0 report from the technical committees arlington, va | june 23, 2008 presented by joyce sensmeier...

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Report from the Technical Committees

Arlington, VA | June 23, 2008

Presented by Joyce Sensmeier MS, RN-BC, and the HITSP Technical Committee Co-Chairs

enabling healthcare interoperability

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In order to better conduct its new work, HITSP has implemented a new Technical Committee structure

Three (3) Perspective Committees aligned with AHIC perspectives

1. Provider

2. Population

3. Consumer

Three (3) Domain Committees focused on healthcare domains

1. Care Management and Health Records

2. Security, Privacy and Infrastructure

3. Administrative and Financial

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New AHIC Use Cases (2008)

Consultations and Transfers of

Care

PersonalizedHealthcare

Immunizations and Response Management

Public Health Case Reporting

RemoteMonitoring

Patient – Provider Secure

Messaging

Provider Consumer Population

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Use Cases Year 3

– Consultations and Transfers of Care -- The exchange of information between clinicians, particularly between requesting clinicians and consulting clinicians, to support consultations such as specialty services and second opinions.

– Personalized Healthcare - The exchange of genomic/genetic test information, family health history and the use of analytical tools in the electronic health record (EHR) to support clinical decision-making.

– Remote Monitoring – Focuses on the exchange of physiological and other measurements from remote monitoring devices in three candidate workflows: Measurement and Communication, Monitoring and Coordination, and Clinical Management.

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Use Cases Year 3

– Patient-Provider Secure Messaging -- Patients consult with their healthcare clinicians remotely using common computer technologies readily available in home and other settings.

– Immunizations and Response Management – The ability to communicate a subset of relevant information about needs for medication and prophylaxis resources, about resource availability, about their administration and about the status of treated and immunized populations.

– Public Health Case Reporting - Leveraging electronic clinical information to address population health data requirements.

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Technical Committee Leadership Provider Perspective – 203 members

– Allen Hobbs, PhD, Kaiser Permanente

– Steve Hufnagel, PhD, DoD/Medical Health System (MHS)

– Mike Lincoln, MD, Department of Veterans Affairs

Consumer Perspective – 192 members

– Mureen Allen, MD, FACP, ActiveHealth Management

– Charles Parisot, EHR Vendor Association

– Scott Robertson, PharmD, Kaiser Permanente

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Technical Committee Leadership Population Perspective - 166 members

– Floyd Eisenberg, MD, MPH, Siemens Medical Solutions

– Peter Elkin, MD, Mayo Clinic College of Medicine

– Steve Steindel, PhD, Centers for Disease Control & Prevention

Administrative and Financial Domain – 42 members

– Don Bechtel, Siemens Medical Solutions

– Durwin Day, Health Care Service Corporation

– Deborah Belcher, GE Healthcare

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Technical Committee Leadership Security, Privacy & Infrastructure Domain - 161

members

– Glen Marshall, Siemens Medical Solutions

– John Moehrke, GE Healthcare

– Walter Suarez, MD, Institute for HIPAA/HIT Education and Research

Care Management and Health Records Domain - 31 members

– Keith Boone, GE Healthcare

– Corey Spears, McKesson Health Solutions

Total Technical Committee Membership – 481 individuals

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Report from the Population Perspective Technical Committee

Two Use Cases–Immunizations & Response Management–Public Health Case Reporting

Outline–Overview–Scope–Reuse Items–Identified new Constructs

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Report from the Population Perspective Technical Committee – Immunizations & Response Management Release I:

– Artifacts for communication of vaccination information between patients, providers, and immunization registries, including registry-to-registry communication

– Allow for optionality of architectures supporting traditional legacy message-based communications, addition of support for patient identification services (TP22, T23), and the addition of support for document-centric sharing and point-to-point communications for PHR Interoperability

– Include security and privacy constraints for implementation of the Immunization and Response Management Interoperability Specifications

Release II:– Identify specification and standard business workflows for supply chain and

distribution management of vaccines and develop needed artifacts

– Incorporation of the vaccine recall processes in the supply chain management.

