personalized healthcare

1enabling healthcare interoperability

2009 Webinar Series

Sponsored by the HITSP Education, Communications and Outreach Committee

Personalized Healthcare

Date: February 12, 2009 | 2:00 – 3:30 pm (Eastern)

Presenters: Allen Hobbs, Ph.D., Stephen Hufnagel, Ph.D.,Keith Boone and Michael Glickman

Using genetics and family history to enhance targeted diagnosis and treatment

HITSP – enabling healthcare interoperability 2009 Webinar Series

Learning Objectives

Explore the concept of personalized healthcare— genetics and family history information can provide more

targeted diagnosis and therapy

Examine the initiation of personalized healthcare — “Genomics and Personalized Medicine Act of 2006” introduced to the

Senate by Barack Obama

— Personalized Healthcare Use Case by the American Health Information Community

Discover how the requirements of the Personalized Healthcare Use Case map to HITSP constructs

Learn how family and genetic history are communicated between healthcare IT systems, and how this information can support genetic risk assessment


Agenda What is HITSP

What is Personalized Healthcare?

Personalized Healthcare Scenarios:

(1) Clinical Assessment

(2) Genetic Testing, Reporting and Clinical Management

Data Requirements and Constructs: Genetic Data, Personal and Family History, Risk Analysis and Decision Support

Next Steps

Conclusion

Questions and Answers


What is HITSP?


HITSP is a volunteer-driven, consensus-based organization that is funded

through a contract from the Department of Health and Human Services

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 that are actually writing healthcare IT standards.

Overview


Roles and Responsibilities

Harmonizes and recommends the technical standards that are necessary to assure the interoperability of electronic health records

— Creates HITSP-recommended Interoperability Specifications (IS) that specify how and what standards should be used for a particular Use Case/Value Case

— Supports deployment and implementation of these IS

— Works with Standards Development Organizations (SDOs) to identify gaps and maintain, revise or develop new standards as required to support the IS


Each HITSP Interoperability Specification defines a set of “constructs” that:

— specify how to integrate and constrain selected standards to meet the business needs of a Use/Value Case; and

— define a Roadmap to use emerging standards and to harmonize overlapping standards when resolved.

In essence, a HITSP IS represents a suite of documents that integrate and constrain existing standards to satisfy a Use Case

Personalized Healthcare Interoperability Specification (IS08)

Deliverables and Mode of Operation


What is Personalized Healthcare? Personalized healthcare enables

providers to customize treatment and management plans for individuals based on their unique genetic makeup

Personalized healthcare focuses on the exchange of genomic/genetic test information, family medical history and the use of analytical tools in the EHR to support clinical decision-making


I’m worried that without a complete personal and family medical history on file, my doctors will miss seeing a trend in my progress

� My grandfather struggles with diabetes and my grandmother died from her thyroid condition

My doctor said that genetic/genomic test information may uncover disease predisposition, and can help determine which medication would be more effective

I support the availability of genetic information, but I’m concerned that my personal data is shared in a safe, secure way

Steve’s story . . . current situation

Patient is a 27-year-old man who had a brain tumor removed as a child


Steve’s health information can be seamlessly and securely exchanged between and among diverse systems

The seamless and secure exchange of information will allow Steve to:− create a personal health record to access his

personal health information and grant access to his various providers

− exchange clinically useful genetic/genomic test information

− exchange personal and family health history− access results, conditions, allergies, and

diagnosis codes in layperson terms Steve’s provider can access analytical tools and

electronic health records (EHRs) to support clinical decision-making

Steve’s story . . . future


Background and Introduction to the Personalized Health Care (PHC) Use Case

A Clear, Highly Visible and Compelling Use Case Michael O. Leavitt, Secretary of the Department of Health and

Human Services stated at the American Health Information Community (AHIC) meeting on September 12, 2006:

…genomics will play an increasingly larger role in medicine, and now is the time to figure out how best to incorporate genetic information into e-health records, before multiple nonstandard approaches take hold.”


