Existing Service Specifications VA118-11-D-1005 VA118-1005-0055 1002AB

Agenda Option Task 2: Identify and document requirements to expand, extend, and complete three existing service specifications Services Overview Reviews Ordering Service Unified Communication Event Publication and Subscription Summary and Next Steps

Services Overview

Ordering Service Overview Ordering Service (ORD) Service Functional Model (SFM) for ordering pharmacy, laboratory, radiology, consult, and nutritional services Identifying orderable items Create/modify orders Role-based and appropriate access control Common governance and orchestration Extends ordering to Clinical Decision Support (CDS), workflow Enables exchange of order sets and plans

Unified Communications Overview Unified Communications Service (UCS) SFM for delivering alerts, recommendations, and other notifications including email, Short Message Service (SMS), and Voice Over Internet Protocol (VOIP) Focus is on communications consumed by human actors Key concepts Dynamic routing—redirect messages via alternate delivery channels Escalation—identifying alternate Conversations—common topic or subject for messages that may span communication channels Unmonitored—metadata (addresses, time) are archived, not content Monitored—metadata and content are archived

Event Publication and Subscription Overview Event Publication and Subscription (EPS) SFM for services, components, and systems to subscribe to clinical events of interest and receive notice when new data are available Defines concepts of topics, publication, and subscription Additional capabilities Content intervention—active intervention during Publication of event data Delivery to a specific subscriber Content brokering—acting as intermediary Managing content requests where original material is not made public Negotiation of preferred format

Health IT Services Reference Architecture These specifications are part of the Health IT Services Reference Architecture, a landscape of services supporting a health environment.

Health IT Services Reference Architecture The Healthcare Services Specification Program (HSSP) is a virtual organization that joins Health Level 7 International (HL7) and the Object Management Group (OMG) .

Current State Policy, Business Drivers Requirements Information Models (HL7)  SFM (HL7) Standard for Trial Use (STU)  ORD, UCS, EPS OMG  ORD Request for Proposals (RFP) (OMG)  Technical Specifications (OMG, Submitters)  Profiles 

Review Process

DSTU Review Process Assembled a cross-disciplinary team Clinical Software architecture Software development Reviewed each Draft Standard for Trial Use (DSTU) specification Group discussion of interfaces Identification of issues Collection of written feedback Feedback collated and prioritized Detailed feedback and recommendations in white paper Sample presented today We assembled a cross-disciplinary team including representatives from the clinical, software architecture, and software development domains. This team reviewed each DSTU specification, including group discussions, identification of issues, and collection of feedback, which was then collated and prioritized. This feedback appears in the Existing Services Specification Review whitepaper we delivered last week. For this presentation, I will summarize the feedback by pulling a few examples for each service.

ORDERING SERVICE

Recommendations (ORD) Order Service Catalog Interface Interface described is limited Recommend expansion of use cases Clarify substitution use case Terminology-driven lookups Other Recommendations (30) Clarify UCS and EPS interactions and relationships Expand and clarify interactions with Computerized Physician Order Entry (CPOE) Expand discussion on reproducible workflow in the Executive Summary Implement editorial corrections

Unified Communications

Recommendations (UCS) Business Storyboards Expand discussion of priority and delivery order; and expand storyboards (currently only two storyboards mention priority) Client Interface Blind carbon copy not addressed in client interfaces; develop additional use cases to clarify this functionality Common Message Concepts Expand priority field discussion; and add distinction between priority, delivery order, and effort Other Recommendations (16) Implement editorial corrections

Event Publication and Subscription

Event Publication and Subscription (EPS) Overall Review use of terms “event,” “message,” “topic,” and “channel”— recommend providing definitions that consider well-established semantics of these terms from other systems Service Description and Purpose Mentions parallel processing to enhance performance, many bus architectures and systems solve this issue—consider revising with unique benefit feature for healthcare Other Recommendations (91) Define standardized data packages Reconsider service name due to overlap with other OMG areas Implement editorial corrections

Summary and Next Steps

Summary Conducted a detailed review of the three specifications ORD UCS EPS Results Primarily minor improvement recommendations Clarify or expand use cases Add more use cases Implement editorial corrections throughout text and figures Recommend cross-cutting services (e.g., workflow) not be defined in each service

Next Steps Implement editorial recommendations Workgroup to consider and possibly implement other recommendations Continue standardization process for all three services Extend STU period for ORD, UCS, EPS Initial submission to OMG for the ORD service in progress for December meeting Standard for Trial Use (formerly Draft Standard for Trial Use)

Questions Questions?

Technical Specification HL7 and OMG HL7 HL7 SOA SIG SFM OMG Requirements HL7 DSTU OMG HDTF OMG RFP ANSI Standard RFP Responders SOA—Service Oriented Architecture SIG—Special Interest Group SFM—Service Functional Model DSTU—Draft Standard for Trial Use (Note: This term is now called STU, Standard for Trial Use.) ANSI—American National Standards Institute OMG—Object Management Group HDTF—Healthcare Data Task Force RFP—Request for Proposal Technical Specification Lessons Learned