Standards and Interoperability Framework - HIT Standards Committee -2010!12!17

8/8/2019 Standards and Interoperability Framework - HIT Standards Committee -2010!12!17

1/14

S&I FRAMEWORK PROPOSED

INITIATIVE SUMMARIES

Dr. Douglas Fridsma, Office

of Interoperability and

Standards

December 10, 2010


2/14

Executive Summary

The Standards and Interoperability (S&I) Framework represents aunique approach to evolve a new model of health information exchange

What is needed to achieve this future are specific initiatives that can be

harnessed into health information exchange initiatives to guide the

design and development of a fully connected health information

infrastructure that will enhance efficiency, quality and effectiveness inhealthcare delivery.

The information exchange foundation envisioned through the S&I

Framework would leverage existing and new investments in technology,

take advantage of health IT innovations, and identify opportunities for

new investments through the management of health information

exchange initiatives within a portfolio

This presentation is a summary of the initiatives under

consideration, for review and selection by ONC leadership, in

consultation with appropriate steering bodies and advisory

groups.

2


3/14

Clinical Summary

3

Challenge

The exchange of Clinical Summaries is hampered by the lack of unambiguous commondefinitions of what data elements must at a minimum be exchanged, how they must be

encoded, and how those common semantic elements map to MU specified formats (C32/CCD

and CCR). Further, the CCD and CCR standards are overly complex and hinder simple

information exchange. Finally, the lack of a robust toolset to aid in development and

validation of conformant Clinical Summaries is a major impediment to the widespread

adoption of the standards.

Scope

Statement

Collaborate with stakeholders and SDOs to create a minimum baseline data set for the clinicalsummary including use of unstructured text and coded data elements that allow for provider adoption

in accordance with Stages 1-3 of meaningful use requirements.

TargetOutcomes

Enable Clinical Summary validation services to be available such as if an organization passesvalidation, they have a high degree of confidence that any other organization passing the samevalidation has a 99.9% opportunity to understand the same clinical summary specification

Reduce template development time through new tools developed through the S&I Framework andpublic/private activities (such as Open Health Tools) by a factor of 1.5x. Reduce time to create anew minimal unstructured summary and structured summaries based on the CCD/CCR by 10% in2011 and by 25% in 2013

Meaningful UseAlignment

Exchange key clinical information among providers of care and with patients and other authorizedentities electronically

Related UseCases/Stories

Consultations and Transfers ofCare,medication summaries and public healthcase reporting (ONC/AHIC)

Endocrinology Referral (HIMSS)

Dermatology Referral (HIMSS)

NHIN DirectUser Stories (see notes for more): Primary care provider refers patient to specialist

including summary care record Primary care provider refers patient to hospital

including summary care record Specialist sends summary care information

back to referring provider


4/14

Templated Clinical Documents

4

Challenge

In addition to clinical summaries, there are other structured and unstructured documentsproduced and exchanged in delivering patient care and providing information to other trusted

organizations for the purpose of patient empowerment, public health, quality reporting,

research and financial and administrative purposes. Currently there are multiple

implementation guides, referenced standards, and terminologies published by different

sources as paper documents with extensive redirection to other paper documents. This

makes unambiguous implementations and validation very difficult. There is a clear need for a

set of simple to use tools to create and validate clinical documents that can be constrained

for different business purposes.

Scope

Statement

Collaborate with stakeholders and SDOs to create computable implementation guide and validationtools for clinical documents including standard headers, sections and data elements that can beconstrained by templates to meet specific information exchange and interoperability requirements.

Key Outcomes

Enable Clinical Summary validation services to be available such as if an organization passesvalidation, they have a high degree of confidence that any other organization passing the samevalidation has a 99.9% opportunity to understand the same clinical summary specification whetheras unstructured data or structured and encoded data.

Reduce template development time through new tools developed through the S&I Framework and

public/private activities (such as Open Health Tools) by a factor of 1.5x. Reduce time to create anew unstructured and structured documents based on the HL7 CDA by 10% in 2011 and by 25%in 2013


Exchange key clinical information among providers of care and with patients and other authorizedentities electronically based on level of system capability, i.e., human readable, unstructured text orfull interoperable structured data


Use cases and coordinated requirements to support direct care and secondary use will bedeveloped as input to sections and data entries


5/14

Lab Interface Improvement

5

Challenge

There is a lack of harmonized specifications standards and code sets to enable the exchange

of lab results. The cost and time to initiate new electronic laboratory results interfaces

hampers broad adoption of such interfaces. The field by field details of HL7 v2 implementation

guides used by clinical labs and EHRs vary, creating a need for mapping or configuration per

interface, and the prevalence of core subsets of LOINC codes for common tests and analyses

also varies, causing downstream issues in decision support and quality reporting.

