hitsp technical committee orientation joyce sensmeier ms, rn-bc, cphims, fhimss vice president,...

HITSP Technical Committee Orientation

Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSSVice President, Informatics, HIMSS

2Evaluation of Standards Harmonization Process for HIT

Agenda

• Welcome/Introductions• Overview of National Health IT Agenda• Relationship between HITSP, HISPC and CCHIT• HITSP Mission and Process• HITSP Technical Committee Focus/Use Cases• Technical Committee Structure/Leadership• Technical Committee Terms of Reference • Harmonization Process Steps• Timeline Overview/Schedule of Meetings• Definition of a Standard• Standards Readiness Criteria – Tier1, Tier 2• HITSP Framework/Constructs• Resources/Tools:

•ANSI Member Library: http://members.ansi.org/default.aspx •ANSI Public Library: www.hitsp.org •Standing Meetings and Numbers


In 2005, HHS awarded contracts to seed a public-private effort to build a nationwide health information network


A public-private “Community” was then established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability

Healthcare Information Technology

Standards Panel (HITSP)

Nationwide Health

Information Network

Architecture Projects (NHIN)

The Health Information Security and

Privacy Collaboration

(HISPC)

The Certification Commission for

Healthcare Information Technology

(CCHIT)

American Health

Information Community

The Community is a federally-chartered commission and will provide input and

recommendations to HHS on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected, in a smooth, market-

led way.

The Community is a federally-chartered commission and will provide input and

recommendations to HHS on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected, in a smooth, market-

led way.

HITSP includes 379 different member organizations and is administered by

a Board of Directors24 SDOs (6%)

308 Non-SDOs (81%) 32 Govt. bodies (9%)

15 Consumer groups (4%)

HITSP includes 379 different member organizations and is administered by

a Board of Directors24 SDOs (6%)

308 Non-SDOs (81%) 32 Govt. bodies (9%)

15 Consumer groups (4%)


What is the Healthcare Information Technology Standards Panel?

The Healthcare Information Technology Standards Panel (HITSP) is a volunteer, consensus-driven organization

The Panel brings together experts from across the healthcare community – from consumers to doctors, nurses, and hospitals; from those who develop healthcare IT products to those who use them; and from the government agencies who monitor the U.S. healthcare system to those organizations who are actually writing the standards

More info at: www.hitsp.org


The HITSP team is charged with completing eleven different tasks, with current efforts focused on the harmonization process

The CommunityHHS Secretary

Mike Leavitt, Chair

Project Management TeamExecutive in Charge, F. Schrotter, ANSI

Program Manager, L. Jones GSIDeputy PM, J Corley, ATI

Project Manager, Julie Pooley, Booz Allen

Project Management TeamExecutive in Charge, F. Schrotter, ANSI

Program Manager, L. Jones GSIDeputy PM, J Corley, ATI

Project Manager, Julie Pooley, Booz Allen

Harmonization Process Delivery

Technical Manager

Joyce Sensmeier, HIMSS

Harmonization Process Delivery

Technical Manager

Joyce Sensmeier, HIMSS

Harmonization Process Definition

Technical Manager

Michelle Deane, ANSI

Harmonization Process Definition

Technical Manager

Michelle Deane, ANSI

HHS ONCHIT1 PO, Dr. John Loonsk

HHS ONCHIT1 PO, Dr. John Loonsk HITSP

Dr. John Halamka, ChairMember populated

Technical Committees

Eleven Tasks are included in this contract:

1. Comprehensive Work Plan

2. Conduct a Project Start Up Meeting

3. Deliver Recommended Use-Cases

4. Participate in related meetings and activities, including the AHIC Meetings

5. Develop a Gap Analysis

6. Standards Selection, Evaluations and Testing

7. Define a Harmonization Approach

8. Develop Interoperability Specifications

9. Develop and Evaluate a Business Plan for the self-sustaining processes

10. Submit Monthly Reports – ongoing efforts

11. Assist with communications – ongoing efforts


HITSP Standards Harmonization Process

1. Identify a pool of standards for a general breakthrough area

2. Identify gaps and overlaps for a specific context

3. Make recommendations to the HITSP for resolution of gaps and overlaps

4. Develop interoperability specifications for using the selected standard for a specific context

5. Test the instruction for using the standard

Mission:To harmonize relevant standards in the health care industry to enable

and advance interoperability

The standards harmonization process is an open, inclusive,

collaborative, use case driven process

www.hitsp.org


HITSP formed Technical Committees to focus on AHIC breakthrough areas

Overview/Structure and Current Use Cases

Care Delivery Technical Committee: – EHR - Lab Reporting -- Deploy standardized, widely available, secure

solutions for accessing laboratory results and interpretations in a patient-centric manner for clinical care by authorized parties.

