Ongoing/Planned Activities for Week of 4/29

Ongoing/Planned Activities for Week of 4/29

• Final UCR Crosswalk due COB 4/30 • Hold two working sessions to complete UCR Crosswalk on 4/30• Hold working session at the Standards SWG on 5/1 to discuss results of the UCR

Crosswalk using summary slides, and choose Standards to move forward with• Present Results of UCR Crosswalk All Hands meeting on 5/2• Our concentration is the Service/Payloads Standards; transport/security and

vocab and code set are secondary discussions

• Discuss selection of standards on 5/1 SWG call and continue conversation/selection during 5/2 WG

• Gap Mitigation Plan will be developed out of the UCR Crosswalk and initial draft will be due COB 5/7

• Solution Diagram has been updated with suggested changes. Will review with the community at the All Hands Call on 5/2, and will update with the Selected Standards

• Populating Data Requirements Table Internally.

Use Case 2 – CDS Guidance Service Transactions

CDS Guidance Requestor

2. CDS Response(Clinical Data, Supporting Evidence, Supporting

Reference, Actions, Attribute-Value List, Response Metadata & Exceptions)

CDS Guidance Supplier

1. CDS Request (Clinical Data & Context)

INSERT SELECTED STANDARDS HERE

INSERT SELECTED STANDARDS HERE

Transport and Security

Transactional Layers

3

Transport and SecurityResponse Service: e.g., DSS Response ElementResponse Items Organizer/Container: e.g., HeD Action Groups Element

Response Item Payload: e.g., VMR Proposal

Request Service: e.g., DSS Request ElementRequest Items Organizer/Container: e.g: VMR or CCDA

Request Item Payload: e.g., VMR Clinical Statement

Use Case 2: CDS Guidance Service Transactions - Standards per Transaction

# Transaction Service Organizer/Container Item PayloadsReference

Information Model

1CDS Request (patient data

and potentially context)

• Decision Support Service (DSS)

• Context Aware Retrieval Application (Infobutton)

• CDS Knowledge Artifact Implementation Guide (HeD UC1 IG)

• Consolidated CDA• Virtual Medical Record

(vMR)


• Virtual Medical Record (vMR)• Consolidated CDA (hL7 Clinical

Statements)• HL7 Version 3 Standard: Order Set

Publication, Release 1

• Federal Health Information Model (FHIM)

• HL7 v2.x• HL7 v3

2 CDS Response (guidance

and/or other response elements)

• Decision Support Service (DSS)


• CDS Knowledge Artifact Implementation Guide (HeD UC1 IG)

• HL7 Version 3 Standard: Order Set Publication, Release 1

• Consolidated CDA• Virtual Medical Record

(vMR)


• Virtual Medical Record (vMR)• Consolidated CDA (HL7 Clinical

Statements)• HL7 Version 3 Standard: Order Set

Publication, Release 1

• Federal Health Information Model (FHIM)

• HL7 v2.x • HL7 v3

Use Case 2: CDS Guidance Service Transactions - Standards per Transaction

# Transaction Transport Authentication/Authorization Encryption Vocab & Code Set

1CDS Request (patient data

and potentially context)

• SOAP• REST

• SAML • TLS • LOINC• SNOMED CT• CVX• Manufacturers of Vaccines (MVX)• OID• RxNorm• ICD-9-CM and ICD-10-CM• HCPCS• C80 - Clinical Document and

Message Terminology Component • NQF Value Sets

• ICD-10-PCS• UCUM• CPT• C154• NDC• FDA Route Administration• HL7 Vocabulary• Diagnostic and Statistical Manual

of Mental Disorders, Fourth Edition (DSM-IV)

2 CDS Response (guidance

and/or other response elements)

• SOAP • REST

• SAML • TLS • LOINC• SNOMED CT• CVX• Manufacturers of Vaccines (MVX)• OID• RxNorm• ICD-9-CM and ICD-10-CM• HCPCS• C80 - Clinical Document and

