Healthcare Information Technology Standards Panel 2006, 2007 and Beyond John D. Halamka MD Chair,...

Healthcare Information Technology Standards Panel

2006, 2007 and Beyond

John D. Halamka MD

Chair, HITSP

2HITSP: Harmonizing standards to support the Nationwide Health Information Network

A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability

Healthcare Information Technology

Standards Panel (HITSP)

Nationwide Health

Information Network

Architecture Projects (NHIN)

The Health Information Security and

Privacy Collaboration

(HISPC)

The Certification Commission for

Healthcare Information Technology

(CCHIT)

American Health

Information Community

HITSP includes 323 different member organizations and is administered by a Board of

Directors19 SDOs

263 Non-SDOs28 Govt. bodies

13 Consumer groups

HITSP includes 323 different member organizations and is administered by a Board of

Directors19 SDOs

263 Non-SDOs28 Govt. bodies

13 Consumer groups

The Community is a federally-chartered commission and will provide input and recommendations to HHS on how to

make health records digital and interoperable, and assure that the privacy

and security of those records are protected, in a smooth, market-led way.

The Community is a federally-chartered commission and will provide input and recommendations to HHS on how to

make health records digital and interoperable, and assure that the privacy

and security of those records are protected, in a smooth, market-led way.


NHIN 2 Awardees

CareSpark

Delaware Health Information Network

Indiana University

Long Beach Network for Health

Lovelace Clinic Foundation

MedVirginia

New York eHealth Collaborative

NorthCarolinaHealthcareInformationand Communications Alliance, Inc.

West Virginia Health Information Network


NHIN Trial Implementations

Participate in NHIN Cooperative -implement, test, and demonstrate core services:– Support of consumer access controls– Lookup and retrieval of clinical information– Exchange of patient summary records

A foundation for other priorities in lab result reporting, medication history exchange, quality and public health


2006 – the First “Turn of the Crank”

Consumer Empowerment– Medications– Allergies– Demographics– Advance Directives

Electronic Health Records– Laboratory including blood banking and microbiology– Ordering and results exchange

Biosurveillance– Deidentified registrations– Labs– Radiology text results


What did we do in 2006?

Established the HITSP Organization and its committees

Created the standards harmonization process including all coordinating committee sub-processes

Harmonized standards for 3 use cases (accepted by Secretary Leavitt) and resolved three controversies along the way– To resolve CCR v. CDA, the CCD was successfully balloted– To resolve the need for Interim standards we accelerated CCD– An enhanced implementation guide for HL7 2.5.1 was successfully balloted

this Summer

To align HITSP interoperability specifications with CCHIT functional criteria, the CCHIT/HITSP Joint Working group has established a joint timeline for the next 3 years


HITSP Organization

The CommunityHHS Secretary

Mike Leavitt, Chair

Program/Project Management Team

Executive in Charge, F. Schrotter, ANSI

Program Manager, L. Jones GSI

Deputy PM, J Corley, ATI

Project Manager, Julie Pooley, Booz Allen

Program/Project Management Team

Executive in Charge, F. Schrotter, ANSI

Program Manager, L. Jones GSI

Deputy PM, J Corley, ATI

Project Manager, Julie Pooley, Booz Allen

Technical Management

Joyce Sensmeier, HIMSS

Technical Management

Joyce Sensmeier, HIMSS

Panel Secretariat and Coordination

Committee Management

Michelle Deane, ANSI

Panel Secretariat and Coordination

Committee Management

Michelle Deane, ANSI

HHS ONCHIT1 PO, Dr. John Loonsk

HHS ONCHIT1 PO, Dr. John Loonsk

HITSPDr. John Halamka, Chair

Member Populated Board and Panel

HITSPMember Populated

Coordination Committees

• Harmonization Readiness– Lynne Gilbertson

• Business Plan– Steve Lieber

• International Landscape– Bill Braithwaite

• CCHIT JWG– Jamie Ferguson

• Foundations– Bob Dolin & Steve Wagner

• Process Review– Lynne Gilbertson &

Erik Pupo

HITSPMember Populated

Technical Committees

• Care Delivery– Jamie Ferguson– Steve Wagner– Steve Hufnagel

• Consumer Empowerment– Elaine Blechman, PhD– Charles Parisot– Scott Robertson

• Population Health– Floyd Eisenberg, MD, MPH– Peter Elkin, MD– Shaun Grannis, MD