– Emergency Responder – EHR -- Covers the use of the ER-EHR from the perspective of on-site care providers and emergency care clinicians. Definitive care clinicians involved in the care and treatment of emergency incident victims, medical examiner/fatality managers investigating cause of death, and public health practitioners using information contained in the ER-EHR, are included because of their interactions with the other portions of this use case.

– Medication Management – Focuses on patient medication and allergies information exchange, and the sharing of that information between consumers, clinicians (in multiple sites and settings of care), pharmacists, and organizations that provide health insurance and pharmacy benefits.


Consumer Empowerment Technical Committee:

– Consumer Empowerment -- Deploy to targeted populations a pre-populated, consumer-directed and secure electronic registration summary. Deploy a widely available pre-populated medication history linked to the registration summary.

– Consumer Access to Clinical Information – Includes three scenarios which describe highlights of the processes, roles and information exchanges which could enable a consumer’s access to clinical information via a personal health record (PHR). The three scenarios are: Consumers receive and access clinical information; Consumers create provider lists and establish provider access permissions; and Consumers transfer PHR information.




Population Health Technical Committee:

– Biosurveillance -- Transmit essential ambulatory care and emergency department visit, utilization, and lab result data from electronically enabled health care delivery and public health systems in standardized and anonymized format to authorized public health agencies with less than one day lag time.

– Quality – This use case depicts two scenarios related to quality measurement, feedback and reporting with respect to a patient’s encounter with the healthcare delivery system: quality measurement of hospital-based care and of care provided by clinicians.




Technical Committees Structure/Leadership

Care Delivery – 185 members– Co-chairs– Allen Hobbs, PhD, Kaiser Permanente, [email protected]

– Steve Hufnagel, DoD/Medical Health System (MHS), [email protected]

– Steve Wagner, Department of Veterans Affairs, [email protected]

Consumer Empowerment – 180 members– Co-chairs– Mureen Allen, MD, FACP, ActiveHealth Management

[email protected]

– Charles Parisot, EHR Vendor Association, [email protected]

– Scott Robertson, PharmD, Kaiser Permanente, [email protected]


Technical Committees Structure/Leadership

Population Health – 144 members– Co-chairs– Floyd Eisenberg, MD, MPH, Siemens Medical Solutions,

[email protected]

– Peter Elkin, MD, Mayo Clinic College of Medicine, [email protected]

– Steve Steindel, PhD, Centers for Disease Control & Prevention, [email protected]

Security and Privacy – 127 members– Co-chairs– Glen Marshall, Siemens Medical Solutions, [email protected]

– John Moehrke, GE Healthcare, [email protected]

– Walter Suarez, MD, Institute for HIPAA/HIT Education and Research, [email protected]

Total Technical Committee Membership – 399 individuals


HITSP Coordinating Committees and Leadership

Foundations Committee

– Steve Wagner

– Bob Dolin

HITSP Process Review Committee

– Lynne Gilbertson

– Erik Pupo

HITSP-CCHIT Joint Work Group

– Jamie Ferguson, Kaiser Permanente

CCHIT Orientation Material

Harmonization Readiness Committee

– Lynne Gilbertson

Business Plan Committee

– Steve Lieber

International Landscape Committee

– Bill Braithwaite

Governance Committee

– Michael Aisenberg


HITSP project team and staff supports each Technical Committee HITSP Technical Committee - Care Delivery

– Don Van Syckle, DVS Consulting, [email protected]

HITSP Technical Committee - Consumer Empowerment– John Donnelly, IntePro Solutions, Inc., [email protected] – Mike Nusbaum, M.H. Nusbaum & Associates Ltd., [email protected]

HITSP Technical Committee - Population Health– Lori Reed-Fourquet, e-HealthSign LLC, [email protected]

HITSP Cross - Technical Committee Coordination– Bob Yencha, Alschuler Associates, [email protected]

