Health eDecisions (HeD) All Hands Meeting May 2nd, 2013

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Agenda TopicTime Allotted Announcements5 minutes Work Stream 1 Update: HL7 Meeting Update 5 minutes Work Stream 2 Update: Pilots5 minutes Work Stream 3: Use Case 265 minutes Next Steps5 minutes Wrap up/Questions5 minutes

Announcements Vocabulary and Terminologies sub work will be meeting this week –Friday 12:30-1:30 EDT – We will be presenting the work of HeD at an AMIA webinar –June 6 th from 1-2 pm EST (please watch the “Announcements” section of our wiki homepage for details on how to participate May HL7 Meeting May 5-10 th –Do we still want to meet next week? HeD will have no formal meetings There will be discussion on the vMR

HL7 Update We have completed a rough draft of the Implementation Guide – The Vocabulary and Terminology IG is also complete and will be incorporated into our IG. –To view and comment on the work of the Vocab and Terminology team please see the pilots tool page: We met this week and approved the pending issues as discovered during the Pilot process with CDC: –Next week: We are postponing our HeD/CDS due to HL7 )

HeD Pilots Update We met this week Pilots Update –CDC and Practice Fusion –ECA Rule Aziz is working on the transformation from HQMF to HeD –There will be 2 rules – one of the Laboratory and one for the clinic –NewMentor and AllScripts – ECA Rule The team has transformed the NQF 0068 (Million Hearts) into HeD and then into the Allscripts native format (CREF) The initial pass was completed and we have successfully loaded the rule into the AllScripts test environment –Still need tweaks –Zynx and DesignClinicals - Order Set Working on simple and complex order sets –VA and Wolters Kluwer - Documentation Template –UTI Documentation Template was transformed into HeD schema –Wolters Kluwer is checking the rule to ensure it captures what is needed –Ken, Robert Lario and Dave Sheilds are working with the VA to prepare for the final rule to be implemented into their system.

HeD Pilots Goal Goal The goal of this initiative is to produce, consume and where feasible, execute implementable CDS interventions. 1.Event Condition Action Rules (ECA Rules) 2.Order Sets 3.Documentation Templates Pilot Scope 1.Health eDecisions will apply defined aspects of the Implementation Guide in a real-world setting. 2.Modify the Implementation Guide to ensure it is usable 3.Submission of explicit feedback to sub workgroups such as vMR and Vocabulary and Terminology work group to close gaps 4.The real-world pilots evaluate not only the technology, standards and model (VMR), but also provide a test bed to evaluate the interaction of technology, implementation support, and operational infrastructure required to meet Health eDecisions use case 1 objectives at the stakeholder or organization levels. 5.Demonstrate intent of artifact (specifically structures and semantics) are communicated either by direct execution or by translation to native format 6.Ensure completeness and consumability of artifact New

Timeline 10/11/20118 We are Here Goal & Activities EST. Time DatesDeliverables Kickoff /Establish Goals & Partnerships: - Review HeD Initiative Goals - Review Piloting Process & Resources - Define Value Statement - Define HeD Pilot Goals & Success Metrics - Establish & Approve Pilots - Develop Pilot Briefs 4 wks. (reality 5 weeks) 1/07-2/25 (we missed 2 meetings in January pushing our Dates back) -Wiki Capturing Pilot Deliverables -Established Partnerships -Documented Value Statements and Success Metrics -Documented Pilot Briefs Pilot Configuration: - Establish Pilot Test Environment & Resources - Establish Pilot Implementation & Testing Process - Develop & Review Pilot Configuration 2 wks. (reality- 4 weeks) 2/25-3/25 -Use Case is Updated with HL7 Comments (3/4) -Approved Pilot Briefs -Committed Pilot Resources -Documented & Reviewed Pilot Configuration Guide -Weekly Feedback on Use-Cases & IG Alignment Pilot Development : - Setup & Develop Pilot Prototypes - Review prototypes 6 wks. or less depending on Pilot activity 3/25 – 5/6 -Use Case is Updated with HL7 Comments (3/4) -Weekly Pilot Development Status Updates -Weekly Feedback on Use-Cases & IG Alignment -Updates to Pilot Configuration Guides Pilot Testing & Showcase : - Complete Testing - Prepare Solution Showcase 2wks5/6 -5/20-Weekly Pilot Testing Updates & KPIs -Showcase -Prepare for HL7 Pilot Wrap-up : - Develop Lessons Learned an ONC Feedback - Review Initiative Goal Alignment - Establish Next-Steps 2 wks.5/20 – 6/3-Documented ONC Feedback - Next Steps Action Plan

