© 2014 White Paper: HIT Standards for HIM Practices Proposed Methodology

Outline 1.IHE White Paper Project Overview 2.Proposed Methodology

HIM and IHE Universes Amalgamation Health Information Systems should support HIM practices HIM practices should inform IHE Profile Specifiers Health Information Systems built based on the IHE Profiles should support HIM practices

Systems: Document Sharing/Exchange HIE System 2 System 1

Systems: Document Sharing/Exchange HIE System 2 System 1 HIM

The White Paper Objectives 1.Explain/model the relationship between HIM practices (clinical-HIM workflow, HIM activities checklist) and capabilities of HIS products to support these practices 2.Conduct a gap analysis between HIM practices and existing IHE and other HIT standards for HIS aimed to support HIM practices 3.Create the roadmap for the development of new IHE profiles to support HIM practices 4.Inform IHE development process by defining Profile Specifier checklist aligned with the HIM practices checklist

Efforts To Date #=8#=? 2014 AHIMA IG White Paper, 2014 AHIMA HIM Principles Taskforce Report (to be developed) IG Principle HIM Principles Information Governance Principles*: 1.Accountability 2.Transparency 3.Integrity 4.Protection 5.Compliance 6.Availability 7.Retention 8.Disposition * American Record Management Association (ARMA). Generally Accepted Record Management Principles. Information Governance Maturity Model. 2013

Needed Efforts

Needed Efforts- White Paper Scope

White Paper Use Cases #=8#=? 2014 AHIMA IG White Paper, 2014 AHIMA HIM Principles Taskforce Report (to be developed) IG Principle HIM Principles Information Governance Principles*: 1.Accountability 2.Transparency 3.Integrity 4.Protection 5.Compliance 6.Availability 7.Retention 8.Disposition * American Record Management Association (ARMA). Generally Accepted Record Management Principles. Information Governance Maturity Model. 2013

White Paper Use Cases #=8#=? 2014 AHIMA IG White Paper, 2014 AHIMA HIM Principles Taskforce Report (to be developed) IG Principle HIM Principles Information Governance Principles*: 1.Accountability 2.Transparency 3.Integrity 4.Protection 5.Compliance 6.Availability 7.Retention 8.Disposition * American Record Management Association (ARMA). Generally Accepted Record Management Principles. Information Governance Maturity Model Use Case 1

White Paper Use Cases #=8#=? 2014 AHIMA IG White Paper, 2014 AHIMA HIM Principles Taskforce Report (to be developed) IG Principle HIM Principles Information Governance Principles*: 1.Accountability 2.Transparency 3.Integrity 4.Protection 5.Compliance 6.Availability 7.Retention 8.Disposition * American Record Management Association (ARMA). Generally Accepted Record Management Principles. Information Governance Maturity Model Use Case 2 Use Case 1

Use Case 1: Standards for Record’s State(s) Medical records states from ARMA Model: 6. Availability 7. Retention 8. Disposition Activities 1.Select one of these record states based on priorities (e.g., record lifecycle model, stakeholder value, other) 2.Develop HIM action checklist(s) by state(s) 3.Conduct IHE and other HIT standards gap analysis for the selected record state 4.Develop a roadmap for IHE standards development by record state

Use Case 2: Standards for State Attribute(s) Medical records states and states’ attributes from ARMA Model: 6. Availability 7. Retention 8. Disposition Activities 1.Select an attribute(s) for a record’s state (e.g., protection, integrity) based on priorities (e.g., record lifecycle model, stakeholder value, other) 2.Model the attribute in the record lifecycle and information exchanges between systems 3.Conduct IHE and other HIT standards gap analysis for the selected attribute(s) 4.Develop a roadmap for IHE standards development by attribute (s) 1.Accountability 2.Transparency 3.Integrity 4.Protection 5.Compliance