Background and Introduction to the Personalized Health Care (PHC) Use Case

109th Congress Genomics and Personalized Medicine Act of 2006

Introduced by Senator Obama to improve access to and appropriate utilization of valid reliable and accurate molecular genetic tests

110th Congress Genetic Information Nondiscrimination Act of 2008

Prohibits discrimination on the basis of genetic information with respect to health insurance and employment


Today – Prior to Personalized Healthcare

Visit your Doctor with Illness

Symptom-based Diagnosis(In-vitro Diagnostics, Anatomical Imaging)

Generic Treatment,Cost-centric

Broad Based Populations

Recover or Revisit


Tomorrow – The Vision of Personalized Healthcare

Diagnostic systems and genetic information

are integrated

Treatment(s)become targeted

Optimal treatment of disease is individualized

Standards of care become patient centric

1

2

3

4


Tomorrow – A Framework for Personalized Healthcare

Aggregating biomedical knowledgeand adoption of interoperable HIT as a supportive foundation

Standards of care becomepatient centric in EHR/PHR

Identifying regulatory structure (e.g. FDA) supporting adoption of targeted drugs and diagnostics

Demonstrate evidence-basedmedicine to assure approacheswork for patients and providers

Intervention Development + Review

Integration into Clinical Practice

Expansion of theScience Base

Health InformationTechnology

PersonalizedHealth Care

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


HITSP IS 08: Personalized Healthcare

The Personalized Healthcare Interoperability Specification focuses on the exchange of clinically useful genetic/genomic test information, personal and family health history, and the use of analytical tools in electronic health records (EHRs) to support clinical decision-making.

Enabling clinical decisions and therapies to be more targeted to the individual, their genetics, and personal/family history


Scenario One: Clinical Assessment The Clinician’s Perspective

(physicians and other clinicians that conduct clinical assessment, clinical management and evaluation activities)

— gathering of a patient’s personal and family history information

— diagnostic planning

— genetic/genomic test ordering

— result interpretation

The Consumer Perspective (patients, caregivers, patient advocates, family members, etc)

— reports family health information

— requests genetic/genomic tests and results


My Family Health Portraita tool from the U.S. Surgeon General


Scenario Two: Testing, Reporting and Clinical Management The Testing Laboratory Perspective

— performs the tests, analyzes the test data using genetic/genomic databases and repositories, and interprets the data

— considers other personal and family health information by performing a risk assessment

— develops a patient report including fully structured results (and interpretation)

— transmits the report back to the authorized providers

The Clinician Perspective — determines appropriate preventive action, treatment protocol, messaging,

and clinical interpretation of test results using decision support tools


Requirements Mapping to HITSP Constructs Information Exchange Requirements

IER DescriptionIER 01 Provide authorization and consent

IER 12 Identify laboratory

IER 14 Send/receive health plan eligibility

IER 15 Send/receive health plan authorization

IER 19 Send/receive genetic/genomic test results

IER 20 Send/receive genomic information

IER 21 Receive updated clinical information

IER 23 Request/provide additional information

IER 25 Send/receive decision support data

IER 41 Receive risk analysis report

IER 44 Send/receive genetic test order

IER 58 Send/receive patient health history

IER 62 Send/receive encounter or full episode of care record


Data Requirement Number (DR)

Description

DR 1 Demographic Data, including (but not limited to):

DR 3 Clinical History, including (but not limited to):

DR 4 Personal genetic/genomic data, including (but not limited to):

DR 5 Family genetic/genomic information, including (but not limited to):

DR 6 Health Plan Eligibility Information, including (but not limited to):

DR 7 Genomic Laboratory registry

DR 8 Unstructured Data

Requirements Mapping to HITSP Constructs Data Requirements


See HITSP website for more detail

For detailed list of the following, download this PowerPoint from http://www.hitsp.org/archived_webinars_09.aspx

— Requirements Mapping to HITSP Constructs

— IERs and DRS Mapped to HITSP Constructs

— Use Case Requirements and Associated Standards Gaps


Data Sets for Personalized Medicine Demographic Data

— Name, Identifiers, Age, Gender, Race, Ethnicity

Personal Medical History— Disorders, Age of Onset, Environmental Exposures,

Treatments, Social History

Personal Genetic Data— Genetic Test Results, Genetic Status, Risk Analysis

Family Medical History— Pedigree, Disorders, Age of Onset/Death/Cause of Death

Family Genetic Data— Genetic Test Results, Genetic Status, Risk Analysis


Genetic Data Reason for the Test

— Genetic Condition Status/Risk/Carrier— Medication Effectiveness/Metabolization/Toxicity

