SDS & Harmonization HeD Leadership Agenda Solution Plan Discussion HeD Standards Selection Risks Timeline review Detailed Data Requirement Analysis Follow-up on discussion with Dave Shields IG Update –Conformance Verbs –Data Model Approach –Functional Interaction Types –Vocab & Codeset inclusion into HeD UC2 IG: update from HL7? 1

SDS & Harmonization HeD Leadership Agenda Solution Plan Discussion HeD Standards Selection Risks Timeline review Detailed Data Requirement Analysis Follow-up on discussion with Dave Shields IG Update –Conformance Verbs –Data Model Approach –Functional Interaction Types –Vocab & Codeset inclusion into HeD UC2 IG: update from HL7? 2

Discussion Points and Activities for Week of 5/20  Solution Plan Discussion o Presentations on vMR and CCDA held last week o Decisions on Standards must be made ASAP Specifically the selection of vMR vs CCDA/QRDA, SOAP vs. REST o Meetings with EPIC and Partners Healthcare being held to help facilitate discussion 3

CDS Request Options Request Service: DSS Request Element Request Items Organizer/Container: CDA Based Container (CCDA, QRDA) Request Item Payload: vMR Clinical Statement Request Service: DSS Request Element Request Items Organizer/Container: vMR/GELLO Request Item Payload: vMR Clinical Statement Request Service: e.g., DSS Request Element Request Items Organizer/Container: CDA Based Container (CCDA, QRDA) Request Item Payload: CCDA Option #3: CDA/CCDA Option #2: vMR/vMR Option #1: CDA/vMR

CDS Request Options Type of Impact vMRC-CDA/QRDA Implementation Guidance IG would need to clarify how vMR is used to support CDS request IG would need to clarify how C-CDA and/or QRDA is used to support CDS request. This includes which template(s) would be used to support which types of requests (e.g. based on type of clinical intervention needed). Standards Development vMR will potentially need to be extended to support additional context items, including Care Setting, Initiating and Receiving Organization and Person information, Request ID. Vocabulary binding harmonization with other standards (e.g. C-CDA/QRDA) New templates or changes to existing C-CDA/QRDA templates will most likely be required to support varying intervention types. EHR VendorsEHR vendors would need to extend capabilities to support export of data into vMR format. EHR vendors would need to extend capabilities to support export of data into new or updated template formats. They would also need logic to inform the template selection based on intervention type.

CDS Response Options Option #2: vMR/vMR Option #1: HeD Schema/vMR Response Service: DSS Response Element Response Items Organizer/Container: HeD Schema Response Item Payload: VMR Proposal Response Service: DSS Response Element Response Items Organizer/Container: vMR/GELLO Response Item Payload: VMR Proposal

CDS Response Options Type of Impact vMRHeD UC1 IG? Implementation Guidance Standards Development EHR Vendors

CDS Options Summary Implementation OptionTransactionServiceOrganizer/ContainerPayload 1II01 - RequestDSSCDA Based Container (CCDA, QRDA)vMR 2II01 - RequestDSSvMR/GELLOvMR 3II01 - RequestDSSCDA Based Container (CCDA, QRDA)CCDA 4II02 - ResponseDSSHeD SchemaVMR 5II02 - ResponseDSSvMR/GELLOVMR

SDS & Harmonization HeD Leadership Agenda Solution Plan Discussion HeD Standards Selection Risks Timeline review Detailed Data Requirement Analysis Follow-up on discussion with Dave Shields IG Update –Conformance Verbs –Data Model Approach –Functional Interaction Types –Vocab & Codeset inclusion into HeD UC2 IG: update from HL7? 9

Discussion Points and Activities for Week of 5/20  HeD Standards Selection Risks o vMR vs. CCDA o SOAP vs. REST Update from Pilots Call on SOAP/REST Information on use of SOAP today? 10

