April 2005Copyright 2005, HL71 Health Level Seven (HL7) ® National Library of Medicine (NLM) Contract 1.Introductions 2.Review HL7-NLM project objectives 3.Conduct demonstration a.Creating and sending initial query b.Viewing available documents c.Selecting one for retrieval, requesting that document d.Viewing requested document in local browser 4.CDA creation and database insertion (on the server) 5.Implementation guide and issues a.Client talks to server b.Handling the received document c.Viewer d.Limitations of message handling 6.Q&A

April 2005Copyright 2005, HL72 Project Management Team Management:  HL7 Staff Project Managers: Sarah Ryan and Jennifer Puyenbroek (interim)  HL7 Contract Officer: Mark McDougall  NLM Project Officer: Vivian Auld  ASPE EHR Project Manager: Suzie Burke-Bebee Technical Leadership:  Chris Chute, Stan Huff, and Ted Klein, Co-leaders for Vocabulary  Ed Hammond, Michael van Campen, and Bill Braithwaite, Co-leaders for EHR Work:  voluntary and contract personnel using the approved HL7 Policies/Procedures  results will feed into the HL7 standards creation processes

April 2005Copyright 2005, HL73 Health Level Seven (HL7.org) Standards Development Organization Developing standards for interoperability  Patient care  Public health  Clinical trials  Reimbursement HIPAA DSMO 20 years, 2000 members 26 international affiliates “A model community”: building standards to a single information model

April 2005Copyright 2005, HL74 Introduction Three year contract with 2 major projects: 1.Develop and apply methods to ensure UMLS Meta-Thesaurus is in step with HL7 Vocabulary Standards 2.Develop and pilot test an HL7 Implementation Guide for the transmission of patient information between disparate electronic health record (EHR) systems using HL7 Messaging Standards Health Level Seven ® National Library of Medicine (NLM) Contract

April 2005Copyright 2005, HL75 Vocabulary Project - briefly Make HL7 vocabularies available from within the Universal Medical Language System (UMLS) Where possible replace HL7 vocabularies with designated Consolidated Health Initiative (CHI)* vocabularies Specify vocabulary bindings from specific HL7 messages to the UMLS (first v2.x, then v3)  Vocabulary access, maintenance and collaboration tooling will also be developed as required for the project.  All activity will be coordinated using established HL7 processes and documented in implementation guides. * Specified by (US) Departments of Health and Human Services, Defense, and Veterans Affairs

April 2005Copyright 2005, HL76 EHR Project - briefly Develop implementation guides that: enable the transmission of patient information between disparate electronic health record (EHR) systems. maintain clinical meaning of information in computable form.  leverage existing work within HL7.  increase the utility/uniformity/usability of HL7 messages.  each successive task producing a useable working product.

April 2005Copyright 2005, HL77 EHR Project Project Description Technical Co-Leaders Ed Hammond Michael van Campen Bill Braithwaite

April 2005Copyright 2005, HL78 Two Phases of EHR Phase I has produced  a short-term solution that will allow implementation of information flow between EHR systems  using existing HL7 formats in a standardized, simple, query-response message set  including instructions and tools for implementation of a secure transmission mechanism encompassing encryption, authentication, and transport verification. Phase II will expand Phase I  based on a broader understanding of what’s being done  messages will enable more semantic interoperability and a richer query set.

April 2005Copyright 2005, HL79 Additional Work Formation of a stakeholder focus group Identification and analysis of various alternative local and international models for the exchange of EHR data Definition of a clinical data element dictionary Live data pilot project Balloting of new artifacts as necessary Implementation guides prepared for all functional activity.

April 2005Copyright 2005, HL710 EHR Project: Phase I Created a simple, 2 step Query/Response between 2 EHR systems: 1.Query for the type of information available on a given patient… Response describes what type of information is available. Followed by 2.Query (by type or date range) for any of the available information… Response uses CDA to ‘wrap’ the information ‘payload’. Provides “varying” levels of granularity, from (required) “text” to (optional) HL7 structured data in any HL7 format.  Included secure,verifiable transmission over the internet  Completed by Persistent Demo Network  Results to be demonstrated today … Implementation Guide Format and Outline completed by Gordon Point Informatics

April 2005Copyright 2005, HL711 EHR Project: Phase II Adds additional specificity at all levels:  allows (arbitrarily) greater specificity in query and response definitions (what information is requested/what is available)  potentially uses CDA release 2 with clinical statements to support variable levels of semantic interoperability (from plain text to fully structured clinical information) depending on the capabilities of the ‘record holder’ system

April 2005Copyright 2005, HL712 Phase II: Review Contract Review current EHR information exchange implementations  Selection of a subset of existing initiatives worldwide that currently exchange patient data between EHR systems.  High level and a detailed analysis and comparison of an agreed upon set of such implementations to inform the progress of the NLM-EHR project. Contractor:  Persistent Demo Network.  Contract underway now.

April 2005Copyright 2005, HL713 Phase II: Review Contract Tasks  Summarize the use case for each model.  Identify the level of negotiation and or built-in assumptions required for successful information transfer between participants to occur.  Compare process, tools, and methods used to create each model.  Compare handling of unstructured documents.  Compare higher level constructs in each model such as episode-of-care.  Compare interactions in the model such as patient roles, order & observations roles.  Compare ability of each model to handle the range of data elements specified by the ASTM Continuity of Care Record (CCR).  Compare model maturity – Is it currently in production? How long? Current tooling level supporting model?  Compare implementations where they exist.  Gather Implementation guides for each project.  Explore issues encountered in comparison.  Summarize disagreements between proponents of each model.

April 2005Copyright 2005, HL714 Phase II: Message Set Develop Phase II EHR Query-Response Message Set – RFQ(s) not yet issued …  Using the model-based HL7 Development Framework (HDF),  Design a message set that can carry full semantic information of as much clinical information as possible and produce an implementation guide and tool set complete enough to enable reliable implementation by a broad range of vendors.

April 2005Copyright 2005, HL715 Phase II: Message Set Tasks  Review results of contract for ‘Current Implementation Review’ and incorporate into a specification for the Phase II delivery mechanism.  Identify issues beyond the raw data transactions that need to be addressed for implementation (e.g., patient ID, document ID, ensuring data integrity, ensuring system security, documenting origin of info, etc.).  Explore the query-response capabilities of existing HL7 messages to determine modifications to allow the Phase II query-response messages to be more complete as to the kinds of patient data that can be requested and delivered.  Generate specifications for Phase II query-response messages.  Design a standard HL7 Version 3 ‘payload’ message to deliver an arbitrary number of clinical statements, each of which is able to handle a variable level of semantic interoperability from plain text to fully structured and coded clinical information, based on the capabilities of the record holder.  Draft an implementation guide for transmitting all the data and documents comprising an entire electronic health record (EHR) between systems using these messages, independent of source and destination architectures.  Using the implementation guide, create a test implementation to provide Proof of Concept of the Phase II model by transferring a subset of meaningful clinical data, which demonstrates the feasibility of variable semantic interoperability between independent systems and refines the implementation guide and tool set.  Submit any additional or changed standards through the HL7 standards approval process.

April 2005Copyright 2005, HL716 More Information … For more information/to declare interest:  Subscribe to  Refer to contains a description of the projects and the sub-tasks to be subcontracted to experts. Contact Sarah Ryan 