Type of Specimen— Germline – Containing genes you were born with— Somatic – Containing genes mutated after birth— Prenatal – Containing genes of a fetus

Genetic Region of Interest— Gene Name – Human Genome Name Committee (HGNC)— Genetic Variant – Human Genome Variation Society (HGVS)

Interpretations


HITSP Constructs C28 – Emergency Care Summary Document C32 – Summary Documents Using CCD * C48 – Encounter Document C84 – Consult and History and Physical Note C83 – CDA Content Modules * C80 – Clinical Document and Message Vocabulary * TP13 – Manage Sharing of Documents T31 – Document Reliable Interchange T33 – Transfer of Documents on Media C90 – Clinical Genomic Decision Support * T81 – Retrieval of Medical Knowledge *

* Key constructs for IS 08


T17 – Secured Communication Channel TP13 – Manage Sharing of Documents TP20 – Access Control TP30 – Manage Consent Directive C19 – Entity Identity Assertion C26 – Non-repudiation of Origin T15 – Security Audit Trail T16 – Consistent Time

For more information

about how HITSP

addresses security and

privacy, refer to the

August 2008 Security and Privacy Webinar at

http://www.hitsp.org/

archived_webinars.aspx

HITSP Security and Privacy Constructs Safeguard Exchange of Personalized Healthcare Info


Information Flows

Patient CentricKnowledge

Banks

ClinicalKnowledge Banks

Genetic Risk Analysis

Family and Genetic History

Personal, Family and Genetic

History


History


History

Family Member PHR

Patient PHR

Provider EHR

Provider EHR

Personal, Family and Genetic History and

Lab Results

LabInformationSystem

Lab Results

EHR = Electronic Health RecordPHR = Personal Health Record


Where they are used

Patient CentricKnowledge

Banks

ClinicalKnowledge Banks

Genetic Risk Analysis

Family and Genetic History

C32C83/C80

TP13/T31/T33


HistoryC28/C32/C48/C84

C83/C80TP13/T31/T33

Family Member PHR

Patient PHR

Provider EHR

Provider EHR

Personal, Family and Genetic History and

Lab Results

LabInformationSystem

Lab ResultsT14/C35/C36

TP13/T31/T33/C35/C37

EHR = Electronic Health RecordPHR = Personal Health Record

Medical Knowledge

T81

Medical Knowledge

T81

C28/C32/C48/C84C83/C80

TP13/T31/T33

AndT14/C35/C36

C35/C37


Next Steps: Where we are with IS 08


Future Enhancements

HITSP harmonization of:— Genomic lab orders and results

— Genetic risk assessments


Sample References

Understanding Genetics— http://motorcycleguy.blogspot.com/

2008/07/understanding-genetics.html

Reporting Genetic Test Results— http://motorcycleguy.blogspot.com/

2008/07/reporting-genetic-test-results.html

HL7 Clinical Document Architecture— http://www.hl7.org/Library/

standards_non1.htm#CDA (Nonmembers)

— http://www.hl7.org/Library/standards_mem1.cfm#CDA (Members only)

IHE Patient Care Coordination Technical Framework

— http://wiki.ihe.net/index.php?title=Family_History_Organizer

Human Genome Variation Society— http://www.hgvs.org/

Human Gene Nomenclature Committee

— http://www.genenames.org/


IS08 – Personalized MedicineBenefits of Implementation . . .

IS08 enables an integrated approach to personalized medicine that:

supports and offers interoperability for information exchange among consumers, providers, and researchers;

enables an evidence-based approach to personalized medicine; and

minimizes the negative effects of less targeted treatment.