Health eDecisions (HeD) Standards Risk vMR vs. C-CDA vs. QRDA Background vMR, C-CDA and QRDA could support the payload of the request for CDS guidance C-CDA is in wide use today within EHRs and is cited in regulation, but there is currently no template specifically for CDS use, and existing templates may require population of data that is non-essential to a CDS guidance request QRDA is used for quality reporting; it leverages the C-CDA construct, but may not be as strictly templated vMR is used more heavily for clinical decision support and was the basis for the HeD UC1 solution, but there may be push back from EHR community if we require another format for export of data The community is torn and is unsure which solution would be better for sending a request for CDS guidance to a CDS service Risk The HeD community is currently exploring the option of writing Implementation Guidance for both vMR and C-CDA and using pilots to determine which solution would be better for HeD. Community time and support team resources would be spent developing implementation guidance that may never be used (depending on which standard is selected after pilots) Ongoing and Planned Mitigation Actions C-CDA and vMR overview presentations will be given to the community this week in order to give them a better idea of how it could be used to support a CDS Guidance Request HeD Leadership is considering developing vMR as its primary implementation guidance, and developing C-CDA guidance only as time and resources allow Another option that is being considered is the use of a C-CDA-to-vMR transform, which would allow EHRs to continue using C-CDA alone but still utilize vMR within the CDS Guidance Request 11 2 of 12

Health eDecisions (HeD) Standards Risk vMR vs. C-CDA (continued) IG Options IDDescriptionProsCons AvMR aloneG This solution would most likely support the full scope of HeD UC2 and would be consistent with HeD UC1 EHRs would have to build in new logic to support vMR, even if they already support C- CDA NOTE: EHRs will already have to be required to support import of data in vMR format due to response being in vMR format BC-CDA alone This solution would require no additional standards cited in regulation This would not be consistent with HeD UC1 It is unclear how well C-CDA can support HeD UC2 requirements as-is, and at minimum may require new C-CDA template(s) and EHRs will have to CQRDA alone This solution would require no additional standards cited in regulation This would not be consistent with HeD UC1 It is unclear how well QRDA can support HeD DvMR, C-CDA and/or QRDA guidance in HeD UC2 IG; selection made at a future point in time This solution would allow us to thoroughly investigate both standards before determining which to go with, therefore giving more weight to a decision either way This would require more work than a single- standard approach Time and resources would be spent developing implementation guidance that would never be used outside of pilots EvMR with C-CDA-to- vMR and/or QRDA-to- vMR transform specified as an appendix within IG This solution would have all of the benefits of all above options, without having to use resources for guidance that may never be used This would require more work than a single- standard approach C-CDA may still require new template(s) to support a transform to vMR 12 3 of 43 of 12

Health eDecisions (HeD) Standards Risk SOAP vs. REST Background SOAP is widely used in the industry today; REST is considered to be the future standard for the industry Risk The HeD community would like to develop Implementation Guidance for both as different vendors may have a preference for one vs. the other However, if the use of SOAP vs. REST varies from vendor to vendor, ultimately this would necessitate EHRs and/or CDS Service Suppliers to support both, which would be a burden on implementers Ongoing and Planned Mitigation Actions We are raising this risk to the HeD Pilot community to get there input on how much of a burden this would be, and if they would instead prefer either SOAP or REST (and which one) Solution Options IDDescriptionProsCons ASOAP alone SOAP is in wide use today Vendors have stated they will not pilot if REST is not included BREST alone The industry seems to be moving towards REST Vendors which currently support SOAP alone for other interfaces would have to develop a RESTful interface CSOAP and REST in Implementation Guidance Vendors with a preference of SOAP vs. REST would be able to pilot whichever they are more comfortable with Would require more time and resources to develop IG Could result in burden on implementers to support both 13 4 of 44 of 12

SDS & Harmonization HeD Leadership Agenda Solution Plan Discussion HeD Standards Selection Risks Timeline review Detailed Data Requirement Analysis Follow-up on discussion with Dave Shields IG Update –Conformance Verbs –Data Model Approach –Functional Interaction Types –Vocab & Codeset inclusion into HeD UC2 IG: update from HL7? 14

