October 2, 2008 | 2:00 – 3:30 pm (Eastern)
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1enabling healthcare interoperability
Webinar Series
Sponsored by the HITSP Education, Communications and Outreach Committee
October 2, 2008 | 2:00 – 3:30 pm (Eastern)
Presenters HITSP Population Perspective Technical Committee
Floyd Eisenberg, MD, MPH, Senior Key Expert, Siemens Healthcare
and co-chair of the Population Perspective TC
Lori Fourquet, e-HealthSign, LLC
Quality
Slide 2HITSP – enabling healthcare interoperability
Learning Objectives
During this 90-minute webinar, participants will explore the population
perspective of health information sharing for quality, gaining
a basic knowledge of:
— quality measure specification data element types and value sets
— defining and selecting a sub-population of patients (measure
denominator)
— defining and identifying expected interventions (measure numerator)
— terminology issues in identifying inclusion and exclusion criteria
a webinar series on U.S. healthcare interoperability
(continued)
Slide 3HITSP – enabling healthcare interoperability
Learning Objectives (continued)
— expectations for information transfer from EHRs to quality reporting
organizations
— HITSP specifications for quality information sharing
— the relationship of the quality use case and interoperability specification
to other efforts for public health and for data repurposing
a webinar series on U.S. healthcare interoperability
Slide 4HITSP – enabling healthcare interoperability
Quality
— Quality Measure Specification
— Clinical Data for Analysis
Inclusion Criteria
Exclusion Criteria
— Quality Reporting
— Security and privacy requirements for Quality
HITSP Interoperability Specification for Quality (HITSP IS 06)
Units of Exchange
— Health Information Summary Documents
— Health Information Messages
Conformance Subsets
Questions and Answers
Agendaa webinar series on U.S. healthcare interoperability
Slide 5HITSP – enabling healthcare interoperability
Introduction: Steve’s Story . . . part six
Patient is a 26-year-old male coping with the long-term effects
of a brain tumor that was removed during his childhood
Patient is assisting with home care for his grandfather, a
recent widower and diabetic who has become despondent
and non-compliant with self-care requirements
— The family is becoming concerned about the quality of care
Steve’s grandfather is receiving
— A search for new providers and a successful diabetes program is
being conducted by the family
— Fact-based information is needed, more than practice locations,
hours of operation, frequency of procedures and anecdotes
based on reputation, e.g.,
Critical care information such as comparative outcomes of
care for diabetic patients and those with depression
General preventive care success factors
Slide 6HITSP – enabling healthcare interoperability
HITSP is a volunteer-driven, consensus-based organization that is funded
through a contract from the Department of Health and Human Services.
The Panel brings together public and private-sector experts from across
the healthcare community to harmonize and recommend the technical
standards that are necessary to assure the interoperability of electronic
health records.
Overview
Slide 7HITSP – enabling healthcare interoperability
The HITSP Standards Harmonization Framework
— Identify a pool of standards for an AHIC (American Health Information
Community) Use Case
— Identify gaps and overlaps in the standards for this specific Use Case
— Make recommendations for resolution of gaps and overlaps
— Select standards using HITSP-approved Readiness Criteria
— Develop Interoperability Specifications (IS) that use the selected
standard(s) for the specific context
— Test the IS
Deliverables and Mode of Operation
Slide 8HITSP – enabling healthcare interoperability
Each HITSP Interoperability Specification defines a set of “constructs” that:
— specify how to integrate and constrain selected standards to meet the
business needs of a Use Case; and
— define a Roadmap to use emerging standards and to harmonize
overlapping standards when resolved.