Health Information Systems (HIS) The White Paper will apply to a variety of HIS: Electronic Health Record Systems (EHRs) Laboratory Information Management Systems (LIMS) Pharmacy Public Health Research Personal Electronic Health Record Systems (PEHRs)

Record Building/Sharing Environment* Clinical Encounter Record/Documents Flow Patient Registration Chief Complaint Orders Test Results Diagnosis & Care Plan IHE XDW, SWF, Cardiology and other Profiles IHE XDW, SWF, Cardiology and other Profiles CCD Prescriptions HIM P R A C T I C E S* HIM P R A C T I C E S* HIM CCD *HL7 EHR Lifecycle Model Release 1, Draft Standard for Trial Use. 27 January 2008 Billing SystemEHR SystemLaboratory SystemPharmacy System

Systems: Document Sharing/Exchange HIE System 2 System 1 HIM

Record Content Populated by Various Systems IHE Data Access Framework White Paper URL: MEDICALRECORDMEDICALRECORD

Our Methodology

Methodology Tasks Deliverable 1.Document HIM best practices in electronic environment by selected Information Governance principle: (a) Integrity; (b) Protection; (c) Availability Literature Review HIM Practice Check list 2. Define Use Cases for selected HIM best practices by principleHIM Use Case List 3. Conduct gap analysis of IHE interoperability standards (integration profiles) to assess their capabilities to support HIM practice by harmonization of the HIM and IHE use cases Gap Analysis Table 4. Develop recommendations and a roadmap for addressing identified gaps in IHE interoperability standards Recommendations and Roadmap 5. Publish draft White Paper for public commentsDraft White Paper 6. Publish final White paper based on the reconciliation of public comments Final White paper 7. Develop proposal for the IHE development cycleProposal for the IHE development cycle 8. Communication, Outreach and MarketingJAHIMA Article Webinar 2015 Convention

In Search of Methodology Based on the Call 12/01/14 discussion: 1.Review of IHE White Papers IHE Health Information Exchange White Paper URL: Profiles_Rev1-0_ pdfhttp:// Profiles_Rev1-0_ pdf IHE Data Access Framework White Paper URL:

IHE HIE White Paper This white paper is focused on explaining the IHE profiles used to address interoperability aspects of document sharing and how they work together to solve common document sharing problems. This paper will describe a set of building blocks for health document sharing and each environment will use some set of those building blocks to enable the architecture desired by the community or communities participating. IHE enables interoperable sharing of documents but assumes this sharing occurs under a document sharing governance structure agreed to by all parties involved. The governance structure addresses all policy issues necessary to enable document sharing; content format and coding; and other operational characteristics. The IHE profiles are designed to be agnostic to governance and policy, while also being designed to support and enforce those governance and policy choices. The governance may apply only within a small group, such as a hospital and small physician’s office, or may apply at a large level, like an entire nation. IHE Profile entitled Template for XDS Affinity Domain Deployment Planning provides support for policy and deployment planning. IHE Health Information Exchange White Paper URL:

IHE HIE White Paper

IHE Data Access Framework (DAF) White Paper The purpose of this white paper is to provide a framework of modular, substitutable and interoperable integration profiles that shows how IHE enables data access for a wide variety of use cases using queries as follows: Queries within and across enterprises Queries accessing individual patient data and queries accessing population data Support for multiple data models based on the type of data being accessed such as clinical data and patient demographic data Securing the data being exchanged (both query requests and query responses) IHE Data Access Framework White Paper URL:

IHE DAF White Paper IHE Data Access Framework White Paper URL:

IHE DAF White Paper IHE Data Access Framework White Paper URL:

Systems: Document Sharing/Exchange HIE System 2 System 1 HIM

Systems: Document Sharing/Exchange HIE System 2 System 1 HIM IHE HIE WP IHE DAF WP IHE HIE WP IHE DAF WP IHE HIE WP IHE DAF WP IHE HIE WP IHE DAF WP IHE HIE WP IHE DAF WP IHE HIE WP IHE DAF WP