Steve’s story . . . accomplished

Steve’s health information can be seamlessly and securely exchanged between and among diverse systems

The seamless and secure exchange of information will allow Steve to:− create a personal health record to access his

personal health information and grant access to his various providers

− exchange clinically useful genetic/genomic test information

− exchange personal and family health history− access results, conditions, allergies, and

diagnosis codes in layperson terms Steve’s provider can access analytical tools and

electronic health records (EHRs) to support clinical decision-making


Webinar 1 Advances in Sharing Information in Healthcare IT

Thursday, January 15th, 2009 — 2:00-3:30 pm EDT

Webinar 7 Health Information Exchange (HIEs) in the Real World

Thursday, July 9th, 2009 — 2:00-3:30 pm EDT

Webinar 2 Personalized Healthcare Interoperability Specification (IS 08)

Thursday, February 12th, 2009 — 2:00-3:30 pm EDT

Webinar 8 Patient - Provider Secure Messaging Interoperability Specification (IS 12)

Thursday, August 13th, 2009 — 2:00-3:30 pm EDT

Webinar 3 Consultations and Transfers of Care Interoperability Specification (IS 09)

Thursday, March 12th, 2009 — 2:00-3:30 pm EST

Webinar 9 Remote Monitoring Interoperability Specification (IS 77)

Thursday, September 10th, 2009 — 2:00-3:30 pm EDT

Webinar 4 NHIN Real World Sites

Thursday, April 16th, 2009 — 2:00-3:30 pm EDT

Webinar 10 Medication Management Real World Sites

Thursday, October 8th, 2009 — 2:00-3:30 pm EDT

Webinar 5 Immunization & Response Management Interoperability Specification (IS 10)

Thursday, May 14th, 2009 — 1:30-3:00 pm EDT

Webinar 11 Security, Privacy, and Infrastructure

Thursday, November 12th, 2009 — 2:00-3:30 pm EDT

Webinar 6 Public Health Case Reporting Interoperability Specification (IS 11)

Thursday, June 18th, 2009 — 1:30-3:00 pm EDT

Webinar 12 Real World Sites – TBA

Thursday, December 10th, 2009 — 2:00-3:30 pm EDT

The 2009 Webinar Serieswww.HITSP.org/webinars


Use or specify HITSP Interoperability Specifications in your HIT efforts and in your Requests for Proposals (RFPs)

Ask for CCHIT certification

Leverage Health Information Exchanges to promote HITSP specifications to make connections easier in the future

Ask . . . Is there a HITSP standard we could be using?

Get involved in HITSP . . . Help shape the standards

How YOU can become involved


Jessica Kant, HIMSS Theresa Wisdom, [email protected] [email protected]

Re: HITSP Technical Committees

Michelle Deane, ANSI [email protected]

Re: HITSP, its Board and Coordinating Committees

Join HITSP in developing a safe and

secure health information network

for the United States.

Visit www.hitsp.org or contact . . .


Sponsor Strategic Partners

www.HITSP.org


Personalized Healthcare

Questions and Answers


Appendix Requirements Mapping to HITSP Constructs

IERs and DRS Mapped to HITSP Constructs

Use Case Requirements and Associated Standards Gaps


Requirements Mapping to HITSP Constructs Information Exchange Requirements

IER DescriptionIER 01 Provide authorization and consent

IER 12 Identify laboratory

IER 14 Send/receive health plan eligibility

IER 15 Send/receive health plan authorization

IER 19 Send/receive genetic/genomic test results

IER 20 Send/receive genomic information

IER 21 Receive updated clinical information

IER 23 Request/provide additional information

IER 25 Send/receive decision support data

IER 41 Receive risk analysis report

IER 44 Send/receive genetic test order

IER 58 Send/receive patient health history

IER 62 Send/receive encounter or full episode of care record


Data Requirement Number (DR)

Description

DR 1 Demographic Data, including (but not limited to):

DR 3 Clinical History, including (but not limited to):

DR 4 Personal genetic/genomic data, including (but not limited to):

DR 5 Family genetic/genomic information, including (but not limited to):

DR 6 Health Plan Eligibility Information, including (but not limited to):

DR 7 Genomic Laboratory registry

DR 8 Unstructured Data

Requirements Mapping to HITSP Constructs Data Requirements


Scenario 1: Clinical Assessment Component Data Flow Diagram

cmp PHC Scenario 1: Clinical Assessment

Electronic Health Record (EHR) System - Clinician IER58

IER25

IER44

IER12

IER21

IER19IER23IER20 IER23

IER20

IER01

IER62

Genetics/Genomics Knowledge Repositories

IER23

IER44

EHR - Healthcare EntitiesIER58

Health Plan System

IER14 IER15

IER12

Testing Laboratories Systems

IER44IER19

IER41

IER23IER20

IER23IER20

IER62

Personal Health Record (PHR)

