD Repository2nd Requestor

1st Requestor

, = Clinical data

A,B =PCD data

= audit record

2308/27/2013

Pilot Data Flow (3)

Custodian of Data being Provided at

Patient

PCD Repository2nd Requestor

1st Requestor

B

, = Clinical data

A,B =PCD data

= audit record

And Subsequent Custodian of Data being Provided at

2408/27/2013

Pilot Data Flow (4)

Custodian of Data being Provided at

Patient

PCD Repository2nd Requestor

1st Requestor

, = Clinical data

A,B =PCD data

= audit record

And Subsequent Custodian of Data being Provided at

2508/27/2013

Pilot Data Flow (5)

Custodian of Data being Provided at

Patient

PCD Repository2nd Requestor

1st Requestor

, = Clinical data

A,B =PCD data

= audit record

And Subsequent Custodian of Data being Provided at

2608/27/2013

Pilot Data Flow (updated)

Custodian of Data being Provided at

Patient

PCD Repository2nd Requestor

1st Requestor

B

, = Clinical data

A,B =PCD data

= audit record

And Subsequent Custodian of Data being Provided at