In essence, a HITSP IS represents a suite of documents that integrate and
constrain existing standards to satisfy a Use Case
Deliverables and Mode of Operation
Slide 9HITSP – enabling healthcare interoperability
HITSP construct types, in decreasing breadth of scope, include:
— Interoperability SpecificationsIntegration of all constructs used to meet the business needs of a Use Case
— Transaction PackagesLogical grouping of transactions
— TransactionsLogical grouping of actions that use components and/or composite standards to realize the actions
— ComponentsLogical grouping of base standards that work together, such as
messaging and terminology
Deliverables and Mode of Operation
Slide 10HITSP – enabling healthcare interoperability
IS Status = State in the acceptance process
— Released
Panel approved for submission to HHS
— Accepted
Secretary of HHS has accepted for a period of testing
— Recognized
Secretary of HHS has recognized the IS for immediate implementation
Revisions and updates may mean that multiple versions of some
Interoperability Specifications exist with differing status levels
Deliverables and Mode of Operation
Slide 11HITSP – enabling healthcare interoperability
Current Interoperability Specifications (IS)
IS 01 Electronic Health Record (EHR) Laboratory Results Reporting
IS 02 Biosurveillance
IS 03 Consumer Empowerment and Access to Clinical Information via Networks
IS 04 Emergency Responder Electronic Health Record (ER-EHR)
IS 05 Consumer Empowerment and Access to Clinical Information via Media
IS 06 Quality
IS 07 Medication Management
Slide 12HITSP – enabling healthcare interoperability
IS 06 Quality
This Interoperability Specification defines specific standards that capture the
integration of data to support quality measurement feedback and reporting into
electronic health records (EHRs), use of quality measures to support clinical decision
making, and public reporting of healthcare quality through the exchange of data
between healthcare organizations and providers and public health via an electronic
network.
— Version: 1.0 Recognized — Version 1.0.1 Panel Review
IS 06VIA AN
ELECTRONIC NETWORK
IS 06VIA AN
ELECTRONIC NETWORK
Healthcare Provider Quality Reporting Organizations
Slide 13HITSP – enabling healthcare interoperability
Hospital-based quality measures
— Automate data capture and reporting of Hospital Quality Alliance (HQA)
measures through EHRs in support of provider workflows
— Communicate HQA measure data to external agencies
Clinician-level data
— Automate data capture and reporting of Ambulatory Quality Alliance (AQA)
measures through EHRs in support of provider workflows
— Communicate AQA quality measure data to external entities for
aggregation and reporting
IS 06 QualityOverall Objectives
Slide 14HITSP – enabling healthcare interoperability
Feedback to Clinicians
— enable real-time or near-real-time feedback regarding specific quality indicators which are relevant for a particular patient
— enable provision of tailored performance information to clinicians on quality measures for specific patient groups
(continued)
IS 06 Quality
Overall Objectives (continued)
Slide 15HITSP – enabling healthcare interoperability
Public Reporting
— Aggregate data across multiple sources (claims data, medication data, laboratory data, etc.)
— Support quality measurement, promote accountability among providers, and aid consumers in making informed choices
— Communicate quality measurement data quickly and clearly in a manner that makes it useful to a wide variety of decision makers (patients, healthcare providers, payers, health plans, and regulators who are involved with this process)
IS 06 Quality
Overall Objectives (continued)
Slide 16HITSP – enabling healthcare interoperability
Ancillary Entities
Clinicians
Consumers
Government Healthcare Agencies
Healthcare Delivery Organizations
Health Information Exchange
Health Information Management
Personnel
Health Information Technology
System Developers
Healthcare Payers
Healthcare Purchasers
Health Researchers
Processing Entities
Public Health Agencies
Quality Organizations
IS 06 QualityStakeholders
Slide 17HITSP – enabling healthcare interoperability
Quality Measure Specification
— Structured and codified
— Denominator and Numerator Inclusions – Value Sets
— Denominator and Numerator Exclusions – Value Sets
Data Capture / Aggregation
Data Reporting to External Agencies
IS 06 QualityRequirements
Slide 18HITSP – enabling healthcare interoperability