• Security and Privacy WG– Glen Marshall– John Moehrke– Walter Suarez


Standards Harmonization Work Plan Tasks

I

Harmonization Request

II

RequirementsAnalysis

III

Identificationof Candidate

Standards

IV

Gaps,Duplications

and Overlaps

Resolution

V

Standards Selection

VI

Constructionof

InteroperabilitySpecification

VII

InspectionTest

VIII

InteroperabilitySpecification

Releaseand

Dissemination

IXProgram Management

3 months

3 weeks

3 months 4 weeks 2 months On-going

Requirements, Standards Selection, and Design

Public Review and

Input

Inspection Test and Public

Comment

Implementation Support and

Testing

Comment Resolution and Panel Approval

Interoperability Specification Construct

Development

IS Docs V 1.0

Review Draft

Summary of comment resolution

IS Docs V 1.0

Summary of comment resolution

Requirements, Standards

Selection, and Design

Consolidated comments

Consolidated comments

Annual Updates as Required

PROCESS

TASKS

DOCUMENTATION


HITSP Comments Received CY 2007

Population Health TC 73Consumer Empowerment TC 30Care Delivery TC 218Security & Privacy WG 240Misc (Project Mgmt, Cross TC, Process) 37

Total598


cd CE Interoperability Specification

«interoperabil ity specification»Consumer Empowerment

- docId: = IS-03

«composite standard»IHE XDS

+ Provide & Register Document Set: ITI-15+ Query Registry: ITI-16+ Register Document Set: ITI-14+ Retrieve Document: ITI-17

«composite standard»IHE PIX

- PIX Query: ITI-9

«composite standard»CAQH

«composite standard»Federal Medication

Terminologies

«base standard»ISO 15000 ebRS 2.1/3.0 «base standard»

HL7 2.5 Message

«base standard»NCPDP 8.1

«base standard»X12 270/271

«base standard»ASTM CCR 2369

«base standard»LOINC

«base standard»HL7 CDA r2

«base standard»NDC RxNorm SPL

«base standard»ASTM/HL7 CCD

«transaction»Patient

Demographics Query

+ docId: = ISTP-23

«composite standard»IHE PDQ

«component»Registration and Med

History Document(s) Content

+ docId: = ISC-32

«transaction»Patient ID Cross-

Referencing

+ docId: = IST-22

«transaction package»Manage Sharing of

Documents

+ docId: = ISTP-13

references

constrains

implementsconstrains

constrains

contains contains

constrains

constrainsconstrains

constrains

constrains

constrains

constrains

contains

constrains

constrains

implements

contains

Example Interoperability Specification Overview


National Council for Prescription Drug Programs (NCPDP) SCRIPT Standard Version 8.1

Logical Observation Identifiers Names and Codes (LOINC®)

Integrating the Healthcare Enterprise (IHE) Patient Care Coordination (PCC) Technical Framework Revision 1.0

Integrating the Healthcare Enterprise (IHE) Laboratory Technical Framework Supplement 2006-2007 Revision 1.0

Health Level Seven (HL7) EHR System Functional Model Draft Standard for Trial Use (DSTU)

Health Level Seven (HL7) Version 2.5

Health Level Seven (HL7) Version 3.0 Clinical Document Architecture (CDA/CDA R2)

Health Level Seven (HL7) Version 3.0 Continuity of Care Document (CCD)

Federal Medication Terminologies

Council for Affordable Quality Health Care (CAQH) Committee on Operating Rules for Information Exchange (CORE) Phase I Operating Rules

American Society for Testing and Materials (ASTM) Standard Specification for Continuity of Care Record (CCR): # E2369-05