HeD UC2 Proposed Harmonization Timeline TaskStatusTarget Start Date Target End Date DurationDependence Solution PlanIn progress4/145/246 weeksGap Mitigation Plan In progress5/56/75 weeksSolution Plan Data Requirements TableIn progress4/216/148 weeksSolution Plan Data Model ApproachIn progress5/126/74 weeksSolution Plan Modify StandardsNot started5/267/128 weeksData Requirements Table, Gap Mitigation Plan, Solution Plan, Data Model Approach, Implementation GuideNot started (internal progress only) 5/267/127 weeksData Requirements Table, Gap Mitigation Plan, Solution Plan, Data Model Approach, Modify Standards ExamplesNot started6/167/124 weeksSolution Plan, Data Model Approach, Modify Standards, Implementation Guide IG ConsensusNot started7/147/262 weeksSolution Plan, Data Model Approach, Modify Standards, Implementation Guide Ballot PackageNot started7/268/193 weeksImplementation Guide, Modify Standards

HeD UC2 Proposed Harmonization Timeline: Solution Plan Impact TaskStatusTarget Start Date Target End Date DurationDependence Solution PlanIn progress4/145/24 5/31 6 weeks 7 weeks Gap Mitigation Plan In progress5/56/7 6/13 5 weeks 6 weeks Solution Plan Data Requirements TableIn progress4/216/148 weeksSolution Plan Data Model ApproachIn progress5/126/7 6/13 4 weeks 5 weeks Solution Plan Modify StandardsNot started5/26 5/31 7/12 7/19 8 weeksData Requirements Table, Gap Mitigation Plan, Solution Plan, Data Model Approach, Implementation GuideNot started (internal progress only) 5/26 5/31 7/127 weeks 6 weeks Data Requirements Table, Gap Mitigation Plan, Solution Plan, Data Model Approach, Modify Standards ExamplesNot started6/167/124 weeksSolution Plan, Data Model Approach, Modify Standards, Implementation Guide IG ConsensusNot started7/147/262 weeksSolution Plan, Data Model Approach, Modify Standards, Implementation Guide Ballot PackageNot started7/26 8/2 8/193 weeks 2 weeks Implementation Guide, Modify Standards

SDS & Harmonization HeD Leadership Agenda Solution Plan Discussion HeD Standards Selection Risks Timeline review Detailed Data Requirement Analysis Follow-up on discussion with Dave Shields IG Update –Conformance Verbs –Data Model Approach –Functional Interaction Types –Vocab & Codeset inclusion into HeD UC2 IG: update from HL7? 17

Discussion Points and Activities for Week of 5/20 (Continued…)  Detailed Data Requirement Analysis o Review approach to complete document Possible to block off 3-4 days to complete? o Should we be using the data elements from the schema instead of in conjunction with the elements from Use Case 2? SDC team noticed that the Actions section had additional elements in the schema that weren’t in the Use Case 18

SDS & Harmonization HeD Leadership Agenda Solution Plan Discussion HeD Standards Selection Risks Timeline review Detailed Data Requirement Analysis Follow-up on discussion with Dave Shields IG Update –Conformance Verbs –Data Model Approach –Functional Interaction Types –Vocab & Codeset inclusion into HeD UC2 IG: update from HL7? 19

Update on Conversation with Dave Shields Transactional Layers 20 Transport and Security Response Service: e.g., DSS Response Element Response Items Organizer/Container: e.g., HeD Action Groups Element Response Item Payload: e.g., VMR Proposal Transport and Security Request Service: e.g., DSS Request Element Request Items Organizer/Container: e.g: VMR or CCDA Request Item Payload: e.g., VMR Clinical Statement  The response needs to include context elements (e.g., patient) that were not part of the HeD UC1 spec.  The request and response should have parallel approaches  The response wrapper would be in a class/complexType called CDSOutput This type would incorporate appropriate pieces of the HeD schema (e.g., actionGroup, actionSentences, etc).  To not have a two-way dependency between vMR and HeDS (HeD schema from UC1), we will move the current CDSInput and CDSOutput types from the vMR namespace into a new namespace The cdsInput and CDSOutput will continue to be part of the vMR specification and project  So the response will look like this: DSS Response Element Contains CDSOutput (new name space, new type that imports HeDS types) Contains vMR Clinical Statements (in vMR namespace; further CDSOutput will be designed so that clinical statements from other types can be incorporated (e.g., FHIR), but this is out of scope for HeD UC2)