Scope Statement Limited to address this challenge for the subset of lab reporting to primary care (internal medicine,family practice, pediatrics)

Target Outcomes Achieve cost savings of up to 90% due to lab interface development improvements by 2015

Reduce total lab interface implementation time by up to 20% by 2013


Incorporate lab results into EHR as structured data


Electronic Health Record (LaboratoryResult Reporting) (ONC/AHIC)

EHR Lab Scenarios (ONC/AHIC)

Laboratory sends lab results to ordering provider(NHIN Direct)


6/14

Medication Reconciliation Improvement

6

Challenge

Medication reconciliation is a critical clinical workflow step that is often manual, time-

consuming and error prone. When medication and medication allergy and adverse reaction

data are electronically available from multiple sources (e.g., e-prescribing hubs, care

summaries sent on transitions of care, HIEs) it should be possible to partially automate

comparisons in medication lists and flag potential changes, deletions, and additions, but

there is no clear guidance on how this should be done, and the lack of guidance has

hampered implementation of this function in clinical IT.

ScopeStatement

Medication reconciliation improvement would be scoped to focus on improving medicationreconciliation tools, with the medications templates and entries undergoing further refinement asambiguities are addressed.

TargetOutcomes

Develop a new standardized medication reconciliation toolset that lowers total costs of medication

reconciliation by 10-20% from current costs by 2013 Develop tools to improve medication reconciliation execution time by up to 25% from current

response times by 2013 Increase adoption of medication reconciliation tools up to 25% by 2013.


Perform medication reconciliation at relevant encounters and each transition of care and referral


Medication Management (ONC/AHIC)

Medication Management (NHIN) Pharmacist sends medication therapy management

consult to primary care provider(NHIN Direct)


7/14

Provider Directories

7

Challenge

There is no consistent practice or infrastructure across the industry to support the

development and maintenance of provider directories. There is also no universal availability of

provider information to locate providers. Without clear guidance as to how to set up a directory

in a way that provides consistent information and promotes interoperability, EHRs and

directories will have to deal with different directory instances that provide overlapping

information on the same entity. In addition, there will be no clear guidance on how to

incorporate interoperable endpoints (e.g. Direct Addresses, HIO SOAP endpoints) in

directories.

ScopeStatement

This specification would focus on developing a specification to allow third parties to build a providerdirectory that is interoperable with other provider directories

TargetOutcomes

Develop a provider directory specification to allow for rapid development of federated providerdirectories that can communicate provider information with initial adoption projected at 10% by 2013.

Develop a content specification for provider directory data elements with a commensurate increasein response time of 25-50%


Exchange key clinical information among providers of care and patient authorized entities electronically


Healthcare Provider Directory (IHE) Entity Level Provider Directory (ONC HITPCInformation Exchange Workgroup)


8/14

Syndromic Surveillance

8

Challenge

The overall adoption rate for syndromic surveillance is extremely low, yet meaningful use

requirements demand an increased level of surveillance reporting. There is a direct need for a

simplified way of reporting standardized data to appropriate public health authorities that will

enable meaningful use requirements associated with surveillance to be fulfilled. It is

debatable as to whether providers can meet existing and future surveillance requirements

with the current implementation guidance available.

ScopeStatement

Develop a syndromic surveillance service specification to be used by vendors to deploy astandardized syndromic surveillance service within their infrastructure

NOTE: This initiative would complement the work conducted by ISDS and CDC to develop Stage 1meaningful use recommendations for syndromic surveillance. The ISDS recommendations areavailable for public comment and review at :

http://www.syndromic.org/uploads/files/ISDSRecommendation-PROVISIONAL_vFINAL.pdf

TargetOutcomes

Increase syndromic surveillance reporting by 10% by 2013 Increase syndromic surveillance data collection response times for at least 2 conditions by 20%


Provide electronic syndromic surveillance data to public health agencies


Public Health Case Reporting (ONC/AHIC)

Hospital or provider send chief complaint data topublic health (NHIN Direct)

Laboratory reports test results for some

specific conditions to public health (NHINDirect)


9/14

Quality Measures

9

Challenge

There is no clear linkage and guidance between defined standards and vocabularies and thequality measures required by CMS. A root cause of this challenge is the lack of good, easy to

use tooling, modeling, and mapping between semantic health concepts and quality

measures. The lack of a defined linkage creates downstream problems in mapping between

data received via interoperability (e.g., care summaries, electronic labs, medication history) and

the associated quality reports leading both to additional cost incurred by providers and to poor

quality data received by CMS and other agencies.

Scope

Statement

Focus on quality reporting format specification to help meet Stage 1 meaningful use requirements, with

initial scope highlighting the most critical quality measures needed.

TargetOutcomes

Develop a quality measure development standard for the 44 Stage 1 Clinical Quality Measures by2012

Promote adoption of quality measure specification by 25% of eligible providers by 2013.