Message Terminology Component • NQF Value Sets

• ICD-10-PCS• UCUM• CPT• C154• NDC• FDA Route Administration• HL7 Vocabulary• Diagnostic and Statistical Manual

of Mental Disorders, Fourth Edition (DSM-IV)

CDS Guidance Request Transaction: Service Standards RationaleStandard

Summary of Findings from UCR

CrosswalkKeep? Rationale

Decision Support Service (DSS)HITSC Rating:*M: 78.69A: 88.6SI: 33.33T: 72.71

(Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions

(P) Partially Fits: Response Metadata;

(N) Does not Fit:

Yes • One significant gap is DSS will tie to SOAP. There is significant industry movement towards REST.

• DSS has 2 levels, one is model of the service which is implementation agnostic. Could support standard with implementation based on REST, but it would have to be developed.

• DSS is designed to be able to support patient data, unlike infobutton.

• Has broader scope than infobutton

* M: Maturity A: Adoptability SI: S&I Specific T: Total

Context Aware Retrieval Application (Infobutton)

HITSC Rating*M: 90.08A: 92.11SI: 47.62T: 82.07

(Y) Fits: Context; Supporting Evidence; Supporting Resource

(P) Partially Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response

(N) Does not Fit: Clinical; Actions; Attribute Value List; Response Meta Data

No

• Can send some patient data, but no designed to support rich patient data payload like DSS

CDS Guidance Response Transaction: Service Standards RationaleStandard



Decision Support Service (DSS)HITSC Rating:*M: 78.69A: 88.6SI: 33.33T: 72.71


(P) Partially Fits: Response Metadata;

(N) Does not Fit:

Yes • One significant gap is DSS will tie to SOAP. There is significant industry movement towards REST.

• DSS has 2 levels, one is model of the service which is implementation agnostic. Could support standard with implementation based on REST, but it would have to be developed.

• DSS is designed to be able to support patient data, unlike infobutton.

• Has broader scope than infobutton



HITSC Rating:*M: 90.08A: 92.11SI: 47.62T: 82.07




No

• Can send some patient data, but no designed to support rich patient data payload like DSS

CDS Guidance Request Transaction: Organizer/Container RationaleStandard



CDS Knowledge Artifact Implementation Guide (HeD UC1 IG)HITSC Rating:*M: 61.39A: 86.84SI: 35.71T: 64.62

(Y) Fits: (Sender) CDS Response; (Receiver) CDS Response; Clinical; Supporting Evidence; Supporting Resource; Actions; Attribute Value List;

(P) Partially Fits: Context; Response Metadata

(N) Does not Fit: Exceptions

No • UC1 is not designed to carry patient data

• If CCDA is chosen, would probably have to use related HL7 Clinical statements for the Item Payload bucket.

• If vMR is chosen, would probably have to use the vMR Clinical Statements for the Item Payload bucket

• External options may exist for transforming CCDA request into a vMR component


Consolidated CDAHITSC Rating:*M: 53.59A: 80.70SI: 33.33T: 58.48

(Y) Fits: Clinical;

(P) Partially Fits:

(N) Does not Fit: Context, Supporting Evidence; Supporting Resource; Actions; Attribute Value List; Response Metadata; Exceptions

Yes • Can transform CCDA request into a vMR component from the execution system

• Not everything from CCDA goes easily into vMR, but vMR is designed to easily accept CCDA components

CDS Guidance Request Transaction: Organizer/Container Rationale (continued…)Standard



Virtual Medical Record (vMR)HITSC Rating:*M: 78.06A: 81.58SI: 33.33T: 70.08

(Y) Fits: Clinical; Attribute Value List

(P) Partially Fits: CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Context; Supporting Evidence; Supporting Resource; Actions;

(N) Does not Fit: Response Metadata; Exceptions

Yes • Lighter weight than the other options• Developed specifically for clinical decision

support computability. • Intended to be used for this initiative, and

has been recently enhanced in this respect


CDS Guidance Response Transaction: Organizer/Container RationaleStandard



CDS Knowledge Artifact Implementation Guide (HeD UC1 IG)HITSC Rating:*M: 61.39A: 86.84SI: 35.71T: 64.62