Accredited Standards Committee (ASC) X12 Standards Release 004010

Accredited Standards Committee (ASC) X12 Insurance Subcommittee (X12N) Implementation Guides Version 004010 plus Addenda 004010A1

HITSP Named Standards

*

Example Interoperability Specification Standards


2007 – The second turn of the crank

Privacy and Security standards

Emergency Responder

Personal Health Records

Medication Management

Quality


Security Standards

Collect and Communicate Security Audit Trails

Consistent Time

Document Integrity

Manage and Control Data Access

Manage and Control Privacy Consents

Manage Entity Identity Credentials

Non-Repudiation

Secure Communications Channel

User Authentication


Consumer Access to Clinical Information


Medications Management


Quality


MAY JUNE JULY AUG SEPT OCT NOV DEC JAN FEB MAR APR

HITSP 2007/2008 Timeline Overview07/09/07

HITSP Board

10/09/07HITSP Board

05/11/07HITSP Panel

09/07/07HITSP Panel

5/08 – 5/10TC F2F

Arlington VA

6/18 – 6/20TC F2F

San Diego CA

09/04 – 09/06TC F2F

Arlington VA

Public Comment

Inspect Test and Public Comment

Implementation Support, Testing, and Gap Resolution

(with annual updates as required)


IS Construct Development

05/17 – 07/19 07/20 – 08/17 08/20 – 10/15

Security and Privacy for All Use Cases and Emergency Responder EHR Use Case

10/15/07HITSP Panel

07/16/07HITSP Panel

Consumer Access and Quality Use Cases

S&P and EHR-ER v 1.005/17 – 06/14

RDSS

Public Comment

Inspect Test and Public Comment

Implementation Support, Testing, and Gap Resolution

(with annual updates as required)