Project Scope: Document Sharing/Exchange HIE System 2 System 1 HIM IHE HIE WP IHE DAF WP IHE HIE WP IHE DAF WP IHE HIE WP IHE DAF WP IHE HIE WP IHE DAF WP IHE HIE WP IHE DAF WP IHE HIE WP IHE DAF WP

Methodology: Tasks 1 and 2 1.Document HIM best practices in electronic environment by selected Information Governance principle: (a) Integrity; (b) Protection; (c) Availability (Examples: Grzybowski, 2014 p. 31 and 40) 2.Define Use Cases for selected HIM best practices by principle HIM PracticeHIM Use Case Protection P1. Does MPI contain the correct number of entries in the right sequence, so that it has episode of care integrity within its account number? To be developed P2. Global or universal authorization can be filed at the enterprise (medical record number) vs. individual episode of care To be developed

IHE Universe – ITI XDS Profiles Family Cross-Enterprise Document Sharing (XDS) Profiles Family enables a number of healthcare delivery organizations belonging to an XDS Affinity Domain (e.g., a community of care) to cooperate in the care of a patient by sharing clinical records in the form of documents as they proceed with their patients’ care delivery activities. This profile is based upon ebXML Registry standards and SOAP. It describes the configuration of an ebXML Registry in sufficient detail to support Cross Enterprise Document Sharing. Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). Cross-Enterprise Document Sharing (XDS) Integration Profile.URL:

IHE Universe – Information Technology Infrastructure (ITI) Technical Framework Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). URL:

IHE Universe – Information Technology Infrastructure (ITI) Technical Framework Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). URL: HIM # P1 HIM # P2

Methodology: Tasks 2 and 3 HIM PracticeHIM Use CaseIHE Use CaseIHE profile Protection P1. Does MPI contain the correct number of entries in the right sequence, so that it has episode of care integrity within its account number? To be developedTo be reviewedPatient Cross Referencing for MPI P2. Global or universal authorization can be filed at the enterprise (medical record number) vs. individual episode of care To be developedTo be reviewedEnterprise user authentication Harmonized 2. Define Use Cases for selected HIM best practices by principle - Protection (Examples: Grzybowski, 2014 p. 31 and 40) 3. Conduct gap analysis of IHE profiles and harmonize use cases

Methodology: Tasks 1 and 2 1.Document HIM best practices in electronic environment by selected Information Governance principle: (a) Integrity; (b) Protection; (c) Availability (Examples: Grzybowski, 2014 p. 40) 2.Define Use Cases for selected HIM best practices by principle HIM PracticeHIM Use Case Availability A1. All documents can be accounted for and the record closed as complete within a specific time period post patient discharge To be developed A2.Single or multiple groups of documents within the electronic medical record can be viewed by or released to the requestor To be developed

IHE ITI XDW Profile The Cross-Enterprise Document Workflow (XDW) Integration Profile enables participants in a multi-organizational environment to manage and track the tasks related to patient-centric workflows as the systems hosting workflow management applications coordinate their activities for the health professionals and patients they support. XDW builds upon the sharing of health documents provided by other IHE profiles such as XDS, adding the means to associate documents conveying clinical facts to a patient-specific workflow. XDW provides a common interoperability infrastructure upon which a wide range of specific workflow definitions may be supported. It is designed to support the complexity of health services delivery with flexibility to adapt as workflows evolve. Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). Cross-Enterprise Document Workflow (XDW). T rial Implementation URL:

IHE ITI XDW Profile Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). Cross- Enterprise Document Workflow (XDW). T rial Implementation URL:

IHE ITI XDW Profile Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). Cross- Enterprise Document Workflow (XDW). T rial Implementation URL: HIM # A1