– Incorporation of pending constructs supporting Clinical Decision Support

lfourquet

added qualification that document support is for PHR interoperability

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Report from the Population Perspective Technical Committee – Immunizations & Response ManagementNew Constructs• Component: Identify communication recipients• Transaction Package: Immunization Feed

• Component: Vaccination (VXU/VXR)

• Component: Unstructured document (communicate generic information to patient)• Component: Generic alert to identified providers (communicate non-patient specific

information)• Transaction Package: Immunization Query & Response• Referencing Public Health Case Reporting constructs (for reporting adverse reaction

to Vaccination)• Terminology Services (requirements driven by other use cases)• Deferred

• Clinical Decision Support Content (immunization schedules, reminders)• Vaccination Documents (including Consumer vaccination view)• Medication Administration• Supply Chain management (inventory management, vaccine recall)

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Report from the Population Perspective Technical Committee – Immunizations & Response Management

Reuse of Existing Constructs• Transaction Package: Immunization Feed Package (PIX/PDQ, TP13)• TP 50 Retrieve Form for Data Capture• TP 21 Query for Existing Data• TP 13 Manage Sharing of Documents• C48 Encounter Document Using IHE Medical Summary• C32 Summary Documents Using HL7 CCD• C25 Anonymize• T24 Pseudonymize• T23 Patient Demographics Query• T29 Notification of Document Availability• T22 Patient ID Cross-Referencing• T16 Consistent Time• T17 Secured Communication Channel• C26 Nonrepudiation of Origin• C19 Entity Identity Assertion• T15 Collect and Communicate Security Audit Trail• TP30 Manage Consent Directives• TP20 Access Control• T31 Document Reliable Interchange• T33 Transfer of Documents on Media

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Report from the Population Perspective Technical Committee – Immunizations & Response Management

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Report from the Population Perspective Technical Committee – Public Health Case Reporting Use Case

– Public Health Case Reporting

•Content Standardization in Progress

•Ongoing Content Source: Council of State and Territorial Epidemiologists (CSTE)

– Adverse Event Reporting


•Ongoing Content Sources:

• Adverse Drug Events – FDA

• Patient Safety – TBD

• AHRQ Patient Safety Data Set Public Comment 9 Aug 2008

• CDC Healthcare Associated Infection definitions / reporting

• Patient Safety Organization (PSO) instantiation

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– 2008 – Trial Implementation Testing, Publication of Roadmap

•TP50 – Retrieve Form for Data Capture

• No determination regarding content structure within RFD

• Content can be mapped to HL7 message – CDA, C32, C48, message or other

•One construct for trial content component consideration• HL7 Healthcare Associated Infection (HAI) report

•Alerts: Reuse from IRM: Generic Alert to Identified Providers and Unstructured Document Components

– 2009 – Release 1


•Reporting Criteria Content – Common / basic (Structured content)

•Refined Transport

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– 2010 – Release 2

• FDA MedWatch, Vaccine Adverse Event Reporting System (VAERS) – Pending successful ballot of Individual Case Safety Report (ICSR)v3 through HL7, ISO, CEN – Expected Dec 2009

• AHRQ Sentinel Event / Adverse Reaction Reporting

• Public Health Case Reporting

• Reporting Criteria Content – Case-specific

• Communications from Public Health

• Clinical Decision Support content, triggers

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New Constructs (Introduction timing not indicated)– Case Reporting Terminology Component– Standard Case Report Construct Adverse Event Reports: (CDC-

HAI, AHRQ, FDA, PH Cases)– Reporting Criteria Content: Basic and Case-specific– Clinical Decision Support Content (Trigger Events: PH, AE,

AHRQ)– Identify Communication Recipients– Generic Alert to Identified Providers – Unstructured Document Components