Systems

IER58IER25

IER01

IER20

IER23

IER12

IER62

IER44

IER21

IER19

IER41

EHR-OtherIER58

Genetic Clinical Decision Support

(Systems)

IER01, IER19, IER20, IER21,IER23, IER44, IER58, IER62

IER23,IER25,IER41

Infrastructure Serv ices

+ PID service()+ Locator Service()+ Data repository()+ Registry()+ Security & privacy services()

IER12Prov ider Administrativ e and Financial Systems

IER14 IER15

IER 01 Provide authorization and consentIER 12 Identify Laboratory IER 14 Send/Receive health plan eligibil ityIER 15 Send/Receive Health plan authorizationIER 19 Send/receive genetic/genomic test resultsIER 20 Send/Receive genomic informationIER 21 Receive updated clinical informationIER 23 Request or provide additional informationIER 25 Send/Receive Decision Support dataIER 41 Receive Risk Analysis ReportIER 44 Send/Receive Genetic Test OrderIER 58 Send/Receive patient health historyIER 62 Send/receive encounter or full episode of care record


Scenario 2: Testing, Reporting and Clinical Management Component Data Flow Diagram

cmp PHC Scenario 2: Testing, Reporting and Clinical Management

Electronic Health Record (EHR) System - Clinician IER58

IER25

IER44

IER12

IER21

IER19IER23IER20 IER23

IER20

IER01

IER62

Genetics/Genomics Knowledge Repositories

IER23

IER44

EHR - Healthcare EntitiesIER58

Health Plan System

IER14 IER15

IER12

Testing Laboratories Systems

IER44IER19

IER41

IER23IER20

IER23IER20

IER62

Personal Health Record (PHR)

Systems

IER58IER25

IER01

IER20

IER23

IER12

IER62

IER44

IER21

IER19

IER41

EHR-OtherIER58

Genetic Clinical Decision Support

(Systems)

IER01, IER19, IER20, IER21,IER23, IER44, IER58, IER62

IER23,IER25,IER41

Infrastructure Serv ices

+ PID service()+ Locator Service()+ Data repository()+ Registry()+ Security & privacy services()

IER12Prov ider Administrativ e and Financial Systems

IER14 IER15

IER 01 Provide authorization and consentIER 12 Identify Laboratory IER 14 Send/Receive health plan eligibil ityIER 15 Send/Receive Health plan authorizationIER 19 Send/receive genetic/genomic test resultsIER 20 Send/Receive genomic informationIER 21 Receive updated cl inical informationIER 23 Request or provide additional informationIER 25 Send/Receive Decision Support dataIER 41 Receive Risk Analysis ReportIER 44 Send/Receive Genetic Test OrderIER 58 Send/Receive patient health historyIER 62 Send/receive encounter or full episode of care record


Requirements Mapping to HITSP Constructs Constructs Used

HITSP/C19 - Entity Identity Assertion

HITSP/C32 - Summary Documents Using HL7 Continuity of Care Document (CCD)

HITSP/C36 - Lab Result Message

HITSP/C37 - Lab Report Document

HITSP/C48 - Encounter Document Using IHE Medical Summary (XDS-MS)

HITSP/C62 - Unstructured Document

HITSP/C80 - Clinical Document and Message Terminology

HITSP/C84 - Consult and History & Physical Note

HITSP/C90 - Clinical Genomic Decision Support

HITSP/T14 - Send Laboratory Result Message

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 Health Plan Eligibility Verification Transaction

HITSP/T64 - Identify Communication Recipients

HITSP/T66 - Retrieve Value Set

HITSP/T68 - Patient Health Plan Authorization Request and Response

HITSP/T81 - Retrieval of Medical Knowledge



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



IERs and DRS mapped to HITSP Constructs

IER1 Provide authorization and consent

DR1 Demographic Data HITSP/C19 - Entity Identity Assertion

HITSP/T15 - Collect and Communicate Security Audit Trail

HITSP/T16 - Consistent Time


HITSP/T64 - Identify Communication Recipients (service)


HITSP/TP20 - Access Control

HITSP/TP30 - Manage Consent Directives

Info ExchangeRequirement

Data Requirement HITSP Construct


IERs and DRS mapped to HITSP ConstructsUnderlying Infrastructure Constructs are NOT shown (e.g., T15, T16, T17, C19, TP20, TP30)

