Consolidated Health Informatics(CHI)

Briefing to HITSP Panel

March 13, 2006

Document Number: HITSP 06 N 55 Rev.Date: March 8, 2006

1

CHI Overview

Background

Strategy

Adoption Process– Federal Governance– Adoption Process– Industry Contribution– Standards Criteria

Accomplishments

Questions

2

CHI Background

One of the 24 Quicksilver eGovernment Initiatives– To enable the sharing of health information in a secure

environment to improve health, decrease medical related errors and decrease health care costs

– To establish Federal health information interoperability standards as the basis for electronic health data transfer in all activities and projects and among all Federal agencies.

– Influence and support industry efforts

Standards Recommendations– 4 Messaging Standards (2003)– 23 Vocabulary Standards (2003/4)– 10 Additional Standards Efforts (2005/6)

3

CHI Strategy

Develop rigorous process to identify, evaluate and adopt clinical vocabulary & messaging standards to enable interoperability in the federal healthcare enterprise

Gain insight and industry endorsement. Become “Tipping point” for private healthcare environment

Use agency partnership and consensus not regulation – verysuccessful to-date

Work closely with domain experts to identify and assess options

Agencies will build standards into individual IT architecture to deploy in new systems and major system upgrades

Adopt existing standards from Standards Development Organizations /Agencies

Use budgets to “enforce” and implement standards

Establish an “evergreening” process to assure long-term viability

4

CHI Adoption Process

Federal Enterprise-Wide Governance Structure: CHI Council/WG

Current CHI Membership: approximately 300 members

Managing Partner

HHS

Supporting PartnersNIST, SSA,

EPA, DHS, DOJ& more…

Lead PartnersVA, DOD, HHS

CHI Work Groups

NCVHS

5

CHI Adoption Process

•Form SME teams•Define scope•Identify candidate terminologies

Identify and Prioritize Needs

•Coordinate outreach•Evaluate terminologies•Assess deployment

Analysis and Feedback •Technical

presentation to CHI Council/WG•Department/ agency review and feedback•CHI Council/WG establishes consensus

Council Consensus

•NCVHS Adoption Notice•OMB/HHS public websites•Federal Registry• Government-wide policy rollout planning

StandardsAdoption

Preliminary Reports To NCVHS

Final ReportsTo NCVHS

•Prioritize standards•Determine approach

Deploy Teams

6

CHI Industry ContributionNational Committee on Vital and Health Statistics (NCVHS) http://www.ncvhs.hhs.gov/

– Adoption Process ContributionNCVHS serves as the forum for communicating CHI recommendations to, and obtaining feedback from the private sectorNCVHS endorsed the CHI standards

– Membership Organizations

– InputExpound the “range” of a clinical domain Clarify the choices availableAlign the public and private industry work

Kaiser PermanenteMedical Records Institute University of Pittsburgh MC Health SystemsPhysician Patient Partnerships for HealthHumanaBeth Israel Deaconess Medical CenterUniversity of Utah College of MedicineUniversity of Louisville School of MedicineUniversity of Pennsylvania School of Medicine

BCBS of NC Health Policy R&DThe Urban InstituteBooz-Allen & HamiltonUniversity of Kansas School of NursingPalo Alto Medical FoundationThe Johns Hopkins University Bloomberg School of Public Health

7

CHI Standards CriteriaCandidate Terminology Criteria Maintained by official Standards Development Organizations (SDOs)

ANSI, ISO and Federal Government approved Low Barriers for use

Freely availableAccessible

State of the StandardMaturity: implementable, evergreening, conditional/full

Subject Matter Experts Responsibility Identify Scope for each standard Scan environment for potential candidates Evaluate each standard against evaluation criteria Develop consensus Present recommendation

8

Standards Adoption ExampleLAB Tests--- LOINC Recommendation

Additional ReviewReport Revision

Identify Scope /Identify Candidates

Identify Team / SME

http://www.hhs.gov/healthit/documents/chiinitiative/ltornm_full_public.pdf

Evaluate Options

Present Preliminary Recommendation to

NCVHS

Final Report Presented and

Adopted

LOINCSNOMED

CPT

DODVA

HHSCMSCDCNIH

NCVHS Approval LetterHHS Website

Federal Registry

9

CHI Accomplishments

35 Standards Adoption Reports– 27 Adopted Standards– 8 Recommendations In Progress

Implementation Guideline Development

Standards Gap Analysis Report

4 Adopted Messaging Standards1. Clinical Standards- HL7®: Includes scheduling, medical record/image

management, patient administration, observation reporting, financial management, patient care

2. Pharmacy Standards - NCPDP: Includes retail pharmacy transactions3. Connectivity Standards- IEEE™ 1073: Includes medical device

messaging4. Imaging Standards – DICOM ®: Includes image information to

workstations

10

CHI Accomplishments

1. Laboratory Result Names – LOINC ®2. Interventions & Procedures, Laboratory Test Order Names - LOINC ®3. Laboratory Result Contents - SNOMED CT®4. Interventions and Procedures, Non-Laboratory – SNOMED CT®5. Medications: Special Populations - HL7 ®6. Medications: Drug Classifications - NDF RT7. Medications: Structured Product Labeling Sections- LOINC ®8. Medications: Drug Product- FDA NDC 9. Medications: Package - FDA/CDER 10. Medications: Active Ingredients FDA UNII Codes11. Medications: Clinical Drug - RxNORM 12. Medications: Manufactured Dosage Form FDA/CDER13. Diagnosis and Problem Lists - SNOMED CT ®14. Nursing - SNOMED CT®15. Demographics - HL7 ®16. Billing / Financial - HIPAA17. Clinical Encounters - HL7 ®18. Immunizations - HL7 ®19. Text Based Reports - HL7 CDA ®20. Anatomy - SNOMED CT ® /HL7 ® /NCI Thesaurus21. Units - HL7 ®22. Chemicals - EPA SRS23. Genes - HUGN for Genes

23 Adopted Vocabulary Standards

11

CHI Accomplishments7 Non Adopted Standards Reports

1. Disability (*)2. History and Physical 3. Medical Devices and Supplies (*)4. Multimedia (*)5. Population Health 6. Physiology 7. Proteins

Reports contains recommendations for follow-up workContinuing Work Groups (*)

1 Additional New Standards Work Group1. Allergy

12

CHI Standards Graphic

13

CHI CollaborationCollaboration Activities– USHIK registry

Developed by CMS Production system deployment planned

– caDSR systemCould function as front end portal for USHIK

– NIST HCSL initiativeCurrent link to CHI references

– Office of the National Coordinator for Health Information Technology (ONC)

Support the Standards Harmonization efforts

Questions?

For further information please contact:

Vish Sankaran, HHS - FHA PMO Vish.Sankaran@hhs.gov202-205-2761

Beth Halley, MITRE- CHI Facilitatorehalley@mitre.org703-983-1076