Meaningful Use

Alignment

Report ambulatory quality measures to CMS or the States


Q

uality(ONC/AHIC)

Quality Use Case Requirements (NHIN)

NHIN DirectUser Stories: Provider or hospital reports quality

measures to CMS Provider or hospital reports quality

measures to State Provider or hospital sends update to

regional or national quality registry

HIMSSUse Cases

Public Health Quality Monitoring usingeMeasure

AmbulatoryQuality BMI eMeasure Utilization HospitalQuality eMeasure Utilization

Quality ACE ARB eMeasure Utilization


10/14

Population Health Query

10

Challenge

Meaningful use places additional demands on providers to provide and report public health

information. Traditional centralized models for public health data management have proven to

be costly, difficult to maintain, a inflexible to across population health conditions. To date,

various distributed query models have been implemented to facilitate public health situational

awareness, quality monitoring, and research. A standardized query approach is needed to help

determine how clinical providers, hospital systems and public health will share and report

information important for public health situational awareness, clinical decision support, and

quality monitoring and prevention.

Scope StatementDevelop detailed specifications focused on enabling distributed query mechanisms to aggregate datafrom multiple public health data sources into a single view

Target Outcomes

Development of a common query standard for all population health data sources, which can bereused by all population health query systems by 2012

Reduce total population health query costs by at least 20% More than 25% of total unique providers using population health query standard by 2013


None


None


11/14

Clinical Decision Support

11

Challenge

Clinical decision support is a key function of EHR systems that is expected to improve care. In

Stage 1 of the meaningful use requirements, provider and hospital EHR systems must execute

clinical decision rules and alerts. There will be a need to standardize these rules and alerts

across EHRs using interoperable templates. There also will be value in enabling interoperability

between an EHR system and a CDS provider, e.g., to notify a provider that a patient or panel of

patients require a test. Without a set of standards to guide development, rule development will

be localized, costly, and non-standardized.

ScopeStatement

Development of a standard content specification for implementation and exchanging clinical decisionsupport rules and alerts across various EHR platforms

TargetOutcomes

Develop a common standardized format for submitting patient data to CDS service providers that isadopted by up to 20% of providers by 2013.

Develop standardized format for submitting and generatingCDS rules that is adopted by 20% ofCDSvendors by 2013.

Increase total deployment cost savings for clinical decision support service capabilities by 25%

Generate a total increase in clinical decision support usage of 10%


Implement Clinical Decision Support Rules


Medical Home: Problem Lists & Practice-Based Registries (ONC/AHIC)

Care of the Stroke Patient in the Acute Care Setting (HIMSS)


12/14

Blue Button

12

Challenge

The Blue Button, should it become ubiquitous on health institutions patient portals (or forsmaller practices, simply on their website), payer-based PHRs, employer-based PHRs (often

just a PHR provided by payer), and even regional or state-wide HIEs, the effort that it would

take for an average consumer to gather their data to create a longitudinal record could be

simplified significantly. In order for the blue button to work, though, there is a need to develop

a common standard for downloadable information (a common standard for the downloaded

text files) so that a text file can be processed as patient readable.

Scope StatementThe focus would be on developing a standard content specification for how the text file would bestructured to make it readable for patients, and ensuring the structure could be mapped and/ortransformed to the CCD (so that documents using those standards could be transformed into thecommon text file format).

Target Outcomes

Develop a common format for representing the blue button text file that is adopted by VA and CMSin 2011.

Increase in blue button deployment to 10 additional organizations in 2012. Develop the capability to map a blue button standardized text file to C32 summary documents by

2013.


Provide clinical summaries to patients


None


13/14

Green Button

13

Challenge

Providers often need to transition from one EHR system to another. Such transitions occur

when providers purchase new EHRs or EHR modules or move practices. There is no

standardized mechanism to allow data transfer to occur in EHR system transitions, creating

a less dynamic market for EHR systems by encouraging lock-in.

Scope StatementDevelop clear standard format for how data from one EHR can be transferred to another EHRusing a green button specification

Target Outcomes Achieve cost reduction of at least 25% compared to paper transfer options by 2012. Promote VLER adoption of green button standard by 2013.


Exchange key clinical information among providers of care and patient authorized entitieselectronically


None


14/14

Value Set Development

14

Challenge

For a given meaningful use requirement needing a value set, experts would need to define the

value sets appropriate to the specific requirement with due consideration of harmonization with

similar and existing solutions. The infrastructure and format for maintaining the actual value

sets and making them available as needed would also require specification. This would include

issues of intellectual property and versioning. Stakeholders would have to agree to use or map

value sets from master(s) code sets like SNOMED rather than maintaining domain specific codes.

Without this value set development flow in place, the localized developed of value sets is likely

to continue, leading to less value set adoption.

ScopeStatement

There is a specific need for standardized value sets in areas such as: Lab Orders critical for meaningful use Reportable Conditions Lab Results for the most frequently reported tests

TargetOutcomes

Initial value sets ready to support meaningful use by end of 2011 Align 2011 developed value sets to existing vocabularies and vocabulary mappings by 2012.

Reduce value set development response time by 50% by 2013


Foundational to Meaningful Use


None

Standards and Interoperability Framework - HIT Standards Committee -2010!12!17

Documents

Transcript of Standards and Interoperability Framework - HIT Standards Committee -2010!12!17