(Y) Fits: (Sender) CDS Response; (Receiver) CDS Response; Clinical; Supporting Evidence; Supporting Resource; Actions; Attribute Value List;

(P) Partially Fits: Context; Response Metadata

(N) Does not Fit: Exceptions

Yes • Fits Clinical; Supporting Evidence; Supporting Resource; Actions data requirements

• Attribute value list is not supported in UC1 schema, however the schema does allow extensions using XSD

• Would use subset of HeD UC1 schema that may require further modifications



(Y) Fits: Clinical;

(P) Partially Fits:


No • There is a profile in IHE that uses DSS and returns IHE as an output. But hasn’t been finalized within IHE

• Lacks the ability to group and organize things that UC1 does

CDS Guidance Response Transaction: Organizer/Container Rationale (continued…)

StandardSummary of

Findings from UCR Crosswalk

Keep? Rationale





No • Does fit this situation, however CDS Knowledge artifact may be the better option

• UC1 action would need to be modified to represent payload for UC2 regarding vMR

• May need a model agnostic response


HL7 Version 3 Standard: Order Set Publication, Release 1HITSC Rating:*M: 46.20A: 75.44SI: 33.33T: 53.31

(Y) Fits: Supporting Evidence; Supporting Resource; Response Metadata

(P) Partially Fits: Clinical; Context; Actions

(N) Does not Fit: Attribute Value List; Exceptions

No • Some vendors may want to support this as an option, however CDS Knowledge Artifact is the better option

• Not many vendors utilize this standard for this initiative

CDS Guidance Request Transaction: Item Payloads Rationale Standard



Context Aware Retrieval Application (Infobutton)HITSC RatingM: 90.08A: 92.11SI: 47.62T: 82.07




No






Yes

CDS Guidance Request Transaction: Item Payloads Rationale (Continued…)Standard




(Y) Fits: Clinical;

(P) Partially Fits:


Yes






No

CDS Guidance Response Transaction: Item Payloads Rationale Standard








No






Yes

CDS Guidance Response Transaction: Item Payloads Rationale (Continued…)Standard



Consolidated CDA


(Y) Fits: Clinical;

(P) Partially Fits:


Yes






Yes

CDS Guidance Request Transaction: Transport RationaleStandard



SOAP



(P) Partially Fits:

(N) Does not Fit:


RESTHITSC Rating:*M: 100.00A: 100.00SI: 42.86T: 88.30


(P) Partially Fits:

(N) Does not Fit:

CDS Guidance Response Transaction: Transport RationaleStandard



SOAP



(P) Partially Fits:

(N) Does not Fit:


RESTHITSC Rating:M: 100.00A: 100.00SI: 42.86T: 88.30


(P) Partially Fits:

(N) Does not Fit:

CDS Guidance Request Transaction: Authentication/Authorization RationaleStandard



SAMLHITSC Rating:*M: 100.00A: 100.00SI: 100.00T: 100.00


(P) Partially Fits:

(N) Does not Fit:* M: Maturity A: Adoptability SI: S&I Specific T: Total

CDS Guidance Response Transaction: Authentication/Authorization RationaleStandard



SAMLHITSC Rating:*M: 100.00A: 100.00SI: 100.00T: 100.00


(P) Partially Fits:


CDS Guidance Request Transaction: Encryption

StandardSummary of


Keep? Rationale

TLSHITSC Rating:*M: 100.00A: 100.00SI: 42.86T: 88.30


(P) Partially Fits:


CDS Guidance Response Transaction: Encryption

StandardSummary of


Keep? Rationale

TLSHITSC Rating:*M: 100.00A: 100.00SI: 42.86T: 88.30


(P) Partially Fits:

(N) Does not Fit: * M: Maturity A: Adoptability SI: S&I Specific T: Total

Ongoing/Planned Activities for Week of 4/29

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