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Reuse of Existing ConstructsTP50: Retrieve Form for Data CaptureTP21: Query for Existing DataTP13: Manage Sharing of DocumentsC48: Encounter Document Using IHE Medical SummaryC32: Summary Documents Using HL7 CCD C25: AnonymizeC35: Lab Report TerminologyC36: Lab Result Message C37: Lab Report DocumentT24: PseudonymizeT23: Patient Demographic QueryT29: Notification of Document AvailabilityT22: Patient ID Cross-ReferencingT16: Consistent TimeT17: Secured Communication ChannelC26: Nonrepudiation of OriginC19: Entity Identity AssertionT15: Collect and Communicate Security Audit TrailTP30: Manage Consent DirectivesTP20: Access ControlT31: Document Reliable InterchangeT33: Transfer of Documents on Media

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Report from the Consumer Perspective Technical Committee

Work items year-to-date

–RDSS57 Patient-Provider Secure Messaging

–RDSS56 Remote Monitoring

–SOW ItemsAdvance Directives

Provider Lists

Consumer-Friendly Clinical Information

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Patient-Provider Secure Messaging -PPSM

– Coordinated work with all three Domain TCs

– RDSS57 complete, sent to IRT/project team

– Public Comment in July

– Will begin IS development early July. Target is IS submission to panel for December 2008.

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PPSM Architectural Variants The most generic variant selected as foundation.First two variants are supported as simplified implementations

Selected

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C62 Unstructured Document Component (new)

– Support for a wide variety of content (PPSM and advanced directives-SOW)

Simple/unstructured textScanned DocumentsPDFs

– New component. References IHE XDS-SD & CDA r2

– Coordination between CPTC, SPI, Admin & Finance

– Minimal document header (compatible with other HITSP CDA docs) to support wide applicability

Secured MessagingAdvance Directives

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Remote Monitoring

– Coordinated work with all three Domain TCs

– RDSS56 complete, sent to IRT/project team

– Public Comment in July

– Will begin IS development early July. IS submission to panel for Dec 2008 may be at risk:

Requires HL7 Personal Health Monitoring (PHM) document IG. First ballot Sept 2008.

Consistency with ongoing work in Continua and IHE PCD. Active partnership but completion expected Dec 2008.

RDSS feedback will be used to confirm schedule.

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Remote Monitoring - Business Actors

Business Actors may be combined:e.g. RM Mgt Syst & EHR or RM Mgt Syst & PHR

Significant reuse of existing constructs in Interfaces 3, 4, 5, 6 and 7.

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Statement of Work Items

– A number of items identified last year (as gaps in use cases) prioritized for possible completion this year

– IS03 / IS05 2007 gap items: Advance DirectivesConsumer-Friendly Clinical InformationProvider Lists

– Planning underway for an update IS03 / IS05 with advance directives and consumer-friendly clinical info.

– Need to schedule reviews with the appropriate TCs

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Advance Directives (partial in 2008)

– Unstructured document component

Consumer-Friendly Clinical Information

– Defined the key actors and interactions

Provider Lists

– Identified scope of workGenerating provider lists – current effortsSetting permissions - TBDOther uses- TBD

– Working on identifying the key actors and interactions

– Given complexity, work may extend in 2009

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Report from the Provider Perspective Technical Committee: Consultations and Transfers of Care

Consultations and Transfers of Care (CTC) focuses upon:

– “…the electronic exchange of information between clinicians…to support consultations, including specialty services and second opinions… (and) the exchange of clinical information needed during transfers of care.”

Status:

– RDSS has been completed and submitted to IRT, following extensive feedback from other perspective and domain tech committees

Gaps:

– For some standards (e.g., electrocardiogram) HITSP does not have a defined construct for all data types. Resolution anticipated: CTC Tech Committee (TC) to monitor emerging standards and include when available.

Future work:

– Submit RDSS document to HITSP Panel and Public for comment

– Dispose of received comments: use persuasive comments to inform the Interoperability Specification; log non-persuasive comments for information

– TC will begin to develop the CTC Interoperability Specification

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Report from the Provider Perspective Technical Committee: Personalized Health Care

Personalized Healthcare:

The exchange of genomic/genetic test information, family health history and the use of analytical tools in the electronic health record (EHR) to support clinical decision-making

Status:

Completed RDSS and submitted to IRT

Noted Gaps:

1. There is an inability to receive a report of risk to consumer based on analysis and interpretation of genetic test results.

