Slide 0 EHR SD RM - EHR Way Forward … Future State Reference Architecture The Practical Guide for SOA in Health Care Volume II: EHR Immunization and Adverse Event Reporting Case Study For presentation at HL7 Rio Workgroup Meeting, 18 May 2010 Five Weeks to Rio, 26 March 2010 Discussion Slides PHONE: Pass code # WEB: Details available at HL7 “EHR SD RM” Project Facilator GovProjects, EHR, PHER, HSSP co-sponsors

Slide 1 EHR SD RM - EHR Way Forward … Future State Reference Architecture EHR SD RM Milestones Healthcare SOA Reference Architecture (H-SOA-RA) EHR SD RM Immunization & Response Management (IRM) Prototype HSSP Practical Guide for SOA in Healthcare Volume II: IRM Case Study __________ EHR SD RM Informative DSTU DSTU is Draft Standard for Trial Use (ANSI standards development) 2011 EHR SD RM Normative Standard

Slide 2 EHR SD RM - EHR Way Forward … Future State Reference Architecture Healthcare SOA Framework Based on HL7 EHR System Functional Model & Thomas Erl’s SOA Layers HL7 System Functions  Direct CareSupportiveInformation Infrastructure Other Business Process Value Chains Composite Services Federated Composition (e.g., Choreograph or Orchestration) Within and Across Business Areas Core Business Services Functional Areas + Focal Classes Functional Areas + Focal Classes Functional Areas + Focal Classes Functional Areas + Focal Classes Entity Services Information Management Information Management Information Management Information Reporting and Management Agnostic Services C r o s s T e c h n I c a l “Common S e r v I c e s” (e.g., Security, Privacy, Auditing, Logging…) Application Services Ambulatory Care Systems, In Patient Care Systems Logistics Systems Financial Systems Decision Support Systems Data Marts Repositories Business Objects Implementation Profiles Integrated Healthcare Enterprise (IHE) Profiles Analysis ProfilesCommunications Profiles/Stacks Implementation Profiles 2

Slide 3 EHR SD RM - EHR Way Forward … Future State Reference Architecture SUPPLY CHAIN (ORDER/CHARGE) ANATOMY OF AN ANCILLARY SYSTEM AUTHORIZATION DOCUMENT RECORDS MANAGEMENT DECISION SUPPORT PERFORMANCE DATA MANAGEMENT SCHEDULING IDENTITY TERMINOLOGY LABORATORYRADIOLOGYPHARMACYCARDIOLOGYOT/PT/SPEECH s CORE BUSINESS SERVICES 3

Slide 4 EHR SD RM - EHR Way Forward … Future State Reference Architecture HL7 EHR_S-Based Functional Architecture/Services Analysis Security Unique ID, Registry, and Director Terminology Information and Records Management Interoperability ETC Support Knowledge Access Support Clinical Communication Clinical Workflow Tasking Clinical Decision Support Record Patient Specific Instructions Documentation of Care, Measurement, and Results Orders and Referral Management Care Plans, Treatment Plans, Guidelines, and Protocols Management of Assessment Summary Lists Preferences, Directives, Consents, and Authorizations Manage Patient History Record Management Manage Business Rules ETC Primary Care Critical/Emergency Care Dental Non-Surgical Specialty Care Laboratory Nursing Pharmacy Population Health Behavioral Health ETC. Cross-Cutting Direct Care/ Support Functions Infrastructure Functions Lines of Business Infrastructure Services Security Policy Records Management Audit Terminology Registry Workflow Business Rules etc Core Clinical Services Entity Identification Resource Location and Updating Services Decision Support Orders Management Scheduling Image Management Etc.

Slide 5 EHR SD RM - EHR Way Forward … Future State Reference Architecture IT PLATFORM SUPPORT ANALYTIC DATA MANAGEMENT PERFORMANCE DECISION SUPPORT RECORDS MANAGEMENT DOCUMENT SUPPLY CHAIN: (ORDERS/CHARGES) SCHEDULING AUTHORIZATION TERMINOLOGY IDENTITY RADIOLOGY LABORATORY PHARMACY CLINIC ASU TEST ONLY OUTPATIENT OTHER INPATIENT ER CARDIOLOGY PT/OT/SPEECH DIETARY SPECIALTY CARE Ancillary Systems Core Business Services INTEGRATED REQUIREMENTS DESIGNS: Putting the H-SOA-RA Pieces Together RESPIRATORY Federated Business Services Agnostic Services Federated Services, may be categorized by: -- Encounter Types -- CMS billing category -- Record type -- Care setting type -- etc. Data sets are defined for each system functional- capability-service module 5 Inter-Agency Inter-Service Across Providers

