Health eDecisions (HeD) All Hands Meeting January 16th, 2014.
Health eDecisions RI/ Pilots Sub-Workgroup
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Transcript of Health eDecisions RI/ Pilots Sub-Workgroup
Health eDecisionsRI/ Pilots
Sub-WorkgroupJune 10th, 2013
10/11/2011 1
Agenda• Announcements • Review and Revisit of Goals• Review of RI/Pilot Sub-WG Timeline• Pilot Updates:
• Zynx/DesignClinicals – Order Sets• Findings and Discussion
• AllScripts and NewMentor (Million Hearts – MU NQF 68)• VA and Wolters Kluwer - Demo• CDC and Allscripts
• Review of Use Case 2 Functional Interactions• Review Implementation Guide• Review Action Items, Next Steps
Announcements• We will be reviewing the IG in our next 2 workgroup Meetings• We need to plan an “Open House” to display our pilots work
• July 8th?
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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
[email protected]@wolterskluwer.com [email protected] [email protected]
Service Supplier/Artifact Supplier
OpenCDS David Shields [email protected] Service Supplier
Zynx HealthClaude Nanjo (primary)Bernadette MintonVictor Lee
[email protected] (primary) [email protected]@zynx.com Service Supplier/Artifact Supplier
Medexter Healthcare Klaus-Peter AdlassnigKarsten Fehre
[email protected]@medexter.com Service Supplier
newMentor Julie SchererMatt Pfeffer
[email protected] [email protected] Service Supplier/Artifact Supplier
CDC Shu McGarveyLaura Conn
[email protected]@cdc.gov Government /Service Supplier/Artifact Supplier
NextGenDr. Sarah CorleyDr. Jeff FriedlinGary Wietecha
[email protected], [email protected],[email protected] EHR Vendor
Practice Fusion Lauren FifieldMichael Poremba
[email protected] [email protected] EHR Vendor
AllScripts Douglas GentileRobin Williams (primary)
[email protected] [email protected] (primary) EHR Vendor
Design Clinicals Dewy Howell [email protected] EHR Vendor
SuccessEHS Claude Ouimet [email protected] EHR Vendor
Applied Pathways Paul Arnone [email protected] Service Supplier
Support Team• Support Team:
• Pilots Lead: Jamie Parker: [email protected]• Support: Ali Khan: [email protected] • Subject Matter Expert: Aziz Boxwala: [email protected]• Subject Matter Expert: Bryn Rhodes: [email protected] • Use Case 1: Dave Shevlin: [email protected] • Implementation Guide: Lynette Elliot: [email protected] • SDO Support: Anna Langhans: [email protected]
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HeD Pilots Goal Goal
The goal of this initiative is to produce, consume and where feasible, execute implementable CDS interventions.1. Event Condition Action Rules (ECA Rules)2. Order Sets3. Documentation Templates
Pilot Scope4. Health eDecisions will apply defined aspects of the Implementation Guide in a
real-world setting.5. Modify the Implementation Guide to ensure it is usable6. Submission of explicit feedback to sub workgroups such as vMR and
vocabulary and terminology to close gaps7. 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.