SDS & Harmonization HeD Leadership Agenda Solution Plan Discussion HeD Standards Selection Risks Timeline review Detailed Data Requirement Analysis Follow-up on discussion with Dave Shields IG Update –Conformance Verbs –Data Model Approach –Functional Interaction Types –Vocab & Codeset inclusion into HeD UC2 IG: update from HL7? 21

Discussion Points and Activities for Week of 5/20 (Continued…)  IG update o Have determined which sections will be populated internally, and which sections will be community homework. Have also drafted a timeline for completion of each section. Internal team beginning to populate the Introduction section Begin Implementation Approach Sections?  Pre Conditions  Constraints o Should Conformance Verbs include the full HL7 v3 list or to cut out the May/Need Not per ONC’s direction? SHALL: an absolute requirement SHALL NOT: an absolute prohibition against inclusion SHOULD/SHOULD NOT: best practice or recommendation. There may be valid reasons to ignore an item, but the full implications must be understood and carefully weighed before choosing a different course MAY/NEED NOT: truly optional; can be included or omitted as the author decides with no implications o Data Model Approach Talking point at HL7 Patient Care/SD/CDS WG Joint session: the XML format of HeD schema/expression language is not as useful/valuable as a more generalizable model (e.g. UML) would be What’s useful to an implementer? What’s in our purview? 22

Discussion Points and Activities for Week of 5/20 (Continued…)  IG update (continued…) o Functional Interaction Types How many should we focus on? –Drug Dosing Calculation –Immunization Forecasting –Disease Management –Quality Measure Evaluation –Transition of Care Support –Prediction Rule Evaluation – APACHE score, AHRQ Pneumonia Severity Index, etc. –Severity of Illness Assessment – Charlson index, etc. Will these be included in the main IG document, or can they be submitted as examples (allowing them to come after the other materials) o Vocab & Codeset inclusion into HeD UC2 IG: update from HL7? How will we leverage Vocab & Terminology WG/work o Scrum calls have been reinstated on Fridays from 3:30 – 4:00 23

Appendix 24

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

Use Case 2: CDS Guidance Service Transactions - Standards per Transaction #TransactionServiceOrganizer/ContainerItem Payloads Reference Information Model 1 CDS 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) Context Aware Retrieval Application (Infobutton) 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) Context Aware Retrieval Application (Infobutton) CDS Knowledge Artifact Implementation Guide (HeD UC1 IG) HL7 Version 3 Standard: Order Set Publication, Release 1 Consolidated CDA Virtual Medical Record (vMR) Context Aware Retrieval Application (Infobutton) 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 #TransactionTransport Authentication/ Authorization EncryptionVocab & Code Set 1 CDS 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 Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale Decision Support Service (DSS) HITSC Rating:* M: A: 88.6 SI: T: (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: A: SI: T: (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 not designed to support rich patient data payload like DSS

CDS Guidance Response Transaction: Service Standards Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale Decision Support Service (DSS) HITSC Rating:* M: A: 88.6 SI: T: (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: A: SI: T: (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 Request Transaction: Organizer/Container Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale CDS Knowledge Artifact Implementation Guide (HeD UC1 IG) HITSC Rating:* M: A: SI: T: (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 Develop options for both CCDA and vMR * M: Maturity A: Adoptability SI: S&I Specific T: Total Consolidated CDA HITSC Rating:* M: A: SI: T: (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 Summary of Findings from UCR Crosswalk Keep?Rationale Virtual Medical Record (vMR) HITSC Rating:* M: A: SI: T: (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 recently been enhanced in this respect * M: Maturity A: Adoptability SI: S&I Specific T: Total