2. There is a need verify eligibility for payer and provide authorization of service.

Next Steps:

1. Submit to the HITSP Panel and interested Public for Comment

2. Disposition the comments

3. Begin construction of Interoperability Specifications

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Report from the Provider Perspective Technical Committee Emergency Responder EHR Use Case

Status: IS04 Version 1.0 was issued Dec 07

– 10 GAP/Overlap closure projects (see next slide)

NEXT STEPS:

– 2008 HITSP Transaction (Package) for OASIS-HL7 header, container and

payload harmonization

– 2009 HITSP Constructs for

NEMSIS and DEEDS harmonized vocabulary

pre-hospital EMS document content (e.g., field and run reports)

OASIS CAP, HAVE and RM (available now)

SITREP and Patient Tracking (in progress)

RECOMMENDATIONS:

– IS04 updates as new HITSP constructs are ready (Dec 2008 and Dec 2009)

22 page ER-EHR Status Report, dated 11-Jun-08 is available athttp://hitsp.wikispaces.com/Emergency+Responder-EHR+Use+Case

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Report from Provider TC: ER-EHR Projects’ Status HITSP Nursing Terminology - done NEMSIS chaired work group:

1. Finding a method of assigning and adopting unique identifiers for both incidents and patients so data from heterogeneous systems can be linked - pending

2. Common approaches of delivering third party incident information such as telematics data to the Emergency Communications System (ECS) and emergency responders - actively working

3. Reaching agreement between healthcare and other emergency responders on a common terminology (“Managed List”) for incident types - pending

4. Harmonizing the data taxonomies of hospital (DEEDS), EMS (NEMSES), and other emergency responders to the extent necessary to implement the ER-EHR – pending October funding start of work

Additional gap area projects are: 1. Decision Support Tool interoperability – monitoring external progress2. Core Services - monitoring external progress3. Situation Awareness Messaging - monitoring external progress4. Emergency Contact Registry (ECON) – in-progress5. Life Critical Remote Monitoring - monitoring HITSP RMON use case

progress

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Report from the Security, Privacy and Infrastructure Domain Technical Committee

Current Work Items:

Minor/Editorial changes to existing constructs and TN900 (Due 11 July)

Development of 6 new constructs (for Public Comment in September)

Modification of 5 existing constructs to meet 2008 Use Case requirements (for Public Comment in September)

Longer term maintenance updates to constructs and TN900 (e.g. revisions to TP30: Manage Consent Directives – to incorporate additional coding/base standards which are now available)

Continue to work with TC-Leadership to address NHIN issues related to the use of SPI constructs in the NHIN Trial Implementations (ongoing)

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New SPI Constructs Under Development

New Construct Construct Description Candidate Standards

C62 - Unstructured Document Component

Document that contains simple text such as a note to the patient or a note from the patient. This document could include an unstructured, presentation preserved format, such as pdf.This construct relates to patient identifiable transactions and will be transported by TP13, T31, or T33.

IHE XDS-SD

T63 - Non Patient Notification Alert/Text Message

Multicast notification message to identified population. OASIS HAVE standards (edxl-DE) and CAP (i.e. CAP over DE)

T64 - Identify Communication Recipients (service)

Identification of communication recipients for the delivery of alerts and bi-directional communications from public health services.

ISO Directory Standard TS21091, also IHE PWP

C65 - Generic Alert to Identified Providers Component

Requires support for communication of non IIHI data to: Population Groups, Consumers, Providers etc. Will not be used to send to a pool of patients based on treatment/condition, but OK if sending to a zip code etc.

Email/MIME

T66 - Terminology Service

Infrastructure service – not content. IHE Sharing Value Sets

T67 - Referral Request Transaction

Authorization request and response for benefit coverage determination for a specific service.

