0 Report from the Technical Committees Arlington, VA | October 6, 2008 Presented by: Joyce Sensmeier...

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Report from the Technical Committees

Arlington, VA | October 6, 2008

Presented by:

Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS

HITSP Technical Committee Co-Chairs

enabling healthcare interoperability

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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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Technical Committee Leadership Provider Perspective – 210 members

– Allen Hobbs, PhD, Kaiser Permanente

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

– Mike Lincoln, MD, Department of Veterans Affairs

Consumer Perspective – 191 members

– Mureen Allen, MD, FACP, ActiveHealth Management

– Charles Parisot, EHR 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

– Anna Orlova, PhD, Public Health Data Standards Consortium

Administrative and Financial Domain – 48 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 - 166

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 - 47 members

– Keith Boone, GE Healthcare

– Corey Spears, McKesson Health Solutions

Total Technical Committee Membership – 505 individuals

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Report from the Population Perspective Technical Committee

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Report from the Consumer Perspective Technical Committee

IS 12 Patient-Provider Secure Messaging (PPSM)

IS 77 Remote Monitoring (RMON)

IS 03 & 05 Consumer Access to Clinical Information (extensions)

– Advance Directives

– Access to Consumer-Friendly Clinical Information

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IS 12: PPSM

– Completed and submitted to IRT for review

– Public Comment Period

–Target: 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

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C62 Unstructured Document Component (new)

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

Simple/unstructured textScanned DocumentsPDFs

– New componentReferences: IHE XDS-SD, PDF/A ISO 19005-1b 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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Report from the Consumer Perspective Technical Committee IS 77: Remote Monitoring

– Completed and submitted to IRT for review

– Public Comment PeriodNote: Access to the Continua (draft) guidelines requires to sign an NDA. Contact John Donnelly.

–Target: IS submission to panel for December 2008

–Two main challenges: Convergence to a single interface between Device Intermediaries and Remote Monitoring Mgmt Systems (used either in Homes or in Care Delivery Organizations) Request to IHE and Continua for harmonization Tight schedule synchronization between completion of IEEE standards, Continua Implementation Guidelines, and IS completion for panel approval in December.

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

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

Device Device Intermediary

EHR System

Remote Monitoring

Mgmt System

PHR System

Health Info Exchange

Interface #1 Interface #2

Interface #3

Interface #4

Interface #5

Interface #6

Interface #7

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Devices that are being considered this cycle include:

–Blood pressure monitor

–Glucometer

–Pulse oximeter

–Thermometer

–Weighing scale

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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 Standard– Implementation Guide for CDA Release 2.0 Personal Health Monitoring

Report (PHMR)

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T73 - Aggregate Device Information Communication

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

Selected Standard– The Tier 2 analysis has resulted in two alternatives:

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

– Public Comment is expected on the selection that should be made between these alternatives. IHE and Continua Health Alliance are currently working collaboratively to analyze the approaches and propose their recommendation to HITSP.

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IS 03 & IS 05 Updates

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

– IS03 / IS05 2008 gap items: Advance Directives Consumer-Friendly Clinical Information Provider Lists (2009)

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Advance Directives (partial in 2008)

– C62: Unstructured document

Consumer-Friendly Clinical Information / translations

– T81: Retrieval of Medical Knowledge

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 extended to 2009

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T81: Retrieval of Medical Knowledge Transaction (new)

– Supports the retrieval of medical knowledge

– References: HL7 v 3.0 Context-Aware Information Retrieval Specification: URL Implementation Guide

– Based on the Infobutton concept

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Report from the Provider Perspective Technical Committee

ISO-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.

