Health eDecisions RI/ Pilots Sub-Workgroup April 22nd, /11/20111

Agenda Announcements Review and Revisit of Goals Review of RI/Pilot Sub-WG Timeline Pilot Presentation CDC New Pilot site: VA Vendor Engagement Review Updates Active Pilots CDC NewMentor- AllScripts Zynx – DesignedClinicals Wolters Kluwer - VA Review Action Items, Next Steps

Announcements We will be continuing our work … Next meeting April 29th, 2013 (plan for a 90 minute meeting) Continue to work on pilot activities –Pilot updates –Working Sessions 10/11/20113

Pilots 10/11/20114 OrganizationPilot Lead Organization’s Role Wolters Kluwer HealthSue Johnson/Steve Claypool/Howard Strasberg/Christy May Service Supplier/Artifact Supplier OpenCDSDavid Supplier Zynx Health Claude Nanjo (primary) Bernadette Minton Victor Lee (primary) Service Supplier/Artifact Supplier Medexter Healthcare Klaus-Peter Adlassnig Karsten Fehre Service Supplier newMentor Julie Scherer Matt Pfeffer Service Supplier/Artifact Supplier CDC Shu McGarvey Laura Conn /Service Supplier/Artifact Supplier NextGen Dr. Sarah Corley Dr. Jeff Friedlin Gary Wietecha EHR Vendor Practice Fusion Lauren Fifield Michael Poremba EHR Vendor AllScripts Douglas Gentile Robin Williams (primary) (primary)EHR Vendor Design ClinicalsDewy Vendor SuccessEHSClaude Ouimet EHR Vendor Applied PathwaysPaul Supplier

Support Team Support Team: Pilots Lead: Jamie Parker: Pilot Support: Christina Arenas: Subject Matter Expert: Aziz Boxwala: Subject Matter Expert: Bryn Rhodes: Use Case 1: Dave Shevlin: Implementation Guide: Lynette Elliot: SDO Support: Anna Langhans: 10/11/20115

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 Sets 3.Documentation Templates Pilot Scope 1.Health eDecisions will apply defined aspects of the Implementation Guide in a real-world setting. 2.Modify the Implementation Guide to ensure it is usable Provide explicit feedback to other sub-working groups (i.e. the vMR and the Terminology and Value Sets SWGs) to identify and close gaps. 3.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. 4.Demonstrate intent of artifact (specifically structures and semantics) are communicated either by direct execution or by translation to native format 5.Ensure Completeness and consumability of artifact

Timeline 10/11/20117 Goal & Activities EST. Time DatesDeliverables 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 – 5/6 -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 2wks5/6 -5/20-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.5/20 – 6/3-Documented ONC Feedback - Next Steps Action Plan We are Here

Pilot Updates New Pilot Site: Veterans Administration (VA) Ken will be leading this effort from the VA side Matched with Wolter’s Kluwer Want to do a documentation template Still working with NextGen and Practice Fusion Have not heard back from Medexter 10/11/20118

CDC Pilot Presentation 10/11/20119

Vendor Engagement Discussion 10/11/ EHRArea of InterestPotential Match Design ClinicalsOrder SetsZynx AllScriptsECA Rules –NQMF Rule (for Ambulatory Setting) NewMentor (have catalog for rules in ambulatory setting) Practice FusionAnything MU centered CDC Success EHS?? Next GenECA Rule (potential)? VADocumentation Template Wolters Kluwer

Pilot Update: CDC – Practice Fusion (ECA Rule) TEAM: Shu McGarvey - CDC Aziz Boxwala – Internal Support Jamie Parker– Standing in for Practice Fusion Notes on the IG Notes on the Vocab Work 10/11/201111

Pilot Updates: NewMentor – AllScripts (ECA Rule –NQF 68) Team: Julie Scherer - NewMentor Bryn Rhodes – Internal Support Robin Williams – AllScripts Notes on the IG Notes on the Vocab Work 10/11/201112

Pilot Updates: Zynx – DesignClinicals (Order Set) Team: Claude Nanjo and Bernadette Minton Zynx ???? – Internal Support Dewy Howell – DesignClinicals Notes on the IG Notes on the Vocab and Terminology Work 10/11/201113

Pilot Updates: Wolters Kluwer – VA (Documentation Template) Team: Christy May -Wolters Kluwer ???? – Internal Ken Kawamoto - VA Notes on the IG Notes on the Vocab and Terminology Work 10/11/201114

Action Items & Next Steps Continue to monitor timeline Continue pilot work Going forward each pilot group will be giving a report out at each meeting 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

Meeting Reminder Pilots Work stream meets (next meeting: April 29th, 2013) Every Monday 1-2:30 pm EDT See Wiki homepage for meeting details: /11/201116

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 group 10/11/201117

Appendix B In Scope/Out of Scope 10/11/201118

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) 10/11/201119

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 10/11/201120

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) 10/11/201121

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 10/11/ 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