Slide 6 EHR SD RM - EHR Way Forward … Future State Reference Architecture EHR SD RM Agenda HSSP Practitioners Guide Volume II Immunization and Adverse Event Reporting Prototype From HL7 and HITSP Artifacts ItemMax Time  Roll Call and Introductions 3 min  Overview Agenda 2 min  Requirements/ Architecture Development Cycle 7 min  Candidate Core Clinical Services15 min  Candidate Cross Cutting Direct Care Support Functions/ Services15 min  Candidate Infrastructure Services15 min  Wrap Up 2 min

Slide 7 EHR SD RM - EHR Way Forward … Future State Reference Architecture EHR SD RM Supporting Requirements/ Architecture Development Cycle EHR SD RM Requirements Analysis Requirements Analysis Architecture Design Architecture Design Stakeholder Requirements Definition Stakeholder Requirements Definition Requirements Loop Verification & Validation Loop Design Loop PROCESS INPUTS -Required Capabilities -Environments -Constraints PROCESS OUTPUTS -System Architecture, -System & Test Specifications -Configuration Management Baselines Test Specifications Test Specifications Conformance Criteria Capabilities - Functions, Information Model Information Exchanges Functions – Dependencies Function or Service Interface Design Specifications Compliance means a system provides support for a given standard. Conformance is a recognition of formal testing, that prove that a system provides 100% support for a given standard.

Slide 8 EHR SD RM - EHR Way Forward … Future State Reference Architecture EHR SD RM Supporting Requirements/ Architecture Development Cycle Stakeholder Requirements – What is the system supposed to do? – Where will the products of the system be used? –Under what conditions will the products be used? – How often? How long? – Who will use the products of the system? Requirements Analysis (“HOW?” using “Action Verbs”) –Analyze functions and Services Decompose higher level functions to lower level functions Allocate performance requirements to the functions Architecture Design ( Which hardware/ software elements) –Define the physical architecture Each part must perform at least one function Some parts may perform more than one function Requirements Loop  Ensure all requirements are covered by at least one function  Ensure all functions are justified by a valid requirement (no unnecessary duplication) Design Loop  Ensure all functions are covered by at least one hardware or software element  Ensure all elements of physical architecture are justified by a valid functional requirement (no unnecessary duplication) Verification & Validation (V&V) Loop  Each requirement must be verifiable that the solution meets requirements and validated that it meets the user’s needs and expectations.  V&V can be accomplished by: Inspection, Analysis, Demonstration, Test

Slide 9 EHR SD RM - EHR Way Forward … Future State Reference Architecture EHR SD RM Supporting Requirements & Architectural Processes 2010 slide

Slide 10 EHR SD RM - EHR Way Forward … Future State Reference Architecture The HL7 Services-Aware Interoperability Framework (SAIF) SAIF Contains:  Enterprise Conformance and Compliance Framework (ECCF) is based on RM-ODP  Behavioral Framework (BF) –Interoperability Scenarios supporting the RM-ODP Computational Viewpoint  Governance Framework (GF) –Governance is the overarching policy structure and set of related processes by which a group exercises its authority and demonstrates accountability for accepted responsibilities within a particular jurisdiction. SAIF Principles:  Applicable within each of HL7’s three Interoperability Paradigms (IPs), –(i.e., messages, documents, and services).  Provide support for measurable conformance and compliance.  Define appropriate governance structures and processes.  Provide support for directly implementable solutions.  Address the growing disparity between the various solution sets emerging from HL7.  Utilize existing V3/RIM artifacts and expertise to the maximum degree possible.

