EHR Functional Model and Standard

Health Level Seven (HL7) EHR SIGGary Dickinson, Linda Fischetti, Sam Heard

SIG Co-Chairs

© HL7 2003

Outline

History & Catalyst Functional Model

– EHR Functions– Profiles

Plan of attack!

© HL7 2003

AHRQ Agency for Healthcare Research and Quality (DHHS)

CMS Centers for Medicare and Medicaid Services (DHHS), formerly Health Care Financing Administration (HCFA)

DHHS US Dept. of Health and Human ServicesEHR Electronic Health RecordEHRFM EHR Functional ModelEHR SIG HL7 EHR Special Interest GroupHIMSS Health Information Management Systems

SocietyVA/VHA US Veterans Health Administration

Glossary

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Expert Panel

Jeff Blair– NCVHS, Medical Record Institute

Diane Carr– Queens Health Network– 2002 Davies Recognition Award

Simon Cohn, MD– Kaiser Permanente, IOM

Ed Hammond, PhD– Duke University, IOM, HL7 BOD

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Expert Panel, con’t

Thomas Handler, MD– Gartner, HIMSS EHR/Davies Criteria

Dipak Kalra, MD– NHS, UK

Clem McDonald, MD– Regenstrief Institute, University of Indiana– LOINC

Ron Parker– Canadian Health Infoway

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Expert Panel, con’t

Paul Tang, MD– Stanford University, IOM

Charlene Underwood– Siemens, HIMSS EHR/Davies Criteria

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History & Catalyst

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EHR SIG Co-Chairs

Linda Fischetti, RN MSUS Department of Veterans Affairs

Gary DickinsonPer-Sé Technologies, Inc. US

Sam Heard, MDOpenEHR, Australia

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HL7 EHR SIG

Formed January, 2002Establishes EHR related priorities for

HL7 Standardization– Architectural issues – working with other

technical committees– Functional specification

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Original timeline

Take 18 months to 2 years to write the standard

And then….. A customer arrived……

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SCULLY URGES HOSPITALS TO HELP DEVELOP STANDARDIZED HEALTH RECORDS

“Tom Scully, Administrator of the federal Centers for Medicare and Medicaid Services, today urged hospital executives to work with the government to develop standardized electronic health records.”

Dateline, Washington, DC21st March 2003:

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Functional Model

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Project Target

Initial Target EHR Functional Model and Standard-

– Draft Standard for Trial Use

Subsequently Full HL7 Standard

– Normative Document

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Task

Create a Functional Model– Determine care delivery functions that are required across all

implementations– Determine infrastructure functions supporting care delivery– Determine care delivery functions that are required in

particular settings– Allow for dynamic additions for innovation and elective

functions

Ballot this model as a standardised description of EHR functionality

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EHR Functional Model

Infrastructure functions

Care Delivery Functions

FunctionalProfiles

Vary across profiles

FunctionalProfiles

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EHR Functions

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Core functionality

Functional Profile 2

Functional Profile1

Core specificfunctions

Essential

Core specific functions

Essential

Core generic functions<- Essential ->

Infrastructure functions<- Essential ->

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Core and Added Functionality

Profile 2Profile 1

Core specific functions

Essential

Added functions

Desirable

Added functions

Desirable

Core specificfunctions

Essential

Infrastructure functionsEssential

Performance and reliability enhancement Desirable

Core generic functions Essential

Added and innovative care delivery functions Desirable

© HL7 2003

Example functions

Infrastructure functions

Care delivery functions

Functional Profiles

Inpatient

Medication Administration Record

Bed management

Demographic Management Demographic Management

Security Security Security Security Security Security Security Security

Standards Compliance Standards Compliance

Order Management Order Management Order Management

Event Capture Event Capture Event Capture Event Capture

Notes Notes Notes Notes Notes Notes

Results Reporting Results Reporting Results Reporting

Drug-Drug Interactions Drug-Drug Interactions Drug-Drug Interactions.

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Increasing granularity

OrdersManagement

RecordingFunctions

WorkflowManagement

Care DeliveryFunctions

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Increasing granularity

MedicationManagement

LaboratoryManagement

ImagingManagement

ReferralsManagement

OrdersManagement

RecordingFunctions

WorkflowManagement

Care DeliveryFunctions

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Functional domain hierarchies

Medication orders

Warnings

Patient preferences

Administration recording

Care Delivery Functions

ePrescribing

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Functional dependencies

Clinical workstation Medicationknowledgebase

Prescriptionprinting

Adverse reactionwarnings

ePrescribing

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Functional dependencies

Problemlist

Pastmedications

Currentmedication list

Adversereactions

Allergies Patientpreferences

Therapeuticprecautions

Historicalrecording

Demographicservice

Userauthentication

Clinical workstation

Drug-druginteractions

Drug-diseaseinteractions

Indicationscontraindications

Medicationknowledgebase

Prescriptionprinting

Adverse reactionwarnings

ePrescribing

© HL7 2003

EHR FunctionSpecification Triplet

For each functional element specified:

1) WHAT - Statement of function(ality)

2) WHY - Rationale (for inclusion)

3) Conformance Criteria

How = Implementation - OUT OF SCOPE

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Functional profiles

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What are functional profiles?