HITSP Security and Privacy Technical Committee – Johnathan Coleman CISM, CISSP, Security Risk Solutions, Inc., [email protected] – Sarah Quaynor, ANSI, [email protected]

HITSP Emergency Responder - EHR Work Group (Care Delivery TC)– Michael Glickman, Computer Network Architects, Inc., [email protected] – Carl F. Husa, Jr., MA, Patriot Technology, [email protected]

HITSP Medication Management Work Group (Consumer Empowerment TC)– Suzi Hines, Principal, Sage Consulting, LLC, [email protected]


HITSP Technical Committees Terms of Reference

Perform high level Requirements Analysis and Design of HITSP Interoperability Specifications, transaction packages, transactions, components, constructs including requirements analysis, and minimum data set.

Identify and analyze gaps and duplications within the standards industry as they are related to each specific Use Case.

Provide a description of the gaps, including missing or incomplete standards.

Provide a description of the duplications, overlaps, or competition among standards for the relevant Use Case.

Review and scope statements of work for each new use case.


HITSP Technical Committees Terms of Reference (cont.)

Provide a listing of all standards that satisfy the requirements imposed by the relevant use cases as well as readiness criteria that shall be used to evaluate the standard.

Select and evaluate recommended standards to meet the relevant Use Case.

Develop, review and evaluate ‘interoperability specifications’ for the selected standards.

Submit recommendations to HITSP for review, approval and resolution.

Ensure timely response and disposition of comments.

Ensure on-going process for addressing corrections/change requests and resolutions.


Security and Privacy Technical Committee Terms of Reference

Harmonize HITSP standards for EHR-Lab reporting, Population Health and Consumer Empowerment with relevant Security and Privacy standards, including the HIPAA Security and Privacy Rules, and basic consents, where appropriate.

Assemble HITSP Security and Privacy Technical Committee (S&PTC) with adequate representation from each TC.

Convene regular meetings of the S&PTC to review current Interoperability Specifications and identify areas of Security and Privacy that were deferred.

Begin work on identifying security standards, approaches, and identifying unresolved issues (e.g. policy issues). Leverage activities of other Security and Privacy related workgroups.

In developing Security and Privacy related content, it will be important to maintain traceability on how existing and emerging HITSP constructs may be affected.


I

Harmonization Request

Harmonization Process Steps

II

RequirementsAnalysis

III

Identificationof Candidate

Standards

IV

Gaps,Duplications

and Overlaps

Resolution

V

Standards Selection

VI

Constructionof

InteroperabilitySpecification

VII

InspectionTest

VIII

InteroperabilitySpecification

Releaseand

Dissemination

IXProgram Management

BeginSupport

ReceiveRequest

The actual harmonization process is a series of steps taken by industry stakeholders within the context of HITSP


Update constructs with S&P

NOV DEC JAN FEB MAR APR

HITSP 2008 Work Plan – TC IS Development 6/16/08

HITSP Board

S&P v 1.0

ER-EHR v 1.1, CA Media and Quality v 1.0 and CA Network v 3.0

Construct Dev Comment Comment Resolution

Medications Management v 1.0

12/13/07HITSP Panel

1/23 – 1/25TC F2FChicago

3/24 – 3/26TC F2FDC Area

3/27/08HITSP Panel

2/11/08HITSP Board

2/20/08HITSP Panel

WE ARE HERE

EHR and BIO v 3.0

RDSS Comment Comment Res

2008 Use Cases v 1.0

MAY JUNE JULY AUG SEPT OCT NOV DECAPR

5/12 – 5/14TC F2F

TBD

6/11 – 6/13TC F2FDC Area

9/8 – 9/10TC F2F

TBD

10/28 – 10/30TC F2FChicago

10/6/08HITSP Panel

9/29/08HITSP Board

12/2/08HITSP Board

12/8/08HITSP Panel

6/23/08HITSP Panel

IS Development Comment

Potential Phase 3 timeline based on receipt of final use cases in mid-March 2008 and based on “standard” 9 to 10 month delivery cycle.

Subject to change based on TC analysis of use cases

Phase I Use Cases

Phase 2 Use Cases

Phase 3 Use Cases

?