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Report from the Provider Perspective Technical Committee: PHC Roadmap

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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)

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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

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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

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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

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Report from the Provider Perspective Technical Committee: Framework for Personalized Healthcare

Intervention Development and Review

Integration into Clinical Practice

Expansion of the Science Base

Health Information Technology

Personalized Health Care

Adapted from DHHSPHC, Opportunities, Pathways, Resources

2007

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Report from the Provider Perspective Technical Committee Emergency Responder Use Case

SITUATION: IS04 Version 1.0 was issued Dec 07

– 10 GAP/Overlap closure projects

NEXT STEP: IS04 Version 1.2.1 for public review

– 2008 ER-EHR New Constructs for for OASIS EDXL DE and CAP

Other New Constructs developed by other TCs

– 2009 and beyond HITSP Constructs for NEMSIS and DEEDS harmonized vocabulary

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

SITREP and Patient Tracking

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

Construct New/Repurposed ‘2008 constructHITSP/T40 Insurance Coverage and EligibilityHITSP/T63 Emergency Message Distribution Element TransactionHITSP/T64 Identify Communication Recipients (service)HITSP/T66 Terminology ServiceHITSP/T67 Clinical Referral Request Transport Transaction HITSP/T68 Patient Health Plan Authorization Request and Response HITSP/T85 Administrative transport to health planHITSP/C48 Encounter/ Discharge Doc. Using IHE Medical Summary (XDS-MS)HITSP/C62 Unstructured Document Component HITSP/C82 Emergency Common Alerting Protocol (CAP)

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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 – October funding start of work at Univ. of Utah

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) – done5. Life Critical Remote Monitoring - pending

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

Information Exchange Requirement - Data Requirement Component Transaction Transaction Package

IER01 Emergency Contact NA NA TP22

IER02 Clinical Summary C32 NA TP13

IER03 Run Report GAP PDF GAP T63, T64 NA

IER04 Present Episode of Care C28, C48 GAP T63, T64 TP13

IER05 Discharge Summary C48 NA TP13

IER06 Situation Report GAP PDF GAP T63, T64 TP13

IER07 Medical Device Data GAP GAP T63, T64 NA

IER08 Info Provider Data (e.g., telematics) GAP PDF GAP T63, T64 NA

IER09 Decision Support GAP GAP T63, T64 NA

IER10 Patient Identification NA T23 TP22

IER11 Public Health Data GAP NA TP13

IER12 Public Health Protocol GAP GAPT63, T64 NA

IER13 Ins. Coverage & Eligibility NA T40 NA

IER14 Ins. Care Authorization/Denial NA NA T68

IER15 Alert (patient en route) NA NA C82

IER16 Transfer-of-care information C28 T63 TP13

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

IS09 was completed September 22, 2008

– Produced by Provider Perspective TC

– Input from Admin and Finance, Care Management, Security TCs

Work 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

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What it 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


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Summary of IS09 constructs used

– 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)


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IS09 gaps Some clinical data without a HITSP construct

– Example-ECG

Functional status “instruments” poorly supported

– We need a CDA implementation guide for assessment instruments including functional status

Nursing documentation

– Highly variable, no good standard for nursing summaries, notes, etc. CDA probably applicable here but needs development


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IS09 gaps

Identifying consultant and transfer setting

– Few tools to identify providers and facilities meeting a complex set of preferences

Patient and referring/transferring provider preferences are multi-faceted

Prefs include specialty, network, location, co-pay preferences…

– Needs Cross TC work and SDO engagement


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IS09 gaps

Decision support (IER 5)

– No current HITSP-defined DSS interoperability

– Needs cross-TC work and possibly SDO engagement (e.g., HL7)


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IS09 Lessons Learned

Tables relating constructs, actors, IER, and ER were very helpful to clarify/speed the work

Tight timelines met by able help of the entire TC team!

– Particular thanks to Steve Hufnagle, Mike Glickman, & Allen Hobbs

– Huge debt to Suzi Hines and Gila Pyke


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Questions?