IER14 Send/ receive health plan eligibility

DR6 Health Plan Eligibility Information



HITSP/T85 – Administrative Transport to Health Plan


IER15 Send/ receive health plan author-ization

DR6 Health Plan Eligibility Information

HITSP/T85 – Administrative Transport to Health Plan






IER19 Send/receive genetic/ genomic test results

DR1 Demographic Data

DR4 Personal genetic/ genomic data










HITSP/T66 – Retrieve Value Set




IERs and DRS mapped to HITSP ConstructsUnderlying Infrastructure Constructs are NOT shown (e.g., T15, T16, T17, C19, TP20, TP30)IER20 Send/ receive genomic info


DR3 Clinical History

DR4 Personal genetic/genomic data

HITSP/C32 - Summary Documents Using HL7 CCD



HITSP/C37 - Lab Report DocumentHITSP/C48 - Encounter & Discharge Document Using IHE Medical Summary












IER21 Receive updated clinical information




HITSP/C84 – Consult and History & Physical Note




HITSP/T64 – Identify Communication Recipients





IER23 Request or provide additional information




DR5 Family genetic/genomic information

DR8 Unstructured Data

Gap HITSP/C36 - Lab Result Message is necessary but not sufficient










Underlying Infrastructure Constructs are NOT shown (e.g., T15, T16, T17, C19, TP20, TP30)



IER41 Receive Risk Analysis Report

DR4 Personal genetic/ genomic data

Gap (use HITSP/C62 - Unstructured Document until construct is developed)






HITSP/T66 – Retrieve Value Set



IER44 Send/ receive genetic test orders




GapHITSP/C62 – Unstructured Document







IER12 Identify Laboratory

DR7 Genomic Laboratory Registry




IER58 Send /receive patient health history




DR5 Family genetic/genomic information

HITSP/C32 - Summary Documents Using HL7 Continuity of Care Document (CCD)


HITSP/C36 - Lab Result MessageHITSP/C48 - Encounter Document Using IHE Medical Summary (XDS-MS)










Underlying Infrastructure Constructs are NOT shown (e.g., T15, T16, T17, C19, TP20, TP30)



IER62 Send/receive encounter or full episode of care record




HITSP/C48 - Encounter Document Using IHE Medical Summary (XDS-MS)

HITSP/C84 – Consult and History & Physical Note









IER Summary Gaps Recommended ResolutionIER41 Ability to

receive report including analysis of risk from a Genetic Clinical Decision Support System

No way to receive a Risk Analysis report into an EHR/PHR

Care Management and Health Records Domain TC will investigate current standards

The resulting Risk Analysis report should use standard Interoperable Clinician/Nursing Terminology with the following local/Interoperable language agreed to by HITSP:

This Interoperability Specification will use the CHI recommended SNOMED CT as a reference terminology to communicate interoperable information among and between systems, with the HITSP Interoperability Specification Pre-condition that the sending and using systems must use formal coded nursing terminologies such as the Clinical Care Classification (CCC) System and the Omaha System that are integrated in SNOMED CT



IER Summary Gaps Recommended ResolutionIER44 Ability to:

Send/receive genetic test orders

No way to send a lab order to a genetic/genomic testing laboratory

Evaluating the creation of construct for lab orders is on the Care Management and Health Records Domain TC 2009 roadmap

IER44

IER23

Ability to:Send/receive genetic test orders, andRequest or provide additional information

No way to receive genetic results. The HL7 standard is still under development

The intent is to constrain HITSP/C36 – Lab Result Message and HITSP/C37 – Lab Report Document usage here to the HL7 standard once it is ready



IER Summary Gaps Recommended Resolution

IER25 Send/receive Decision Support data

The component for clinical decision support does not exist in HITSP

Track HL7 work in this area

DR4

DR5

IER20

IER19

Personal genetic/genomic dataFamily genetic/genomic informationSend/receive genomic information Send/receive genetic/genomic test results

HITSP/C36 – Lab Result Message is necessary but not sufficient to communicate genomic lab results. More detailed implementation guidance is necessary to satisfy the requirements.

Pending approval of 2009 HL7 2.5.1 ballot