IHE ITI TF ’08-’09 Referral Requests: (MRR; SRR; RRC)

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New SPI Constructs Under Development

HITSP Doc #

DRAFT TITLE

RDSSs for 2008 Use Cases Existing ISs

RMON PPSM PHC CTC IRM PHCRIS02:BIO

IS04:ER-EHR

IS06:Quality

C62Unstructured Document Component

X X X X X X

T63Non Patient Notification Alert/Text Message Transaction

X

T64Identify Communication Recipients (service)

X X

C65Generic Alert to Identified Providers Component

X X

T66 Terminology Service X X X X

T67Referral Request Transaction

X

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Existing Constructs to be Modified to Meet New Use Case Requirements

Doc # Construct Change Description

TP22 Patient ID Cross-Referencing Transaction Package

PIX/PDQ Update: Demographic Data

T23 Patient Demographics Query Transaction

PIX/PDQ Update: Demographic Data

TP20 Access Control Transaction Package

TP20/C19 Update for Policy Attribute Service: WS-XACML, WS-Trust

C19 Entity Identity Assertion Component

TP20/C19 Update for Policy Attribute Service: WS-XACML, WS-Trust

C25 Anonymize Component Update C25 Anonymize for IRM purposes to include content considerations for immunizations

TP50 Retrieve Form for Data Capture Transaction Package

Needs to be able sign the information that is being submitted (AE). May now need to support electronic signature.Also looking at XFormsNote that RFD goes beyond XForms

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Report from the Care Management & Health Records Domain Technical Committee

12 New constructs identified

– 2 technical notes on HITSP Care Management framework

– 2 for restructuring of existing work for reuse

– 5 for which there are significant gaps in standards

– 5 in support of CTC, PHCR, PH, and ICRM use cases

Tier 2 evaluations underway

Significant work completed on one new construct

Coordination needed with SPI TC on a few constructs

– Scanned/Text Documents

– Order/Response Messages for Referrals

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Care Management & Health RecordsConstruct Reorganization for Reuse

TN90?DocumentFramework

C28

C48C37

VocabularyCDA and CCD

DocumentModules

C32

TN90?Message

Framework

C34

C39

C36

MessageSegments

C41

C??C??

C??C??

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Report from the Administrative and Financial Domain Technical Committee

Current Work

Reviewed all RDSS documents and met with Provider and Consumer Perspective TCs

Minor Editorial changes T40 and TP46 (due July 11)

Develop 1 new construct (for public comment in September)

Modify 1 existing construct to meet 2008 use case requirements (for public comments in September)

Long Term - Develop a Technical Note document for Administrative and Financial Domain TNnnn

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New Construct Construct Description Candidate Standards

Txx – Authorization Request and Response

When conditions require, this construct will be used to request authorization from or to notify a health plan for certain testing, consultations (referrals), treatment, therapies, and/or transfer of care.Will also support information exchanges between a provider and a health plan when addition patient information is required to make authorization decisions.

ASC X12 278HL7 V2.6 HL7 V3

New Construct Development Work

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Existing Constructs to be Modified to Meet New Use Case Requirements

Doc #

Construct Change Description

T40 Patient Generic/Specific Health Plan Eligibility Verification Transaction

Update to support service/procedure specific inquiry and response

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HITSP Doc #

TITLE(Draft TITLE)

RDSSs for 2008 Use Cases Existing ISs

RMON

PPSM PHC CTC IRM PHCR

T40

Patient Generic Health Plan Eligibility Verification Transaction

x x x

TxxAuthorization Request and Response

x x x

Construct Development/Modification Work

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Current Work Plan

Project/task Target date

Tier 2 Document for Txx Authorization Request and Response

6/24/2008

Review RDSS documents during public comment 7/25/2008

Modify Construct: T40 9/10/2008

New Construct: Health Plan Authorization Request and Response

9/10/2008

Draft Administrative and Financial Technical Note 9/10/2008