IHE DAF White Paper IHE Data Access Framework White Paper URL: HIM # A2

HIM PracticeHIM Use Case Availability A1. All documents can be accounted for and the record closed as complete within a specific time period post patient discharge To be developedTo be reviewedXDW A2.Single or multiple groups of documents within the electronic medical record can be viewed by or released to the requestor To be developedTo be reviewedIHE DAF White Paper Methodology: Tasks 2 and 3 (continued) 2. Define Use Cases for selected HIM best practices by principle – Availability (Examples: Grzybowski, 2014 p. 31 and 40) 3. Conduct gap analysis of IHE profiles and harmonize use cases Harmonized

Methodology: Tasks 1 and 2 (continued 1.Document HIM best practices in electronic environment by selected Information Governance principle: (a) Integrity; (b) Protection; (c) Availability (Examples: Grzybowski, 2014 p. 31 and 40) 2.Define Use Cases for selected HIM best practices by principle HIM PracticeHIM Use Case Availability A3. A log of all requests and accounting of disclosures is kept as an audit trail and can be referenced as needed To be developed

Methodology: Tasks 2 and 3 (continued) Harmonized 2. Define Use Cases for selected HIM best practices by principle – Availability (Examples: Grzybowski, 2014 p. 31 and 40) 3. Conduct gap analysis of IHE profiles and harmonize use cases HIM PracticeHIM Use CaseIHE Use CaseIHE Profile Availability A3. A log of all requests and accounting of disclosures is kept as an audit trail and can be referenced as needed To be developedTo be reviewedAudit Trail and Node Authentication (ATNA) Harmonized

IHE Universe – Information Technology Infrastructure (ITI) Technical Framework Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). URL: HIM # P1 HIM # P2 HIM # A3

Gap Analysis Examples of IHE Profiles to be Reviewed

IHE Radiology Domain The Scheduled Workflow (SWF) Integration Profile establishes the continuity and integrity of basic departmental imaging data acquired in an environment where examinations are generally being ordered. It specifies a number of transactions that maintain the consistency of patient and ordering information as well as defining the scheduling and imaging acquisition procedure steps. This profile also makes it possible to determine whether images and other evidence objects associated with a particular performed procedure step have been stored (archived) and are available to enable subsequent workflow steps, such as reporting. It may also provide central coordination of the completion of processing and reporting steps as well as notification of appointments to the Order Placer. Integrating the Healthcare Enterprise (IHE). Radiology Technical Framework (TF). Scheduled Workflow (SWF) Integration Profile. URL:

IHE Radiology Domain Integrating the Healthcare Enterprise (IHE). Radiology Technical Framework (TF). Scheduled Workflow (SWF) Integration Profile. URL: IHE Scheduled Workflow (SWF) Profile

IHE Radiology Domain Integrating the Healthcare Enterprise (IHE). Radiology Technical Framework (TF). Scheduled Workflow (SWF) Integration Profile. URL: IHE Scheduled Workflow (SWF) Profile HIM

IHE Cardiology Domain The Evidence Documents Profile defines ways for data recorded in the course of carrying out a procedure step, such as observations, measurements, and results (i.e., evidence documents), to be output by devices, such as acquisition systems and other workstations; to be stored and managed by archival systems; and to be retrieved and presented or used by display and reporting systems. This allows detailed non-image information, such as measurements, CAD results, procedure logs, etc. to be made available as input to the process of generating a clinical Report, either as additional evidence for the reporting physician, or in some cases for selected items in the Evidence Document to be included in the report. Integrating the Healthcare Enterprise (IHE). Radiology Technical Framework (TF). Scheduled Workflow (SWF) Integration Profile. URL: hhttp://ihe.net/uploadedFiles/Documents/Cardiology/IHE_CARD_TF_Vol1.pdf

IHE Cardiology Domain Integrating the Healthcare Enterprise (IHE). Radiology Technical Framework (TF). Scheduled Workflow (SWF) Integration Profile. URL:

IHE Cardiology Domain Integrating the Healthcare Enterprise (IHE). Radiology Technical Framework (TF). Scheduled Workflow (SWF) Integration Profile. URL: HIM