8. Demonstrate intent of artifact (specifically structures and semantics) are communicated either by direct execution or by translation to native format
9. Ensure Completeness and consumability of artifact
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Timeline
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Goal & Activities EST. Time
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
4 wks.(reality 5 weeks)
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
2 wks.(reality- 4
weeks)
2/25-3/25
-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
6 wks. or less
depending on Pilot activity
3/25 – 5/20
-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
2wks 5/20 -6/04 -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
2 wks. 6/4 – 6/18 -Documented ONC Feedback- Next Steps Action Plan
We are Here
Vendor Engagement Discussion
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EHR Area of Interest Potential Match
Design Clinicals Order Sets Zynx
AllScripts ECA Rules –NQMF Rule (for Ambulatory Setting)
NewMentor (have catalog for rules in ambulatory setting)
Allscripts San Diego Pertussis ECA rule CDC
VA Documentation Template Wolters Kluwer
Pilot Updates: Zynx – DesignClinicals (Order Set- Heart Failure )• Team:
• Claude Nanjo and Victor Lee Zynx• Dewy Howell – DesignClinicals
• Status• What we learned
• How to capture that in the IG
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Pilot Updates: NewMentor – AllScripts (ECA Rule Million Hearts –NQF 68)Team:
• Julie Scherer - NewMentor• Bryn Rhodes – Internal Support • Robin Williams – AllScripts
Team Meetings
Status:• Notes on the IG• Notes on the Vocab Work
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Pilot Updates: Wolters Kluwer – VA (Documentation Template)• Team:
• Christy May -Wolters Kluwer• ???? – Internal • Ken Kawamoto - VA• Robert – Lario - VA
• Status: - DONE ….DEMO!!!!• Notes on the IG• Notes on the Vocab and Terminology Work
• ENM Code issue (maybe include them in LOINC)• Follow up with Mark (examples are in the UTI template – send to LOINC
folks)• Tracking sheet has been created to track these follow up issues through the
vocab and term group
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Pilot Update: CDC – AllScripts (ECA Rule) – 99%• TEAM:
• Shu McGarvey - CDC• Aziz Boxwala – Internal Support• Bryn Rhodes- Internal Support• Manoj Sharma- AllScripts Technical guru
• Status• Expected Completion Date
• Shu to provide value sets for the Labs (general culture)• We are only piloting the Clinical Rule not the Lab Rule (for stand alone
labs)• HL7 – act/relationship value sets (work with Terminology team to get this
done - • Notes on the IG• Notes on the Vocab Work
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Pilot Updates: Zynx – DesignClinicals (Order Set- Heart Failure )• Team:
• Claude Nanjo and Victor Lee Zynx• Dewy Howell – DesignClinicals
• Status• Expected Completion Date?
• Notes on the IG
• Notes on the Vocab and Terminology Work
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Working Session on the UC 1 IG:http://wiki.siframework.org/HeD+Pilot+Tools
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HeD UC2 Solution Plan
Create implementation guidance that leverages vMR as the base model but is aligned with C-CDA and QRDA (semantics, terminologies, and templates) to the highest extent possible.– Solution will be to update the vMR model to align with the
semantics of C-CDA and QRDA to the extent possible and reasonable
– vMR is a streamlined data model for CDS. This model is at a similar level of granularity to models such as Green CDA
Request Service: DSS Request ElementRequest Items Organizer/Container: vMR
Request Item Payload: vMR Clinical Statement
vMR Payload
This approach supports vMR as the payload standard with mappings to CCDA and QRDA
HeD UC2 Solution Plan
HeD Schema/vMR
Response Service: DSS Response ElementResponse Items Organizer/Container: Harmonized vMR/HeD Schema
Response Item Payload: vMR Clinical Statements
CDS Response
CDS Request
HeD UC2 Solution Plan
We will utilize templates to guide the IG development and Functional Interaction Types as examples– vMR templates will be used as building blocks of data that are
coordinated to meet template requirements– The Functional Interaction Types will be the examples that use
the building blocks– Leverage pilots from UC1 for functional interaction types
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Potential Functional Interaction Types1. Disease Management 2. Drug Dosing Calculation3. Immunization Forecasting4. Quality Measure Evaluation5. Transition of Care Support6. Prediction Rule Evaluation – APACHE score, AHRQ Pneumonia Severity
Index, etc.7. Severity of Illness Assessment – Charlson index, etc.
Which functional interaction types best align with current pilot efforts? Which types would be the most straight forward to test? Which types would best validate the HeD UC2 solution, or be the most widely
used in the industry?
Pilot Support Tools and Feedback channels Discussion Board: • http://
wiki.siframework.org/HeD+Pilot+Activities#HeD_Pilot_Discussion
Vocabulary and Terminology Feedback:• http://
wiki.siframework.org/HeD+Pilot+Tools
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Action Items & Next Steps• Continue to work on the IG
• Begin to step through the UC 1 IG based on Pilot activities• As needed and necessary we will be discussing issues and
challenges during the pilot activities• Update the IG• Update the Vocabulary and Terminology work• Identify additional support resources if necessary
• Prepare for our HeD Pilots “open house”• July 8th???
Meeting Reminder
• Pilots Work stream meets (next meeting: June 24th, 2013) • Every Monday• 1-2:30 pm EDT See Wiki homepage for meeting details: http://
wiki.siframework.org/Health+eDecisions+Homepage
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Appendix A: Success Criteria
NOTE: This is a work –in-progress we will need to re-evaluate this 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 group10/11/2011 22
Appendix B
In Scope/Out of Scope
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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
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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