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Completed editorial changes to existing construct documents

(out for Public Comment in September)

Developed 10 new constructs


Modified 3 existing constructs


Worked with PTCs to ensure new constructs meet the requirements of the use cases

Report from the Security, Privacy & Infrastructure Domain Technical Committee

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Continued to work with TC-Leadership to address NHIN issues related to the use of SPI constructs in

the NHIN Trial Implementations (ongoing)

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

Report from the Security, Privacy & Infrastructure Domain Technical Committee

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New & Updated SPI constructs use in Interoperability Specifications

Doc# Document Name IS08

CTCIS09PHC

IS10PHCR

IS12PPSM

IS11IRM

IS77RMON

IS03CE-

Networks

IS03ER-

EHR

IS05CE-

Media

C62 Unstructured Document

C82 Emergency Common Alerting Protocol

C87 Anonymize – Public Health

C88 Anonymize - Immunization

T23Patient Demographics Query (*new option)

T63 Emergency Message Distribution Element

T64 Identify Communication Recipients

T66 Terminology Services

T67 Clinical Referral Request Transport

T81 Retrieval of Medical Knowledge

T85 Administrative Transport to Health Plans

TP22Patient ID Cross-Reference (*new option)

New

Inte

rop

erab

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Sp

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ion

s

Exi

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g In

tero

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abili

ty S

pec

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C62 Unstructured Document

Concept– Capture and storage

of patient identifiable, unstructured document content, such as text, PDF, images rendered in PDF

Selected Standards

– IHE XDS-SD

– ISO PDF/A 19005-1b

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C82 Emergency Common Alerting Protocol

Concept

– Multicast notification message sent to an identified channel

– Intended recipients are populations such as “all emergency departments in XXX county”, “within a geographic area”, etc

– Construct can only be used to transport text message alerts

Selected Standards

– OASIS CAP v1.1

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New Approach to Anonymize Construct

Existing C25 construct contains anonymization requirements for two different use cases (Bio and Quality)

– Adding new requirements to same construct (from new use Public Health Care Reporting and Immunization Management) would be inefficient and less effective

– Would require constant updates to construct, and constant updates to IS’s that use it

New Approach– Dedicate separate anonymize construct to each use case

– Modify current anonymize construct (C25) to focus only on the IS02 – Biosurveillance

– Develop two new anonymize constructs, one for Public Health Case Reporting (C87) and one for Immunizations and Response Management (C88)

– Create a new construct for the Quality IS

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C87 Anonymize Public Health Case Reporting Data

Concept

– Provides specific instruction for anonymizing repurposed data created as part of routine clinical care delivery

– Defines anonymization requirements specific to Public Health Case Reporting data

Selected Standards

– ISO Pseudonymisation TS# 25237

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C88 Anonymize Immunizations and Response Management Data

Concept

– Provides specific instruction for anonymizing repurposed data created as part of routine clinical care delivery

– Defines anonymization requirements specific to Immunizations and Response Management data

Selected Standards

– ISO Pseudonymisation TS# 25237

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TP22 Patient ID Cross-Referencing

Concept

– Identifying and cross-referencing different attributes for the same patient. It contains following transactions:

– Patient ID Cross-Referencing

– Patient Identity Feed

– Updated to include an optional transaction - Patient Identity Management transaction - for Pediatrics Demographics

Selected Standards

– IHE PIX

– IHE Technical Framework Supplement, Pediatric Demographics

– HL7 v2.5

– HL7 v2.3.1

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T23 Patient Demographics Query

Concept

– Involves request for patient demographic information, and a response with a list of patient demographics for matching patients, if any were found

– Updated to include Pediatric Demographics option which makes use of six additional demographic fields to aid record matching in databases with many pediatric records

Selected Standards

– IHE PDQ

– IHE Technical Framework Supplement, Pediatric Demographics

– HL7 v2.5/v2.5.1

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T29 Notification of Document Availability

Concept

– Defines mechanism for a healthcare stakeholder (e.g. provider, public health, etc) to notify providers or the patient about information that is available for retrieval pertaining to an identified patient

– Updated to expand the use of this construct for notifications from other contexts such as public health, or other sources

Selected Standards

– IHE NAV

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T63 Emergency Message Distribution Element

Concept

– Multicast notification message sent to an identified radio channel

– Intended recipients are populations such as “all emergency departments in XXX County”

Selected Standards

– OASIS EDXL-DE

sd Emergency Message Distribution Element Transaction

Message Receiver Message Transmitter

Send Alert Message()

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T64 Identify Communication Recipients

Concept

– Identification of communication recipients

– Delivery of alerts and bi-directional communications (e.g., public health agencies notifying a specific group of service providers about an event)

Selected Standards

– IHE PWP

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T66 Terminology Service

Concept

– Used to transform human or computer vocabularies.