IHE Information Technology Infrastructure (ITI) Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). URL:

Examples of Other Standards to be Reviewed

1.AHIMA Information Governance Principles for Healthcare, September AHIMA First Information Governance Benchmarking White Paper, May Grzymbowski D. Strategies for Electronic Document and Health Record Management Other 1.Cohasset Associates | AHIMA 2014 Information Governance in Healthcare: Benchmarking White Paper. URL: 2.AHIMA Information Governance Principles for Healthcare (IGPHC). URL: Review of HIM Business Standards Methodology: Tasks 1 & 2 1.Document HIM best practices in electronic environment by selected Information Governance principle: (a) Integrity; (b) Protection; (c) Availability 2.Define Use Cases for selected HIM best practices by principle

ISO Record Lifecycle Model Standard* * ISO/TR 21089:2004 Health informatics -- Trusted end-to-end information flows Methodology: Task 3 3. Conduct gap analysis of various HIT standards and harmonize use cases ISO/TR 21089:2004 Health informatics -- Trusted end-to-end information flows

ISO Technical Committee (TC) 215 Health Informatics Methodology: Task 3 3. Conduct gap analysis of various HIT standards and harmonize use cases

Methodology: Tasks and Deliverables Tasks Deliverable 1.Document HIM best practices in electronic environment by selected Information Governance principle: (a) Integrity; (b) Protection; (c) Availability Literature Review HIM Practice Check list 2. Define Use Cases for selected HIM best practices by principleHIM Use Case List 3. Conduct gap analysis of IHE interoperability standards (integration profiles) to assess their capabilities to support HIM practice by harmonization of the HIM and IHE use cases Gap Analysis Table 4. Develop recommendations and a roadmap for addressing identified gaps in IHE interoperability standards Recommendations and Roadmap 5. Publish draft White Paper for public commentsDraft White Paper 6. Publish final White paper based on the reconciliation of public comments Final White paper 7. Develop proposal for the IHE development cycleProposal for the IHE development cycle 8. Communication, Outreach and MarketingJAHIMA Article Webinar 2015 Convention

Project methodology and logistics set-up Gap Analysis of IHE Profiles Recommendations and Roadmap Draft White Paper Final White Paper Proposal for HIM Standard for IHE cycle Month HIM Practices Checklist. Use Case List Gap Analysis Table Recommendations and Roadmap Draft White Paper JAHIMA Article HIM best practices review, HIM Use Case selection Defined Methodology, Wiki set-up Communication and Outreach Final White Paper Proposal 2015 ConvemtionWebinar Methodology: Timeline

AHIMA Team (Harry, Diana, Anna) Subject Matter Experts (SMEs) Developers – HIM SMEs (Sandra, Jonathan, Kathleen) – IHE SMEs (John, Michael) Reviewers – HIM SMEs (to be defined, e.g., Practice Councils) – IHE SMEs (IHE ITI Committee members) Methodology: Roles

Tasks Team 1.Document HIM best practices in electronic environment by selected Information Governance principle: (a) Integrity; (b) Protection; (c) Availability AHIMA Team HIM Subject Matter Experts (SMEs) 2. Define Use Cases for selected HIM best practices by principle AHIMA Team HIM SMEs 3. Conduct gap analysis of IHE interoperability standards (integration profiles) to assess their capabilities to support HIM practice by harmonization of the HIM and IHE use cases AHIMA Team IHE SMEs 4. Develop recommendations and a roadmap for addressing identified gaps in IHE interoperability standards Full Team 5. Publish draft White Paper for public commentsAHIMA Team 6. Publish final White paper based on the reconciliation of public comments Full Team 7. Develop proposal for the IHE development cycleAHIMA Team 8. Communication, Outreach and Marketing (JAHIMA Article, Webinar, 2015 Convention) AHIMA Team. HIM SMEs, IHE SMEs