CDS Guidance Response Transaction: Organizer/Container Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale CDS Knowledge Artifact Implementation Guide (HeD UC1 IG) HITSC Rating:* M: A: SI: T: (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 * M: Maturity A: Adoptability SI: S&I Specific T: Total Consolidated CDA HITSC Rating:* M: A: SI: T: (Y) Fits: Clinical; (P) Partially Fits: (N) Does not Fit: Context, Supporting Evidence; Supporting Resource; Actions; Attribute Value List; Response Metadata; Exceptions Probably 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 the way that UC1 does Do not anticipate using, unless modification or subset of UC1 approach does not work

CDS Guidance Response Transaction: Organizer/Container Rationale (continued…) Standard Summary of Findings from UCR Crosswalk Keep?Rationale Virtual Medical Record (vMR) HITSC Rating:* M: A: SI: T: (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 No (Probably) 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 Do not anticipate using, unless modification or subset of UC1 approach does not work * M: Maturity A: Adoptability SI: S&I Specific T: Total HL7 Version 3 Standard: Order Set Publication, Release 1 HITSC Rating:* M: A: SI: T: (Y) Fits: Supporting Evidence; Supporting Resource; Response Metadata (P) Partially Fits: Clinical; Context; Actions (N) Does not Fit: Attribute Value List; Exceptions No (Probably) Some vendors may want to support this as an option, however CDS Knowledge Artifact is the better option Adoption of this standard is low, so there is not a driving reason to extend support to it

CDS Guidance Request Transaction: Item Payloads Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale Context Aware Retrieval Application (Infobutton) HITSC Rating M: A: SI: T: (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 The information that is contained in infobutton is already represented in vMR, or if not can be Can use infobutton as a reference to modify vMR or CCDA * M: Maturity A: Adoptability SI: S&I Specific T: Total Virtual Medical Record (vMR) HITSC Rating:* M: A: SI: T: (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 The vMR has relevant information in a reasonable format The contents and scope of the vMR are aligned with the requirements of the Use Case Maintained by CDS WG As a reference model, part of its purpose is to provide exchangeable representation clinical information

CDS Guidance Request Transaction: Item Payloads Rationale (Continued…) Standard Summary of Findings from UCR Crosswalk Keep?Rationale Consolidated CDA HITSC Rating:* M: A: SI: T: (Y) Fits: Clinical; (P) Partially Fits: (N) Does not Fit: Context, Supporting Evidence; Supporting Resource; Actions; Attribute Value List; Response Metadata; Exceptions Yes Several stake holders have a business need to have this supported A methodology is needed to be able to reflect changes, which currently does not exist * M: Maturity A: Adoptability SI: S&I Specific T: Total HL7 Version 3 Standard: Order Set Publication, Release 1 HITSC Rating:* M: A: SI: T: (Y) Fits: Supporting Evidence; Supporting Resource; Response Metadata (P) Partially Fits: Clinical; Context; Actions (N) Does not Fit: Attribute Value List; Exceptions No Order Set does not hold patient data, not suitable for request transaction

CDS Guidance Response Transaction: Item Payloads Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale Context Aware Retrieval Application (Infobutton) HITSC Rating:* M: A: SI: T: (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 The information that is contained in infobutton is already represented in vMR, or if not can be Can use infobutton as a reference to modify vMR or CCDA * M: Maturity A: Adoptability SI: S&I Specific T: Total Virtual Medical Record (vMR) HITSC Rating:* M: A: SI: T: (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 The vMR has relevant information in a reasonable format The contents and scope of the vMR are aligned with the requirements of the Use Case Maintained by CDS WG As a reference model, part of its purpose is to provide exchangeable representation clinical information