Plan


HITSP Definition of a Standard

A standard specifies a well-defined approach that supports a business process and: (1) has been agreed upon by a group of experts; (2) has been publicly vetted; (3) provides rules, guidelines, or characteristics; (4) helps to ensure that materials, products, processes, and services are fit for their intended purpose; (5) is available in an accessible format; and (6) is subject to an ongoing review and revision process.


The standards required to support each major Use Case event were organized within an agreed upon standards taxonomy

The standards selected for inclusion in the pool were examined using ‘HITSP approved’ Tier 1 and Tier 2 Harmonization Readiness Criteria

Tier 1 Standards Readiness Criteria


Tier 2 Standards Readiness Criteria

Suitability

– The standard is named at a proper level of specificity and meets technical and business criteria of use case

Compatibility

– The standard shares common context, information exchange structures, content or data elements, security and processes with other HITSP harmonized standards or adopted frameworks as appropriate

Preferred Standards Characteristics

– Approved standards, widely used, readily available, technology neutral, supporting uniformity, demonstrating flexibility and international usage are preferred

Standards Development Organization and Process

– Meet selected criteria including balance, transparency, developer due process, stewardship and others.

Total Costs and Ease of Implementation

– Deferred to future work


HITSP FrameworkBasis for Interoperability Specification Template

HITSP receives Use Cases and Harmonization Requests from external sources, such as AHIC and ONC.

The Use Case or Request defines scenarios, business actors, and business and functional/interoperability requirements.

HITSP decomposes the Use Case requirements into scenario(s) and then into transactions providing context: technical actors, actions and content. It may create or reuse a transaction or a grouping of transactions (transaction package) based on commonality at this level.

Transactions are logical groupings of actions that are decomposed into components, which are groupings of base standards that work together, such as message and terminology.

Each HITSP construct, i.e., transaction package, transaction or component, may constrain the construct or standard below it. Constraints follow a strict hierarchy and are only imposed by the next higher construct.

Transaction packages, transactions and components all are potential candidates for reuse if a new set of requirements and context are successfully fulfilled by the existing construct.

While reuse is a HITSP goal, it is established in the context of a Use Case and its functional/interoperability requirements.

HITSP constructs are version controlled and, if reused, will be uniquely identified.


Use Case/Modification Request

Interoperability Specification

Transaction1… n components or composite standards

Component1... n base standards or composite standard

Base Standard

#1

Base Standard

#2

Base Standard

#3

Transaction Package1…n transactions or composite

standards

Package (Composite)

Standard

Component (Composite)

Standard

Transaction(Composite)

Standard

Pot

entia

l for

Reu

se in

Oth

er C

onte

xt

Defines and N

arrow

s Context

Policy Makers and Industry

Base Standard

#4

HITSP

Base Standard

#6

Base Standard

#7

Base Standard

#8

Base Standard

#9

Base Standard

#5

HITSP Framework


Level Definition Example Rules

Use Case or Harmonization Request

Defines business/functional requirements

Sets Context

ONC EHR- Lab Use Case

Interoperability Specification

Models business/ functional/ interoperability requirements

Identifies technical/system requirements to meet use-case

Identifies how to use one or more HITSP constructs to meet use-case requirements

HITSP EHR – Lab Interoperability Specification (IS01)

Based on UML diagram to identify technical actors and actions

Sets context Testable functional requirements Ids transactions or transaction packages

Transaction Package

Defines how two or more transactions are used to support a stand-alone information interchange within a defined context between two or more systems

Record Locator Service

Entity Identification Service

Thin context and interoperability requirements

Testable Based on analysis of like technical actors,

context and content harmonized across transactions

May be fulfilled by one or more transactions or composite standard

Expresses constraints on the transactions or composite standard

Transaction Logical grouping of actions, including necessary content and context, that must all succeed or fail as a group.

Query lab result Send lab result

Fulfills all actions between two or more systems needed to meet one or more interoperability requirements

Testable May be fulfilled by components or

composite standard Expresses constraints on components or

composite standard

Definitions and Rules


Definitions and Rules (cont.)

Level Definition Example Rules

Component An atomic construct used to support an information interchange or to meet an infrastructure requirement (e.g., security, logging/audit)

Lab result message

Lab result context

Typically will use one “primary” standard and may have other “secondary” standards

Expresses constraints on base or composite standards

Base Standard A standard capable of fulfilling a discrete function within a single category produced and maintained by a single standards organization.

