Health eDecisionsRI/ Pilots

Sub-WorkgroupFebruary 4th, 2013

10/11/2011 1

Agenda• Announcements• HL7 …what we learned• Verification of Pilot Sites• Review RI/Pilot Sub-WG Timeline - Updated• Review of Materials for Pilot• Review In Scope/Out of Scope

• Pre-conditions/ Post Conditions• Schedule of pilot project presentations• Questions and Answers • Review Action Items, Next Steps

Announcements• We will be continuing our work …

• Next meeting February 11, 2013• We will start the presentation of Project Plans

• New potential partnerships and pilots• Practice Fusion• AllScripts

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HL7 What We Learned• We will continue the work of pilots

• Our IG passed it is important we continue to pilot the IG with an eye toward – we will pilot our ballot with minor changes

• Harmonization with HQMF– This will happen starting with alignment of metadata structures

» Bulk of work will be done by Keith Boone» This work will be done after pilots with a goal of presenting this work at the

September HL7 meeting• vMR and QDMH

– There is a new HL7 group CQI (Clinical Quality Information) spearheading this effort» Claude and Aziz will represent us here

– This work is going to take a bit more time and falls outside of our initiative/pilot timeline

• The work in pilots will create significant and meaningful input into both of these activities

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Pilots

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Organization Pilot Lead Email Organization’s Role

Wolters Kluwer Health Sue Johnson/Steve Claypool/Howard Strasberg/Christy May

sjohnson@uptodate.comsteve.claypool@wolterskluwer.com howard.strasberg@wolterskluwer.com christy.may@wolterskluwer.com

Service Supplier/Artifact Supplier

OpenCDS David Shields david.shields@opencds.org Service Supplier

Zynx HealthClaude Nanjo (primary)Bernadette MintonVictor Lee

CNanjo@zynx.com (primary) bminton@zynx.comVLee@zynx.com

Service Supplier/Artifact Supplier

OZ Systems K. D. Pool, MD kpool@oz-systems.com Service Supplier

Medexter Healthcare Klaus-Peter AdlassnigKarsten Fehre

kpa@medexter.comkf@medexter.com Service Supplier

Elsevier Jonathan Teich j.teich@elsevier.com Service Supplier

newMentor Julie SchererMatt Pfeffer

jscherer@newmentor.com mpfeffer@newmentor.com Service Supplier/Artifact Supplier

CDCHilary WallKate ShawNikolay Lipskiy

hwall@cdc.govkmshaw@cdc.govdgz1@cdc.gov

Government /Service Supplier/Artifact Supplier

NextGenDr. Sarah CorleyDr. Jeff FriedlinGary Wietecha

scorley@nextgen.com, jfriedlin@nextgen.com,Gwietecha@nextgen.com

EHR Vendor

Practice Fusion Lauren FifieldMichael Poremba

lfifield@practicefusion.com mporemba@practicefusion.com EHR Vendor

AllScripts Douglas GentileRobin Williams (primary)

Douglas.Gentile@allscripts.com Robin.Williams3@allscripts.com (primary) EHR Vendor

Support Team• Support Team:

• Pilots Lead: Jamie Parker: jamie.parker@esacinc.com• Pilot Support: Rebecca Angeles: rebecca.angeles@esacinc.com • Subject Matter Expert: Aziz Boxwala: aziz.boxwala@meliorix.com• Subject Matter Expert: Bryn Rhodes: bryn@veracitysolutions.com • Use Case 1: Dave Shevlin: d.s.shevlin@accenturefederal.com • Harmonization: Cem Mangir: cmangir@deloitte.com • SDO Support: Anna Langhans: anna.langhans@accenture.com

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HeD Pilots Goal Goal

The goal of this initiative is to produce and consume implementable CDS interventions.1. Event Condition Action Rules (ECA Rules)2. Order Sets3. Documentation Templates

Pilot Scope

4. Health eDecisions will apply defined aspects of the Implementation Guide in a real-world setting.

5. Modify the Implementation Guide to ensure it is usable 6. The real-world pilots evaluate not only the technology, standards and

model (VMR), but also provide a test bed to evaluate the interaction of technology, implementation support, and operational infrastructure required to meet Health eDecisions use case 1 objectives at the stakeholder or organization levels.

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Timeline

10/11/2011

Goal & Activities Week Dates Deliverables

Kickoff /Establish Goals & Partnerships: - Review HeD Initiative Goals - Review Piloting Process & Resources - Define Value Statement - Define HeD Pilot Goals & Success Metrics - Establish & Approve Pilots - Develop Pilot Briefs

1-2(4wks)

1/07-2/25 (we missed 2 meetings in January pushing our Dates back)

-Wiki Capturing Pilot Deliverables-Established Partnerships-Documented Value Statements and Success Metrics-Documented Pilot Briefs

Pilot Configuration: - Establish Pilot Test Environment & Resources - Establish Pilot Implementation & Testing Process - Develop & Review Pilot Configuration

3-4(2 wks.)