CDS Guidance Response Transaction: Item Payloads Rationale (Continued…) Standard Summary of Findings from UCR Crosswalk Keep?Rationale Consolidated CDA HITSC Rating:* M: A: SI: T: (Y) Fits: Clinical; (P) Partially Fits: (N) Does not Fit: Context, Supporting Evidence; Supporting Resource; Actions; Attribute Value List; Response Metadata; Exceptions No Several stake holders have a business need to have this supported A methodology is needed to be able to reflect changes, which currently does not exist However, CCDA is not a commonly used standard for the response transaction * M: Maturity A: Adoptability SI: S&I Specific T: Total HL7 Version 3 Standard: Order Set Publication, Release 1 HITSC Rating:* M: A: SI: T: (Y) Fits: Supporting Evidence; Supporting Resource; Response Metadata (P) Partially Fits: Clinical; Context; Actions (N) Does not Fit: Attribute Value List; Exceptions No Order set model contains recommendations for clinical actions, which is applicable to the types of outputs relevant in the Use Case Unsure of adoptibility of this standard in CDS Guidance

CDS Guidance Request Transaction: Transport Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale SOAP HITSC Rating:* M: A: SI: T: (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: Yes There is currently implementation guidance on DSS to be used with SOAP, not REST Has the capabilities and functions needed for this initiative * M: Maturity A: Adoptability SI: S&I Specific T: Total REST HITSC Rating:* M: A: SI: T: (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: Yes Industry is moving towards using REST Guidance could be written for DSS to work with REST

CDS Guidance Response Transaction: Transport Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale SOAP HITSC Rating:* M: A: SI: T: (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: Yes There is currently implementation guidance on DSS to be used with SOAP, not REST Has the capabilities and functions needed for this initiative * M: Maturity A: Adoptability SI: S&I Specific T: Total REST HITSC Rating: M: A: SI: T: (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: Yes Industry is moving towards using REST Guidance could be written for DSS to work with REST

CDS Guidance Request Transaction: Authentication/Authorization Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale SAML HITSC Rating:* M: A: SI: T: (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: * M: Maturity A: Adoptability SI: S&I Specific T: Total

CDS Guidance Response Transaction: Authentication/Authorization Rationale Standard Summary of Findings from UCR Crosswalk Keep?Rationale SAML HITSC Rating:* M: A: SI: T: (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: * M: Maturity A: Adoptability SI: S&I Specific T: Total

CDS Guidance Request Transaction: Encryption Standard Summary of Findings from UCR Crosswalk Keep?Rationale TLS HITSC Rating:* M: A: SI: T: (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: * M: Maturity A: Adoptability SI: S&I Specific T: Total

CDS Guidance Response Transaction: Encryption Standard Summary of Findings from UCR Crosswalk Keep?Rationale TLS HITSC Rating:* M: A: SI: T: (Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions (P) Partially Fits: (N) Does not Fit: * M: Maturity A: Adoptability SI: S&I Specific T: Total

Solution Plan View the different combination of standards, across the different buckets, and determine the viability of each implementation option Decide which implementation option(s), and therefore combination of standards, is the best approach Document reasons why certain implementation options were chosen or not chosen View the different combination of standards, across the different buckets, and determine the viability of each implementation option Decide which implementation option(s), and therefore combination of standards, is the best approach Document reasons why certain implementation options were chosen or not chosen

Solution Plan Next Steps Decide which implementation option(s), and therefore combination of standards, will be used as the approach in the IG and incorporated into the final design

Gap Mitigation Plan Identify any gaps for all standards under consideration Determine if the gap is for the request or response transaction, or both Document recommendations on how to close the gap (i.e. modification to existing standard) Identify any gaps for all standards under consideration Determine if the gap is for the request or response transaction, or both Document recommendations on how to close the gap (i.e. modification to existing standard)

Gap Mitigation Plan Next Steps: Pull out the standards which have gaps requiring modifications and document in the IG Contact the SDO to initiate modification needed Gaps that are related to a standard being utilized in a manner which it has not previously been designed for will be addressed and written into the IG Pull out the standards which have gaps requiring modifications and document in the IG Contact the SDO to initiate modification needed Gaps that are related to a standard being utilized in a manner which it has not previously been designed for will be addressed and written into the IG