“ Jericho / UT Austin Pilot” Privacy with Dynamic Patient Review September 17, 2013 Presented by: David Staggs and Michael Dufel Jericho Systems Corporation

209/17/2013 Agenda Administrative issues Pilot scope Pilot data flow Test scenarios Transaction and Document tests Discussion Pilot Timeline Plan of Action

309/17/2013 Pilot Administrivia This pilot is a community led pilot –Limited support provided by the ONC Johnathan Coleman (Security Risk Solutions) Zachary May (ESAC) Penelope Hughes (ONC) Libbie Buchele (ONC Sponsor) In conjunction with DS4P bi-weekly return of an All Hands meeting Access to DS4P Wiki, teleconference, and calendar Meeting times: Tuesdays 11AM (ET) –Dial In: Access code: URL: d= d=

409/17/2013 Scope of the Pilot 1.Define the exchange of HL7 CDA-compliant PCD between a data custodian and a PCD repository that includes a report on the outcome of the request to the healthcare consumer (subject). 2.Additional goal: use identifiers to identify the subject/ PCD repository for use in reporting the outcome of the “secondary user” request use case to subject by subsequent EHR custodians. 3.Stretch goal: mask and/or redact the clinical document based on data segmentation and PCD choices retrieved from the PCD repository.

509/17/2013 Pilot Data Flow Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor   B ,  = Clinical data A,B = PCD data = audit record And Subsequent Custodian of Data being Provided at 

Test Approach Sections included in each test scenario in the DS4P Pilot Execution Script: 1.Scenario 2.Actors 3.Preconditions 4.Test steps 5.Test results 6.Log Capture 7.Data Set Verification 09/17/20136

Test Cases 09/17/20137 DS4P Pilot Execution Script: 1.Consent To Patient Discovery : No Consent 2.Consent To Patient Discovery : 1 st Requestor (1 st ) 3.Consent To Patient Discovery : 2 nd Requestor (2 nd ) 4.Consent To Document Query : No Consent 5.Consent To Document Query : 1 st To PC - Allow 6.Consent To Document Query : 2 nd To PC - Deny 7.Consent To Document Query : 2 nd to SC - Deny 8.Consent To Document Retrieve : No Consent 9.Consent To Document Retrieve : 1 st to PC - Allow 10.Consent To Document Retrieve : 2 nd To PC - Deny 11.Consent To Document Retrieve : 2 nd to SC - Deny 12.Consent To Document Retrieve : With Segmentation

Test Cases (Visual Representation) 09/17/20138 ScenarioPCDITI-55ITI-38ITI-39 1 st Requestor → PCY259 2 nd Requestor → PCY nd Requestor → SCY711 1 st Requestor → PCN148 Clinical Data SegmentationY12 PC = Primary Custodian SC = Secondary Custodian

Original Query & Response 909/17/2013 Complete solution must retrieve PCD during ITI 55, ITI 38, ITI 39

J-UT Pilot Sequence Detail (A) 09/17/ Retrieving & applying PCD, reporting during patient discovery

J-UT Pilot Sequence Detail (B) 09/17/ Retrieving & applying PCD, reporting when returning document list

J-UT Pilot Sequence Diagram (C) 09/17/ Retrieving & applying PCD, reporting when returning a clinical document

1309/17/2013 Transaction Tests (Last Meeting) NwHIN messages o Test messages must comply with NwHIN specification Request for PCD from Document Custodian o ITI 55: Data Set A o ITI 38: Data Set B o ITI 39: Data Set C ATNA audit record from Document Custodian o ITI 55: Audit data Set A o ITI 38: Audit data Set B o ITI 39: Audit data Set C

1409/17/2013 Document Tests HL7 Documents o HL7 Documents must comply with HL7 specification Clinical document from Document Custodian o Must include a reference to the patient consent repository PCD document from PCD Repository o Must follow HL7 Privacy Consent Directive o Must include specific elements

1509/17/2013 Discussion Review of J-UT DS4P Test Document Draft o Overview o Scenario Tests o Transaction Tests o Document Tests o Appendixes: Test Results

1609/17/2013 Pilot Timeline General Timeline, conditioned on agreement of stakeholders

17 Plan of Action Upon agreement of the participants the POA is: Identify the elements available from previous DS4P pilots Scope level of effort, decide on extended scenario Determine first draft of functional requirements Review standards available for returning information on requests Determine any gaps or extensions required in standards Stand up information holders and requestors Create XDS.b repository holding PCD Identify remaining pieces, create test procedures Document and update IG with results of our experience 09/17/2013

1809/17/2013 Backup Slides

DS4P Standards Material Location of DS4P Standards Inventory: Location of DS4P Standards Mapping Issues: xlsx/ /Copy%20of%20DataMappingsIssues% xlsx General Standards Source List: %20Analysis.xlsx/ /General%20SI%20Framework%20Standards%20A nalysis.xlsx Standards Crosswalk Analysis monizationhttp://wiki.siframework.org/Data+Segmentation+for+Privacy+Standards+and+Har monization (at bottom of page, exportable) Implementation Guidance 20Guidance_consensus_v1_0_4.pdf/ /Data%20Segmentation%20Impl ementation%20Guidance_consensus_v1_0_4.pdf 09/17/201319

2009/17/2013 DS4P References Use Case: ases ases Implementation Guide: nsensus nsensus Pilots Wiki Page: +Pilots+Sub-Workgroup +Pilots+Sub-Workgroup

2109/17/2013 Pilot Data Flow Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor   B ,  = Clinical data A,B = PCD data = audit record And Subsequent Custodian of Data being Provided at 

2209/17/2013 Pilot Data Flow Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor Clinical exchange #  Clinical exchange #  B ,  = Clinical data A,B = PCD data = audit record And Subsequent Custodian of Data being Provided at  Fetch PCD Send audit

2309/17/2013 Pilot Data Flow (1) Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor  ,  = Clinical data A,B = PCD data = audit record

2409/17/2013 Pilot Data Flow (2) Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor  ,  = Clinical data A,B = PCD data = audit record

2509/17/2013 Pilot Data Flow (3) Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor  B ,  = Clinical data A,B = PCD data = audit record And Subsequent Custodian of Data being Provided at 

2609/17/2013 Pilot Data Flow (4) Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor  ,  = Clinical data A,B = PCD data = audit record And Subsequent Custodian of Data being Provided at 

2709/17/2013 Pilot Data Flow (5) Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor ,  = Clinical data A,B = PCD data = audit record And Subsequent Custodian of Data being Provided at 

2809/17/2013 Pilot Data Flow (updated) Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor   B ,  = Clinical data A,B = PCD data = audit record And Subsequent Custodian of Data being Provided at 