Slide 11 EHR SD RM - EHR Way Forward … Future State Reference Architecture HL7 SAIF Responsibilities Conformance and Compliance Framework (ECCF) Consistency Traceable Implementation “ Where ” Behavior “ How ” Content “ What ” Policy “ Why ”

Slide 12 EHR SD RM - EHR Way Forward … Future State Reference Architecture

Slide 13 EHR SD RM - EHR Way Forward … Future State Reference Architecture HL7 SAIF Specification Stack Views Conformance and Compliance Framework (ECCF) Consistency Traceable ImplementationBehaviorContentPolicy Topic Specification Enterprise / Business View “WHY” Information View “WHAT” Computational View “HOW” Engineering View “WHERE” Conceptual Business Context, Reference Context Domain Analysis (Information) Model Collaboration Analysis, Functional Profile(s), Service Roles and Relationships Existing Platform capabilities Platform- Independent Business GovernanceProject-oriented Domain Information Model, Constrained Information Model, Localized Information Model, Hierarchical Message Definition Collaboration Types, Interface Specification and Functional Groups, Interaction Types and Collaboration Participations, Contracts Parts Existing Platform models, libraries, etc. Platform- Specific Rules, ProceduresLocalized Information Model, Transforms, Schema Collaboration scripts, Orchestrations, Realized Interfaces Execution Context, Platform Bindings, Deployment Model

Slide 14 EHR SD RM - EHR Way Forward … Future State Reference Architecture HITSP Within HL7 SAIF ECCF Specification Stack Topic Specification Enterprise / Business View “WHY” Information View “WHAT” Computational View “HOW” Engineering View “WHERE” Conceptual Business Context, Reference Context Domain Analysis (Information) Model Collaboration Analysis, Functional Profile(s), Service Roles and Relationships Existing Platform capabilities Platform- Independent Business GovernanceProject-oriented Domain Information Model, Constrained Information Model, Localized Information Model, Hierarchical Message Definition Collaboration Types, Interface Specification and Functional Groups, Interaction Types and Collaboration Participations, Contracts Parts Existing Platform models, libraries, etc. Platform- Specific Rules, ProceduresLocalized Information Model, Transforms, Schema Collaboration scripts, Orchestrations, Realized Interfaces Execution Context, Platform Bindings, Deployment Model Consistency Traceable HITSP DA HITSP CAP Harmonization Requests/ Use Case HITSP CAP HITSP Transaction, Transaction Package and Service Collaboration HITSP Component HITSP IS ImplementationBehavior HITSP Security EHR-S FM is EHR System Functional Model EHR SD RM is EHR System Design Reference Model RIM is Reference Information Model FHIMS is Federal Health Information Model & Standards DA is Data Architecture ContentPolicy

Slide 15 EHR SD RM - EHR Way Forward … Future State Reference Architecture HL7, HITSP, HSSP, FHIMS, NIEM and NHIN Within HL7 SAIF ECCF Specification Stack Topic Specification Enterprise / Business View “WHY” Information View “WHAT” Computational View “HOW” Engineering View “WHERE” Conceptual Business Context, Reference Context Domain Analysis (Information) Model Collaboration Analysis, Functional Profile(s), Service Roles and Relationships Existing Platform capabilities Platform- Independent Business GovernanceProject-oriented Domain Information Model, Constrained Information Model, Localized Information Model, Hierarchical Message Definition Collaboration Types, Interface Specification and Functional Groups, Interaction Types and Collaboration Participations, Contracts Parts Existing Platform models, libraries, etc. Platform- Specific Rules, ProceduresLocalized Information Model, Transforms, Schema Collaboration scripts, Orchestrations, Realized Interfaces Execution Context, Platform Bindings, Deployment Model Consistency Traceable HL7 RIM FHA FHIMS HITSP DA HITSP Capability HL7 EHR-S FM Harmonization Requests/ Use Case HITSP Capability NIEM IEPs, HITSP Transaction, Transaction Package and Service Collaboration HITSP Component NIEM Information Exchange Package HL7 EHR-S FM HITSP Security Framework HITEC MU HITSP IS EHR-S FM is EHR System Functional Model EHR SD RM is EHR System Design Reference Model HITEC MU is HITEC Meaningful Use Objectives/ Criteria NIEM IEPs is National Information Exchange Model Information Exchange Packages RIM is Reference Information Model FHIMS is Federal Health Information Model & Standards DA is Data Architecture HSSP & NHIN Connect Services Tomcat, JBoss, J2SE, Eclipse, GlassFish ESB, OpenSSO ImplementationBehaviorContentPolicy

Slide 16 EHR SD RM - EHR Way Forward … Future State Reference Architecture IS10 IRM HITSP Constructs Mapped to Standards