2/25-3/4

-Use Case is Updated with HL7 Comments (3/4)-Approved Pilot Briefs -Committed Pilot Resources-Documented & Reviewed Pilot Configuration Guide-Weekly Feedback on Use-Cases & IG Alignment

Pilot Development : - Setup & Develop Pilot Prototypes - Review prototypes

5-10(6 wks. or

less depending

on Pilot activity)

3/4 – 4/15

-Use Case is Updated with HL7 Comments (3/4)-Weekly Pilot Development Status Updates-Weekly Feedback on Use-Cases & IG Alignment-Updates to Pilot Configuration Guides

Pilot Testing & Showcase : - Complete Testing - Prepare Solution Showcase

11-12(2wks)

4/15-5/6 -Weekly Pilot Testing Updates & KPIs-Showcase-Prepare for HL7

Pilot Wrap-up : - Develop Lessons Learned an ONC Feedback - Review Initiative Goal Alignment - Establish Next-Steps

13-14(2 wks.)

5/13-5/29 -Documented ONC Feedback- Next Steps Action Plan

We are Here

Logistics• Wiki Page:• http://wiki.siframework.org/Health+eDecisions+Pilots

• Process:1. Register as a “committed member” and attend Pilot Sub-WG calls.2. Complete Pilot Brief and submit to Pilot Sub-WG

– Think of this as “what do you intend to pilot”– See Pilots wiki for the document:

• http://wiki.siframework.org/Health+eDecisions+Pilots 3. Pilot RI/ Pilot implementation – Development, Testing.4. Provide feedback to ONC and HeD All Hands Community Meeting

– Select a community member to represent our work at these meetings.

Review: Value Statement (need to re-evaluate after Pilot Project Plans)

• Discuss Value Statement:

• Health information technologies designed to improve clinical decision making are particularly attractive for their ability to address the growing information overload clinicians face and to provide a platform for rapidly incorporating knowledge into care delivery.Standardized expressions of Clinical Decision Support have a number of important benefits including:Increased quality of care and enhanced health outcomes for individuals and populations

• Improvement in workflow (does not always come with standardized expressions of clinical decision support – it depends on how it is presented)

• Avoidance of errors and adverse events• Improved efficiency, cost benefit, and provider and patient satisfaction

– May not be the end result of pilots• Reduced latency for incorporating new clinical knowledge and evidence-based guidelines

into clinical practice– This is the focus for pilots?– Harmonization of Knowledge

• Focusing the S&I Framework community on Clinical Decision Support through the Health eDecisions Initiative will enable the translation of interventions into implementable components, increasing the speed and ease of adoption by the provider community.

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Success Criteria – Work in Progress will need to re-evaluate after Pilot Project Plans• Discuss Pilot Success Criteria:

• Individual Criteria• Initiative Criteria

• EHR Involvement - DONE• Production (at least one of each artifact and consumption of those artifacts)

– Addressed as part of the Pilot Project Plans (who will be doing which artifacts)• Successful implementation of artifacts

– EHR involvement» Validate artifact – perhaps Pilots focuses on this ?» Execute the artifact

• Cross initiative function» Potential Alignment with eDOC and esMD » SDC

• Alignment with MU 3 objective» 10% knowledge based engine (align 402b)» ACTION ITEM: Review MU3 Criteria» Determine the delivery model we want to pilot

• External (i.e. cloud service)• Assets are portable (can be run locally)

• Discuss this with the group

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Scope of Use Case 1

• This Use Case defines the requirements to build a standard for the contents of CDS Knowledge artifacts.  The use case focuses on the following artifact types: Event Condition Action (ECA) Rules, Order Sets, and Documentation Templates. To support this purpose the Use Case has one scenario:  A CDS Knowledge Artifact Supplier makes computable CDS Knowledge Artifact available to CDS Artifact Integrator (From HeD Use Case: CDS Artifact Sharing)

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In Scope• Standards to structure medical knowledge in a shareable and executable

format for use in CDS• In Scope Artifact Types (definitions for these artifact types can be found in

Appendix A)– Event Condition Action Rules– Order Sets – Documentation Templates

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Out of Scope• Tools:

– Authoring tools, source “content” management.– Terminology server and mapping tools including management of concept coordination.– Semantic processing of text, including structured string processing and natural language processing.