Integrating the Healthcare Enterprise (IHE) Quality, Research & Public Health Domain, Performance Measurement Value Set White Paper, August 2008
IS 06 QualityRequirements (continued)
Slide 19HITSP – enabling healthcare interoperability
Hospital-based care
Clinician / Ambulatory-based care
IS 06 QualityPerspectives
Slide 20HITSP – enabling healthcare interoperability
Healthcare Information Technology Expert Panel (HITEP)— Convened by the National Quality Forum (NQF)
— Identified 84 Institute of Medicine (IOM) High Priority Measures
Common data types
Reduce logic to common data types
Analyze frequency
— 88 Data Elements (9 additional subtypes added by HITEP)
Facility / clinician demographics
Patient demographics
Clinical data
IS 06 QualityData Elements / Types
Slide 21HITSP – enabling healthcare interoperability
— Base Facility Data Elements Identifier
Name
Location
— Patient Data Elements Pseudonymized Data Linker
Encounter Date/Time
History
Birth
Gender
Visit Data
Location
Discharge
Death
— Clinical Data Elements
Problem Data
Diagnosis Data
Allergy / Adverse Reaction
Vital Signs
Procedures and Diagnostic Tests
Medication Data
Study Findings/Test Results – Laboratory
Study Findings/Test Results – Radiology and Other Studies
Other (e.g. clinician-clinician communications, provider-patient communications, care classification-”comfort measure only,” clinical trial)
IS 06 Quality
Data Elements / Types / Examples
Slide 22HITSP – enabling healthcare interoperability
Processing Entity / HIE
Other Communities
Hospital
Clinician/Ambulatory
Provider
Document-Based
Transmission
Message-Based
Transmission
Quality Measurement
Organization
IS 06 QualityMain Business Actors
Measurement Consumer
Slide 23HITSP – enabling healthcare interoperability
Quality Report
MDO
MDO NQF
MDO
EHR
Quality Measure
Patient Data
measure endorsement, maintenance, syndication, and live broadcast
Quality Measure imported
EHR creates patient data summary internally, uses imported measure to calculate quality scores and export quality report
Quality report detail exported
IS 06 QualityImplementation Option #1: EHR does the work
Acronym LegendMDO – Measure Development OrganizationNQF – National Quality Forum
Slide 24HITSP – enabling healthcare interoperability
Quality Report
MDO
MDO NQF
MDOmeasure endorsement, maintenance, syndication, and live broadcast
Quality Measure imported QIO
Quality MeasureEHR
Quality data assembled internally
Data transmit Clinical Data
importedQIO uses imported Quality measures and clinical details to calculate quality scores and export Quality report
Quality report detail exportedPatient Data
IS 06 QualityImplementation Option #2:Quality Improvement Organization (QIO) / HIE
Acronym LegendHIE – Health Information ExchangeMDO – Measure Development OrganizationNQF – National Quality Forum
Mes
sage
Doc
umen
t
Slide 25HITSP – enabling healthcare interoperability
IS06 QualityTraditional HL7 Messaging
Slide 26HITSP – enabling healthcare interoperability
IS06 QualityDocument Sharing
Slide 27HITSP – enabling healthcare interoperability
IS06 QualityAssembly of Patient-Level Quality Data
Slide 28HITSP – enabling healthcare interoperability
Query for Existing Data (NEW)
TP 21
Patient Level Quality Data Message (NEW)
C 34
Patient Level Quality Data Document (NEW)
C 38
Patient Demographics Query (NEW)
T 23
IS 06 Quality New Constructs for IS06
Supports dynamic queries for clinical data to gather patient-level quality data elements
Support the process of sending patient-level quality data to an aggregator for analysis and aggregation of quality measures
Provide a list of patients and their demographics
Slide 29HITSP – enabling healthcare interoperability
Collect & Communicate Security Audit Trail
T 15
Secured Communication Channel
T 17
Access Control
TP 20
Nonrepudiation of Origin
C 26
Consistent Time
T 16
IS 06 QualityPrivacy and Security
Ensure the authenticity, integrity, and confidentiality of transactions, and the mutual trust between communicating parties
Provides a mechanism to ensure that all the entity systems communicating within the network have synchronized system clocks
Record audit event in repository
Ensure that an entity is the person or application that claims the identity provided
Describes the mechanisms to define and identify security relevant events and the data to be collected and communicated as determined by policy, regulation or risk analysis. It also provides the mechanism to determine the record format to support analytical reports that are needed.
Slide 30HITSP – enabling healthcare interoperability
Manage Consent Directives
TP 30
Entity Identity Assertion
C 19
IS 06 QualityPrivacy and Security
Ensure that an entity is the person or application that claims the identity provided
Deals with the capture and communication of patient consent directives and non-patient originated authorizations for disclosure of health information
Pseudonymize
T 24
Anonymize
C 25
Provides specific instruction for anonymizing data that is ready for repurposing.
Anonymization: According to the International Organization for Standardization (ISO), is the process that removes the association between the identifying data set and the data subject.
Defined to support pseudonymization of protected health information.
Pseudonymization : The process of supplying an alternative identifier that permits a patient to be referred to by a key that suppresses his/her actual identification information
Slide 31HITSP – enabling healthcare interoperability
Notification of Document Availability
T 29
Manage Sharing of Documents
T 13
Retrieve Form for Data Capture
TP 50
Patient ID Cross-Referencing
TP 22
IS 06 QualityInfrastructure
Deals with identifying and cross-referencing different patient attributes for the same patient.
Facilitates the registration, distribution and access of patient electronic health records across health enterprises
Notifies its recipient that a document is available and provides the information needed to retrieve the document
Supports public health authority reportable conditions monitoring and management.Enables capture of supplemental data variables not typically maintained in an electronic health record or laboratory information system
Document Reliable Interchange (NEW)
T 31
Supports a point-to-point interchange of metadata and documents
Transfer of Documents on Media (NEW)
T 33
Supports media interchange of metadata and documents
Slide 32HITSP – enabling healthcare interoperability
Measurement Criteria Message
TBD
Measurement Criteria Document
TBD
IS 06 QualityFuture Direction
New Constructs Required
Current Activities:Collaborative for Performance Measure Integration with EHR SystemsNational Committee for Quality Assurance (NCQA)American Medical Association (AMA)Electronic Health Records Association (EHRA, formerly EHRVA)
http://www.ama-assn.org/ama/pub/category/18352.html
Slide 33HITSP – enabling healthcare interoperability
Quality Measurement Message
TBDQuality Measurement Document
TBD
New Constructs Required
Current Activities:Quality Reporting Document Architecture (QRDA)September 2008 Ballot – HL7, Vancouver, BC
IS 06 Quality
Future Direction (continued)
Slide 34HITSP – enabling healthcare interoperability
Derived Information
TBD
Validation, Data Quality Checking
TBD
New Constructs Required
Case Review Document
TBD
Case Review Message
TBD
IS 06 Quality
Future Direction (continued)
Feedback mechanism to the provider to assure patients represented in the quality report are valid; review step
Quality check of the output for a quality reportDescribe how to derive information from existing data element, e.g., duration of medication from frequency and # dispensed.
Slide 35HITSP – enabling healthcare interoperability
Constructs(single purpose
or reusable)
Type 1: Base or Composite Standards
Re-Use
Applying an existing
construct to more than one IS
Re-Purpose
Updating a construct to
meet the needs of a
new Use Case
Can extend or constrain when reusing or re-purposing
— Specifications contain a common superset
— Superset can be extended as new requirements are encountered
— Superset can be constrained with use-specific constraints
Units of Information Exchange HITSP IS Constructs - Re-Use and Re-Purpose
Slide 36HITSP – enabling healthcare interoperability
Effective interoperability
— Quality Measurement is based on existing EHR available data
— Reporting is processed in a standard, machine readable format
— Current activities that increase data entry for quality measurement are reduced
— Implementation is flexible for local architecture
— Data are secure and private
— Near real-time feedback is available for clinicians
— Information is available for consumers to make healthcare choices
IS 06 QualityStrengths
Slide 37HITSP – enabling healthcare interoperability
Steve’s story . . . the future
Patients can make informed decisions about the ongoing care
of themselves and their family members
— consumers have access to quality and safety reports
about individual providers and care facilities
Data is collected automatically during routine care and reused
for performance measurement
Outcome data is available for determining best care protocols,
enables standards-based and evidence-based care
Reports are standard and comparable enabling true
benchmarking and continuous improvement
— Transparency is the rule
Decision support is part of the workflow, with useful safety alerts
Slide 38HITSP – enabling healthcare interoperability
Healthcare in an interoperable world . . .
The Future is Now HIT data exchange is becoming transparent so that the quality of
care delivered by providers and hospitals can be known no
matter where the patient is located
Consumers are empowered to
— get the right information at the right time
— find appropriate, quality and safe care for themselves and
their families
— assume that repeatable information will be safe and secure
while also being accessible by those who need it – before,
during and after a visit to a care provider
Care providers are empowered to
— provide safe, effective and evidence-based care with
information integrated within a clinical care workflow
Slide 39HITSP – enabling healthcare interoperability
Use or specify HITSP Interoperability Specifications in your HIT efforts
and in your Requests for Proposals (RFPs)
Ask for CCHIT certification
Leverage Health Information Exchanges to promote HITSP specifications
to make connections easier in the future
Ask . . . Is there a HITSP standard we could be using?
Get involved in HITSP . . . Help shape the standards
How YOU can become involved
Slide 40HITSP – enabling healthcare interoperability
Webinar 1 Standardizing How We Share Information in Healthcare: An Introduction to HITSP
Thursday, June 5, 2008 — 2:00-3:30 pm EDT
Webinar 6 Quality
Thursday, August 7, 2008 — 2:00-3:30 pm EDT
Webinar 2 HITSP Foundational Components
Thursday, June 19, 2008 — 2:00-3:30 pm EDT
Webinar 7 Security, Privacy and Infrastructure
Thursday, August 21, 2008 — 2:00-3:30 pm EDT
Webinar 3 Consumer Access to Clinical Information
Thursday, June 26, 2008 — 2:00-3:30 pm EDT
Webinar 8 EHR and Emergency Response
Thursday, September 4, 2008 — 2:00-3:30 pm EDT
Webinar 4 Biosurveillance
Thursday, July 10, 2008 — 2:00-3:30 pm EDT
Webinar 9 Medication Management
Thursday, September 18, 2008 — 2:00-3:30 pm EDT
Webinar 5 Electronic Health Record (EHR) and Lab Reporting
Thursday, July 24, 2008 — 2:00-3:30 pm EDTReplays available for all Webinars
www.HITSP.org/webinars
How YOU can become involved
Learn more about specific HITSP activities in these webinars available for replay:
Slide 41HITSP – enabling healthcare interoperability
Webinar Series IIComing soon
Stay Tuned – same timeThursdays — 2:00-3:30 pm EDT
Send your Webinar ideas to [email protected]
Slide 42HITSP – enabling healthcare interoperability
Jessica Kant, HIMSS Theresa Wisdom, [email protected] [email protected]
Re: HITSP Technical Committees
Michelle Deane, ANSI [email protected]
Re: HITSP, its Board and Coordinating Committees
Join HITSP in developing a safe and
secure health information network for
the United States.
Visit www.hitsp.org or contact . . .
Slide 43HITSP – enabling healthcare interoperability
A Successful Collaboration
Interweaving many different standards to address business needs
A successful collaboration between HITSP and several HITSP
member organizations developing base standards and
implementation guides/profiles
Slide 44HITSP – enabling healthcare interoperability
Sponsor Strategic Partners
www.HITSP.org
45enabling healthcare interoperability
Webinar Series
Sponsored by the HITSP Education, Communications and Outreach Committee
Quality
Questions and Answers