Vendor Partners 10/11/20119 EHRArea of InterestPotential or Actual Match Design ClinicalsOrder SetsZynx AllScriptsECA Rules –NQMF Rule (for Ambulatory Setting) – Million Hearts NewMentor (have catalog for rules in ambulatory setting) Practice FusionAnything MU centered CDC (also may need Artifact supplier to help) Wolters Kluwer NewMentor (MU rule as example) VADocumentation Template Wolters Kluwer

HeD Use Case 2

Ongoing/Planned Activities for Week of 4/29 Final UCR Crosswalk due COB 4/30 Hold two working sessions to complete UCR Crosswalk on 4/30 Hold working session at the Standards SWG on 5/1 to discuss results of the UCR Crosswalk using summary slides, and choose Standards to move forward with Present Results of UCR Crosswalk All Hands meeting on 5/2 Our concentration is the Service/Payloads Standards; transport/security and vocab and code set are secondary discussions Discuss selection of standards on 5/1 SWG call and continue conversation/selection during 5/2 WG Gap Mitigation Plan will be developed out of the UCR Crosswalk and initial draft will be due COB 5/7 Solution Diagram has been updated with suggested changes. Will review with the community at the All Hands Call on 5/2, and will update with the Selected Standards Populating Data Requirements Table Internally. Final UCR Crosswalk due COB 4/30 Hold two working sessions to complete UCR Crosswalk on 4/30 Hold working session at the Standards SWG on 5/1 to discuss results of the UCR Crosswalk using summary slides, and choose Standards to move forward with Present Results of UCR Crosswalk All Hands meeting on 5/2 Our concentration is the Service/Payloads Standards; transport/security and vocab and code set are secondary discussions Discuss selection of standards on 5/1 SWG call and continue conversation/selection during 5/2 WG Gap Mitigation Plan will be developed out of the UCR Crosswalk and initial draft will be due COB 5/7 Solution Diagram has been updated with suggested changes. Will review with the community at the All Hands Call on 5/2, and will update with the Selected Standards Populating Data Requirements Table Internally.

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

Transport and Security Transactional Layers 13 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 Request Service: e.g., DSS Request Element Request Items Organizer/Container: e.g: VMR or CCDA Request Item Payload: e.g., VMR Clinical Statement

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 * 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 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

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 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 * 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 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 * 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

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 * 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

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 * 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

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 Yes * 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 Yes

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: * 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:

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: * 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:

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

Ongoing/Planned Activities for Week of 4/22 Initial feedback on UCR Crosswalk received COB 4/23 Held working session to continue filling out the UCR Crosswalk during the Standards SWG on 4/24 Hold working session to continue filling out the UCR Crosswalk during the All Hands Meeting on 4/25 Gap Mitigation Plan will be developed out of the UCR Crosswalk and will be due COB 5/7 Solution Diagram has been drafted. Will review with the community the week of 4/29, and will update with the Selected Standards Working on drafting a template for the Data Requirements Table 32

Work Stream 1 – HL7: –Next HL7 meeting TBD –(see HeD Homepage wiki for meeting details: Work Stream 2 – Pilots: –We are beginning working on pilots –Next Pilots meeting: May 6th, 1-2:30 pm EDT see HeD home page wiki for meeting details: –Updates on Pilot Activities, Review of Timelines Work Stream 3 – Use Case 2: –Data Elements and Standards Sub Work Group Next Meeting ????? Homepage wiki for meetings: All Hands Community Meeting –We will reviewing candidate standards –Next meeting May 9 th, 2013(see the HeD Homepage wiki for meeting details: Next Steps

Questions?

Contact Information For questions, please contact your support leads –Coordinator: Ken Kawamoto: –Co-Coordinators: Aziz Boxwala: Bryn Rhodes: –ONC Leadership: Alicia Morton: –Project Management: Jamie Parker: –Use Case 2: Dave Shevlin: Virginia Rhiel: –Harmonization: Lynette Elliot: Anna Langhans:

Useful Links Wiki – Use Case 1& 2 – –UC 2: Use Case 2: +CDS+Guidance+Servicehttp://wiki.siframework.org/UC+2+- +CDS+Guidance+Service Pilots – HL7 Ballot Submission: – #Ballothttp://wiki.siframework.org/Health+eDecisions+Reference+Materials #Ballot UC 1 Harmonization and IG: – Standards+%28Implementation%29http://wiki.siframework.org/Health+eDecisions+Harmonization+and+ Standards+%28Implementation%29 HeD Glossary –