– Retrieve and resolve a value set with the appropriate terminology or code system

– Retrieve a value set with an appropriate map from one terminology to another

Selected Standards

– IHE SVS

– HL7 CTS Release 1

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T67 Clinical Referral Request Transport

Concept

– Transport for provider-to-provider referral request interaction.

– Bundle referral request document & other relevant clinical documents of interest, and optionally send a trigger message to receiving provider system

Selected Standards

– IHE Document-based Referral Request (DRR)

sd Clinical Referral Request Transport Interaction

Referral Requestor Referral Dispatcher

Convey Printed Referral Request()

Request Referral (HL7 ORM andHITSP/C48)

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T81 Retrieval of Medical Knowledge

Concept

– Enables request and receipt of additional knowledge about medical concept based on specific context parameters

– Does not prescribe knowledge content of message returned

– Provides specifications for query/receipt of additional knowledge

Selected Standards

– HL7 v3.0 Context-Aware Information Retrieval

sd Retriev al of Medical Knowledge

Knowledge Requestor Knowledge Resource

Retrieve topic medical knowledge()

Retrieve sub-topic medical knowledge()

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T85 Administrative Transport to Health Plan

Concept

– Transport for administrative transactions between provider and health plan

– Example: pharmacy obtaining health plan eligibility, or physician requesting referral or authorization information from a health plan

Selected Standards

– CAQH CORE Phase II, #270 rule

sd Administrativ e Transport Interaction

Administrative Client Administrative Server

Administrative Request()

Administrative Response or Error()

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Report from the Care Management & Health Records Domain Technical Committee

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Report from the Administrative and Financial Domain Technical Committee

Current Work

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

Reviewing proposed 2009 Use Cases

Long Term - Develop a Technical Note document for Administrative and Financial Domain TN902

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HITSP Doc #

TITLE

2008 Use Cases2007 Use

Case

RMONIS77

PPSMPHCIS08

CTCIS09

IRM PHCRE-EHRIS04

T40Patient Health Plan Eligibility Verification Transaction

x x x x

T68

Patient Health Plan Authorization Request and Response Transaction

x x x x

T79Pharmacy to Health Plan Authorization Request and Response

x x

Construct Work

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Existing Constructs Modified to Meet New Use Case Requirements

Doc #

Construct Change Description

T40 Patient Health Plan Eligibility Verification Transaction

• Updates to support service/procedure specific inquiry and response • Replaced CORE Phase 1 rules with new CORE Phase 2 rules• Renamed to remove word “Generic” in the name

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New Construct Construct Description Selected Standards

T68 – Patient Health Plan Authorization Request and Response

Used by a healthcare provider (other than a retail pharmacy) to request approval from a health plan to authorize certain healthcare services, when required by the patient’s health plan contract. The health plan responds to the healthcare provider authorization request.

ASC X12 278 v4010A

T79 – Pharmacy to Health Plan Authorization Request and Response Transaction

Used by a retail pharmacy to request approval from a health plan to authorize certain healthcare services, when required by the patient’s health plan contract. The health plan responds to the healthcare provider authorization request.

NCPDP Telecommunication Standard Implementation

Guide version 5.1

New Construct Development Work

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Current Work Plan

Project/task Target date

Support Prospective TC with 2008 Use Cases 11/16/2008

Draft Administrative and Financial Technical Note 902 12/15/2008

Review & Comment on Proposed 2009 Use Cases 10/16/2008

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