Messaging standard

Security standard Code set.

Per HITSP definition the term “standard” refers, but is not limited to,:

– Specifications

– Implementation Guides

– Code Sets

– Terminologies

– Integration Profiles

Composite Standard

Grouping of coordinated base standards, often from multiple standards organizations, maintained by a single organization. In HITSP, it can serve as a component, transaction or transaction package functional requirements..

Integration profiles

Implementation guides

Health transaction services

Per Definition above


Familiarization with existing HITSP Constructs

Document Naming Convention:

[Document Type]_HITSP_[Document Number]_[Version]_[year]_[Short_Title]_[Date]

Example: IS_HITSP_02_v1.2_2006_Biosurveillance_10202006.pdf

Document Type: IS (Interoperability Specification)

Document Number: 02

Version: 1.2

Year: 2006

Short Title: Biosurveillance

Date: October 20th, 2006

Document Types:

IS: Interoperability SpecificationISTP: Transaction PackageIST: TransactionISC: Component Collectively known as “Constructs”


Familiarization with existing HITSP Constructs There are three approved Interoperability Specifications:

– IS-01 v1.2 EHR-Lab-Result-Reporting– IS-02 v1.2 Biosurveillance– IS-03 v1.2 Consumer Empowerment

There is also a high-level Executive Summary of the three main ISs

Each IS has a number of HITSP Constructs which it calls upon to describe the implementation of lower level, specific interactions

The beginning of each IS contains a diagrammatic overview of the lower level constructs it calls upon and their relationship to the IS


Technical Committee Resources

The ANSI Public Document Library is used for publicly posting completed works and related materials. It can be found on the “Document Library” links from the main HITSP site: www.hitsp.org

HITSP Interoperability Specifications (ISs) and Executive Summary can also found at www.hitsp.org which links to them directly.

The Use Cases are located in the Public Document Library in the following link:– AHIC Harmonized Use Cases

– The Members Document Library is used for works in progress and can be found at:

– http://members.ansi.org/sites/– Login using: ANSI_Membership\{your ANSI assigned user ID}– Password: {your ANSI assigned password}

Technical Committees have standing meeting times with dedicated conference bridge lines supported by various web-based collaboration tools including:– GoToMeeting: Up to 26 participants; “Meet Now” capability– GoToWebinar: Up to 1001 participants; Survey, Poll and Q &A Capabilities


Technical Committee Resources

Standing Conference Calls all scheduled for the TCs and Work Groups as follows:

For all standing meetings: Dial in: 1-866-469-3239

Consumer Empowerment: Every Monday 12:00pm to 1:00 pm EST – Participant code: 67737291

Care Delivery, ER-EHR: Every Monday from 3:00 -5:00pm EST. – Participant code: 57455041

Care Delivery, Medication Management: Every Thursday from 2:00 -4:00pm EST. – Participant code: 88796841

Population Health: Every Monday from 1:00 -3:00 pm EST. – Participant code: 64035221

Security and Privacy: Every Thursday from 1:00-2:00pm EST– Participant code: 67278751

Security and Privacy, Identity Credentials Management Work Group: Every Wednesday from 2:00-3:00pm EST– Participant code: 67278751


Troubleshooting For Technical Committee related questions please contact your TC facilitators or:

Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS Vice President, Informatics HIMSS 230 East Ohio, Suite 500 Chicago, IL 60611-3269 Phone: 312-915-9281 email: [email protected]

Theresa Wisdom, MBA, RHIA Manager, Standards Harmonization HIMSS 230 East Ohio, Suite 500 Chicago, IL 60611-3269 Phone: 312-915-9513 email: [email protected]

Jessica KantCoordinator, Standards HarmonizationHealthcare Information & Management Systems Society230 E. Ohio St., Suite 500Chicago, IL 60611Phone: 312-915-9283 Fax: 312-915-9511 email: [email protected]

For ANSI Document Library related questions please contact: Alison Ziegler

Program Administrator, Standards PanelsAmerican National Standards Institute25 West 43rd StreetNew York, NY 10036Phone: 212-642.4947 email: [email protected]


Questions?

Thank you for volunteering to participate in HITSP. We cannot succeed without you!

hitsp technical committee orientation joyce sensmeier ms, rn-bc, cphims, fhimss vice president,...

Documents