IS Construct Dev

7/11 – 9/14 9/17 – 10/12 10/15 – 12/13

Consumer Access and Quality v 1.07/20 – 8/17

Requirements Design and Stndrds Selection

05/07 – 07/10

Medication Management Use Case

Public Comment

Inspect Test and Public

Comment

Implementation Support, Testing, and

Gap Resolution


IS Construct Development

9/17 – 12/7 12/10 – 1/11 1/14 – 3/27

Medications Management v 1.09/17 – 10/12

Requirements Design and Stndrds Selection

6/18 – 9/14

10/29 – 10/31TC F2F

Lombard IL

12/13/07HITSP Panel

1/23 – 1/25TC F2FChicago

3/24 – 3/26TC F2FDC Area

3/27/08HITSP Panel

2/11/08HITSP Board

2/20/08HITSP Panel


HIT Implementation Testing Web Site Preview


AHIC Priorities and Use Case Roadmap

2006 2007 Use Cases 2009 and Beyond

Consumer Empowerment

Use Case

· Registration· Medication

History

AHIC Priorities and Use Case Roadmap

Consumer Access to

Clinical Information

· Access to Clinical Data

· Provider Permissions

· PHR Transfer

Medication Management

· Medication Reconciliation

· Ambulatory Prescriptions

· Contra-indications

EHR Use Case

· Laboratory Result Reporting

Emergency Responder

EHR

· On-Site Care· Emergency Care· Definitive Care· Provider

Authentication and Authorization

Remote Consultation

· Structured email

· Reminders· On-line

Consultation

Referrals and Transfer of Care

· Referrals· Problem Lists· Transfer of Care

Personalized Healthcare

· to be developed

2008 Possible Use Cases

CE 3.0 Administrative features CE 3.1 Appointment schedulingCE 3.2 Demographic profileCE 3.3 Editing account profileCE 3.4 Insurance eligibility & claimsCE 3.5 Financial recordkeeping & managementCE 4.0 Reminders (examples)CE 4.1 Annual check-ups CE 4.2 Cancer screening—mammogramsCE 4.3 Cancer screening—colonoscopiesCE 4.4 Immunizations CE 6.0 Summaries of healthcare encountersCE 6.1 Dates of servicesCE 6.3 Procedure codesCE 7.0 Educational informationCE 7.1 Evidence based health information CE 8.0 Decision supportCE 8.1 Shared decision makingCE 8.2 Communications preferencesCE 9.0 Patient health outcomesCE 9.1 Adverse eventsCE 9.2 Medical errorsCE 9.3 Patient reported health outcomesCC 3.0 Glucose monitoringCC 4.0 SpirometeryCC 5.0 AnticoagulationCC 7.0 Fall/motion monitoringCC 11.0 Lesion assessmentCC 12.0 Remote monitoring for chronic conditionsCC 13.0 HIT use in specific populationsCC 15.0 Product and services certificationCC 16.1 State licensure constraintsCC 18.0 Patient identification for authorization and authenticationEHR 5.0 Clinical/encounter notesEHR 6.0 Anatomic pathology resultsEHR 8.0 Radiology reportsEHR 12.0 Machine readable and interoperable EHR 12.1 Encounter notesEHR 12.2 Radiology reportsEHR 12.3 Lab results

Q 3.1 Clinical decision support Q 5.0 Clinical decision supportQ 6.0 Expanded inpatient quality measuresQ 7.0 Expanded ambulatory quality measuresBIO 1.2 Clinical symptomology BIO 1.3 Integration with EHRsBIO 1.4 Health alerting (HA)/email alerts BIO 2.1 Collaborative discussionsBIO 2.2 Web pagesBIO 3.2 ChemoprophylaxisBIO 3.3 TreatmentBIO 3.4 Isolation/quarantineBIO 3.6.2 Disease registryBIO 4.0 Adverse event reportingBIO 4.1 Devices, drugs, biologic BIO 5.0 Nosocomial infectionsBIO 5.1 Medication errorsBIO 5.1.1 Ordering/ prescribing/dispensing BIO 5.1.2 Drug-drug, drug-allergy interaction decision supportBIO 5.1.3 Linkage to FDA structured product labeling database results BIO 10.0 Public health information network (PHIN) can be leveraged BIO 14.0 National notifiable disease conditions have been identifiedAHIC 1.0 Labs, medications, allergies, immunizationsAHIC 2.0 Secure messaging/online consultationAHIC 3.0 Bi-directional communicationsAHIC 4.0 Adverse event reportingAHIC 5.0 Case reporting AHIC 6.0 Clinical decision support systemsAHIC 7.0 Identification/authentication AHIC 8.0 Problem listsAHIC 9.0 Clinical encounter notesAHIC 10.0 Family history/social factorsAHIC 11.0 Vitals signsAHIC 12.0 Population health/conditionsAHIC 13.0 Minimum data setAHIC 14.0 Confidentiality, privacy, & security of patient data

AHIC 15.0 Data access/data controlAHIC 16.0 Data aggregationAHIC 17.0 Infrastructure areas missingAHIC 17.1 Security, network, repositoriesAHIC 18.0 Vital measurementsAHIC19.0 Text documentsAHIC 21.0 Health literacy (multilingual support)AHIC 23.0 Advance directive/living willsAHIC 24.0 Social/family historyAHIC 26.0 Medication historyAHIC 27.0 E-prescribingAHIC 28.0 Standardization of device interfacesAHIC 29.0 Care plans/clinical flowsheetsAHIC 30.0 Provider listAHIC 31.0 Adverse eventsAHIC 32.0 Nosocomial infectionsAHIC 33.0 Clinical data storage for surveillanceAHIC 34.0 Case reporting AHIC 35.0 Bi-directional communicationsAHIC 36.0 Lab resultsAHIC 37.0 Anatomic pathology resultsAHIC 38.0 Radiology reportsAHIC 39.0 Social historyAHIC 40.0 Procedure reportsAHIC 41.0 MedicationsAHIC 43.0 DentalAHIC 44.0 Workflow integrationAHIC 45.0 Int’l public health collaborationAHIC 46.0 Legal liability & regulatory barriersAHIC 47.0 Consumer consentCCHITCCHIT 1.0 Patient safetyCCHIT 2.0 Transfer of careHITSP 1.1.4 Text reportsHITSP 1.1.5 Numeric resultsHITSP 1.1.7 ImagesHITSP 1.2 HIPAA covered entities HITSP 1.2.1 X12 Claims attachment