Sets of functions– Care setting specific

Based on consensus

– Purpose specific Registered for specific use Not controlled through standards process

Standard

Registered

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Care setting profiles

Institute of Medicine– Agree standard care settings– Minimal functionality required

Express in EHR Functional Model– Review functions– Ballot functions

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Example functions

Infrastructure functions

Care delivery functions

Profiles

OutpatientInpatient Home

Wellness Reminders

Medication Administration Record

Bed management

LifestyleWellness

Reminders

Medication Administration Record

Demographic Management Demographic Management

Security Security Security Security Security Security Security Security

Standards Compliance Standards Compliance

Order Management Order Management Order Management

Event Capture Event Capture Event Capture Event Capture

Notes Notes Notes Notes Notes Notes

Results Reporting Results Reporting Results Reporting

Drug-Drug Interactions Drug-Drug Interactions Drug-Drug Interactions.

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What are registered functional profiles?

Sets of functions– Determined by users– Determined by authoritative bodies– Defined by quality or safety initiatives– Defined by regulation– Defined by payors

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Profiles

Infrastructure functions

Care Delivery Functions

Use Profiles

Care SettingProfiles

Profiles

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Profiles

Provider Profiles

Care SettingProfiles

Profiles

Vendor Profiles

Regulation Profiles

Professional Association

Profiles

Accreditation Profiles

Part of StandardRegistered – Not in standard“How-to” is part of Standard

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Use of Profiles

Provider Profiles

Care SettingProfiles

Profiles

Vendor Profiles

Regulation Profiles

Professional Association

Profiles

OutpatientOncologist

Guideline

HIPAA

ProductX

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Use of the Model: VendorApplication profile

ApplicationProfile 1

ApplicationProfile 1

ePrescribing

Laboratory resultmanagement

Chronic diseasePrompts and recalls

Dom

ain

s

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Providerprofile

Use of the Model: Provider

ApplicationProfile 1

ApplicationProfile 2

ePrescribing

Laboratory resultmanagement

Chronic diseasePrompts and recalls

Dom

ain

s

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EHR SIG Work PlanDeliverables

Top down functional decomposition– References and sources

Standard care setting functional profiles– EHR SIG/IOM collaboration

Functional profile “How-to”– Guidance: build, adapt, extend and integrate

profiles– Registry, conformance

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Project Work & Timeline

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Plan of Attack

EHR Functions HL7 EHR SIG

EHR Care Setting Profiles HL7 EHR SIG, IOM collaboration Profile per setting

– E.g. acute inpatient, ambulatory, long-term care, care in the community, home health, Integrated Delivery Network

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Plan of Attack (cont.)

EHR Registered Use Profile “How-to” Government: CMS, VA, FDA… Accreditation Providers, Practitioners Vendors Professional Societies Patients, consumers?

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Project Timeline…

21 July Ballot draft published - ready for meeting

23-24 July Open EHR SIG MeetingEnd July Ballot draft revised - ready to ballot

1 August Ballot opens

1 September Ballot closes

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Project Timeline…

8-12 September 2003 HL7 Fall Working Group Meeting Memphis, Tennessee

9-11 September 2003 EHR SIG Meeting Reconciliation of ballot comments

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How to Participate

Join HL7 Subscribe to HL7 EHR SIG Listserver (HL7 members) Attend open public sessions (no HL7 membership

required) Join teleconference calls (HL7 members) Join ballot group (HL7 members) Review ballot draft (no HL7 membership required) Vote and submit pertinent comments (HL7 members)

ContactsLinda Fischetti, RNVeterans Health AdministrationLinda.Fischetti@med.va.gov

Gary DickinsonPer-Sé Technologies, Inc.gary.dickinson@per-se.com

Sam Heard, MDOpenEHR, Australiasam.heard@bigpond.com

© HL7 2003

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EHR SIG Work PlanFunctional Perspectives

Front-end user functions– Explicit functions

– Extrinsic - externally invoked process/action

Embedded functions– Implicit functions– Intrinsic - bound to internal process

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EHR SIG Work PlanFunctional Perspectives, con’t

Service Oriented Architecture functions

Communication functions

– Interface functions

– Multimedia functions

Interface functions

– HL7 trigger events, messages, query/response– In and outbound data streams

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EHR SIG Work PlanFunctional Perspectives, con’t

Reporting and notification functions– Outbound data streams

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Functional dependencies

Historicalrecording

Demographicservice

Userauthentication

Clinical workstation

Drug-druginteractions

Drug-diseaseinteractions

Indicationscontraindications

Medicationknowledgebase

Prescriptionprinting

Adverse reactionwarnings

ePrescribing