• System Functions– Messaging Layer– Means of sharing– Security

• Authoring, creation and maintenance of clinical decision support knowledge• Knowledge Repository Design• Search and query mechanisms• Implementation in systems• User presentation, Transport layers• Market factors: regulatory incentive/mandate, liability shield, IP shield (patent/licensing litigation),

certification body, marketplace design, test procedures, FDA rules• Clinical Decision Support Services (this will be covered in Use Case 2 CDS Guidance Services)• CDS Content Development Activities, including the distribution and sharing of artifacts• Context-Aware information retrieval (HL7 Information Button) – This will be covered in UC 2 (CDS

Guidance)

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Pre and Post Conditions• Pre-Conditions

– CDS Artifact Supplier makes CDS artifacts available for search and consumption by CDS Artifact Integrators _ ACTION ITEMS (Clarify this –what is a precondition for this to be useful)

– CDS Artifact integrator has the means to obtain the knowledge artifact from a CDS Repository (e.g. they have either browsed or queried the CDS Repository for available artifacts)

– CDS Artifact Integrator Selects Artifacts of Interest to Use in their CDS System• Post Conditions

– The CDS Knowledge Artifact Supplier has sent the CDS Knowledge Artifact to the requesting CDS Artifact Integrator

– CDS Artifact has been received by CDS Integrator and is available for processing– CDS Artifact is available for mapping, structural transformations and local adaptation– Strategy

10/11/2011

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Decision: In the pilot activities we will not directly address these as part of our pilot. We will focus the pilot activities on those tasks which occur between the pre and post condition

Pilot Preparations Revisited…• Pilot Team

• Identify the members of your organization who will be supporting this pilot. If possible include the role he/she will play in the pilot and contact information

 

• Goal of the Pilot• Please include a write up or create a Visio diagram of what you intend to show/prove/support during the pilot

process. Make this an actionable statement with specifics. Also include in this description what you hope to gain from this pilot.

 

• What portions of the IG are you Piloting• Please use this section to document what parts of the IG your are intending to pilot. Please be as specific as

possible. This should include any of the examples you intend to pilot (ECA Rules, Documentation Templates, Order Sets)

 

• Identify the Use Case Actors Involved:• A pilot may involve the following participants from the healthcare ecosystem: (For example): Laboratories, Vendors,

Standards Organizations, System Integrators, EHR Vendors, Physicians/Providers, Payors, Patients etc. 

• Minimum Configuration• What is your current set up? What will you be using to conduct the pilot? For example: An ambulatory Electronic

Health Record (EHR) system, A transport system being used in Production environments, A security system being used in Production environments, Standards (and any types of mappings you suspect you will need, a database (which one/type), Any type of interface between 2 different systems etc.

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Pilots Preparation cont.• Timeline

• What is your proposed timeline given we want to wrap up pilots by end of April/Mid May at the latest? (see Appendix A for more detailed timeline and activities) As a high level reminder here are the overarching tasks per month – please document in more details your plans

• January – Kick off and Logistics• February: Start Pilots• March: Continue with Pilots• April: Conclude Pilots

 • Success Criteria

• What will you/your organization use to determine the success of this pilot? This needs to be quantitative and not subjective in as much as possible. (For example: Successfully implement 1 ECA Rule showing successful execution from the EHR system)

 • In Scope/Out of Scope

• If you already know what will be in and out of scope for your pilot (beyond the IG or the UC) please document it here: (for example in scope – working with 1 vendor – out of scope customizing the ECA Rules to include a trigger event from a Documentation template)

•  Questions/Needs• Please include those items you wish to consider any questions you have or hope the pilot addresses.

Additionally, please include those items you need in order to succeed.(we will try to accommodate as many of these needs as possible within the scope of ONC, S&I and HeD)

 

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Pilot Project Schedule• We will do 4 – 10 minute project presentations each week• February 11th, 2013

1. 1:10-1:20 –Julie - NewMentor2. 1:20-1:30 – Dave Shields3. 1:30-1:40 - 4. 1:40-1:50

• February 25th, 20131. 1:10-1:20 - Zynx2. 1:20-1:303. 1:30-1:404. 1:40-1:50

• March 4th, 2013 (HIMSS WEEK) – might be a conflict so we are canceling this meeting

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Action Items & Next Steps• Review and Provide Feedback on the Value Statement and Success

Metrics• Establish partnerships if necessary• Begin Pilot Brief for next WG meeting

• If you need help with this activity please contact:• Jamie Parker (jamie.parker@esacinc.com) • Becky Angeles (rebecca.angeles@esacinc.com)

Meeting Reminder

• Pilots Work stream meets (next meeting: February 11th, 2013) • Every Monday• 1-2:30 pm EDT (we have increased the duration of this call to 90

minutes in order to complete our work knowing we are canceling the Feb 18th and March 4th meetings)

• See Wiki homepage for meeting details: http://wiki.siframework.org/Health+eDecisions+Homepage

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