HITSP 2.0 Secondary uses of dataHITSP 2.1 Clinical researchHITSP 2.2 Clinical trialsHITSP 2.3 Population healthHITSP 3.0 Quality/control measurementsHITSP 3.1 Consistency across usesHITSP 4.0 Clinical device dataHITSP 4.1 GlucometersHITSP 4.2 MonitorsHITSP 4.2 Smart pumpHITSP 5.0 Cross use case work on security (standards)HITSP 5.3 Authentication models to support chain of trust data exchanges

Quality

· Hospital Measurement and Reporting

· Clinician Measurement and Reporting

· Feedback to Clinicians

BiosurveillanceUse Case

· Visit· Utilization· Clinical Data· Lab and

Radiology

Public HealthCase Reporting

· Case Reporting· Bidirectional

Communication· Labs

ResponseManagement

· Resource Identification

· Vaccine· EHR Data

RemoteMonitoring

· Remote Monitoring of Vital Signs and Labs (Glucose)


Overall Timeline

2006 2008Timeline (Calendar Year)

2007 2009 2010

2006 Use Cases

· Consumer Empowerment

· EHR· Biosurviellance

HITSP RDSS & ConstructsRelease 1

HITSPRelease 2

Accepted by Sec.

CCHIT 2008 Certification

CCHIT 2008 Criteria Development

Recognized by Sec.

New Federal Systems and Upgrades

HITSPRelease 2

AHIC Medication Management, Quality

and Consumer Access to Clinical Information Use Cases Published New Federal Systems and Upgrades


2008Use Cases

· Referrals and Transfer of Care

· Remote Monitoring

· Remote Consultation

· Public Health Case Reporting

· Response Management

· Personalized Healthcare

AHIC Use Cases Published

Accepted by Sec. Recognized by Sec.

New Federal Systems and Upgrades



HITSP RDSS and ConstructsRelease 1

HITSPRelease 2




HITSP Medication

Management, Consumer

Access and Quality

RDSS and Constructs Release 1

Accepted by Sec.

Recognized by Sec.

2007Use Cases

· Emergency Responder EHR

· Medication Management

· Quality· Consumer

Access to Clinical Information

HITSPEmergency

Responder EHRRDSS and

Constructs r1

AHIC Emergency Responder EHR Use

Case Published

Accepted by Sec.

New Federal Systems and UpgradesHITSPRelease 2

Recognized by Sec.

2011AHIC Use Cases


Summary

Over the past year, HITSP has become an established, trusted organization with a multi-stakeholder, open, transparent process for standards harmonization

In 2007, we will complete 4 additional use cases plus security/privacy

In 2008, we will complete an additional 6 use cases

CCHIT and HITSP are now aligned via a common schedule, an ongoing joint working group and a Memorandum of Understanding

Our Foundations Committee will work on the medium to long term alignment of standards organizations and their work products in parallel with the Use Case work of the entire panel


Contact Information

For general HITSP-related questions please contact:

Michelle Maas-DeaneHITSP SecretariatAmerican National Standards InstitutePhone: 212-642.488 email: [email protected]

For ANSI Document Library related questions please contact:

Alison ZieglerProgram Administrator, Standards PanelsAmerican National Standards InstitutePhone: 212-642.4947 email: [email protected]

For Technical Committee questions:

Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS Vice President, Informatics HIMSS Phone: 312-915-9281 email: [email protected]

or

Jessica KantCoordinator, Standards HarmonizationHealthcare Information & Management Systems SocietyPhone: 312-915-9283 Fax: 312-915-9511 email: [email protected]

Healthcare Information Technology Standards Panel 2006, 2007 and Beyond John D. Halamka MD Chair,...

Documents

Transcript of Healthcare Information Technology Standards Panel 2006, 2007 and Beyond John D. Halamka MD Chair,...