Slide 17 EHR SD RM - EHR Way Forward … Future State Reference Architecture EHR SD RM Agenda HSSP Practitioners Guide Volume II Immunization and Adverse Event Reporting Prototype From HL7 and HITSP Artifacts ItemMax Time  Roll Call and Introductions 3 min  Overview Agenda 2 min  Requirements/ Architecture Development Cycle 7 min  Candidate Core Clinical Services15 min  Candidate Cross Cutting Direct Care Support Functions/ Services15 min  Candidate Infrastructure Services15 min  Wrap Up 2 min Walk through EHR-S FM

Slide 18 EHR SD RM - EHR Way Forward … Future State Reference Architecture DRAFT Table of Contents for HSSP Practitioners Guide Volume II  See “HSSP Practitioners Guide Volume II May 2010 – DRAFT-A.Docx” –Note that the version will change each week … A, B, C D, … till HL7 Rio  Versions available at –Weekly Agenda/Minutes –Weekly Read Ahead Slides –Weekly updated “ HSSP Practitioners Guide Volume II May 2010 DRAFT-A.Docx”

Slide 19 EHR SD RM - EHR Way Forward … Future State Reference Architecture We are inviting all interested to participate in the 11th International HL7 Interoperability Conference (IHIC-2010), to be held in Rio de Janeiro, Brazil on May This time will be the first for IHIC in South America. Following the success of previous IHIC venues in Kyoto(2009), Crete (2008), New Zealand (2007), Germany (2006), Taiwan (2005), Mexico (2004), IHIC2010 aims to serve as a meeting place for more than 30 HL7 affiliates around the world as well as individuals interested in interoperability and standards, to share their HL7 implementation experience and strengthen their shared vision. The paper submissions are invited to show to the international community successful experiences using HL7 V3 and CDA R2 interoperability between informatics applications using standards. Also, results and experiences from the collaborative use of standards are most welcome, especially if they are related to HL7 standards. Topics of interest include but are not limited to the following: HL7 implementation experience from regional, trans-regional, or national implementation: HL7 v2.x and 3.0 messages Clinical Document Architecture (CDA) Imaging Diagnostics and DICOM Standard Use of HL7 in IHE profiles Terminologies, Ontologies and Coding Systems: use of local and international standards Use of other standards in combination with HL7 standards: ASTM, ISO, CEN, etc. Business Models, regional & large scale deployment: Electronic Healthcare Record: from strategy to implementation Legal and regulatory issues. Epidemiology, disease surveillance and control Geographical information systems for population health Disaster medicine, emergency management and public health This year, along with the successful “Show me your CDA!” track, IHIC will also incorporate the "Send me your CDA!" HL7 CDA Interoperability Showcase to display basic interoperability of applications using a HL7 V3 and HL7 CDA R2 standards. All submitted papers will be reviewed based on their technical quality and merit by the technical committee and reviewers. Papers that describe research and experimentation are encouraged. All paper submissions will be handled electronically using IEEE format, and detailed instructions on submission procedure will be available on IHIC2010 web pages ( Accepted papers will be published online. For other information, please contact IHIC2010, Important Dates: Call For papers : November 2, 2009 Deadline for submissions extended to February 15, 2010 Evaluation and notification, March 15, 2010 Camera-papers ready due : April 15, 2010 Call for Participation – HL7 in Rio

Slide 20 EHR SD RM - EHR Way Forward … Future State Reference Architecture Agenda  Roll Call and Introductions 3 min  Overview Agenda 2 min  Overview of HSSP Practitioners Guide Volume I 10 min  Overview of Services Aware Interoperability Framework (SAIF) 10 min  Overview of EHR System Design Reference Model (EHR SD RM) 10 min  Overview of candidate HSSP Services for use in HSSP Practitioners Guide Volume II 10 min  Overview of DRAFT Table of Contents for HSSP Practitioners Guide Volume II 13 min  Wrap Up 2 min

Slide 21 EHR SD RM - EHR Way Forward … Future State Reference Architecture Wrap Up  Any new attendees?  Agenda Time Metrics  Volunteers to help prepare for next week’s meeting? –Do we need one-on-one working meetings?  Suggestions for Improvement  Next Meeting April 2, 2010 at 12:30 Eastern Time –PHONE: Pass code # –WEB: