“ Jericho / UT Austin Pilot” Privacy with Dynamic Patient Review August 27, 2013 Presented by: David Staggs, JD, CISSP Jericho Systems Corporation

208/27/2013 Agenda Administrative issues Pilot scope Pilot data flow Review of previous demonstration Report on current progress Discussion Pilot Timeline Plan of Action Announcement of “all hands meeting”

308/27/2013 Pilot Administrivia This pilot is a community led pilot –Limited support provided by the ONC Zachary May (ESAC) Jeanne Burton (Security Risk Solutions) Melissa Springer (HHS) In conjunction with DS4P bi-weekly return of an All Hands meeting Access to DS4P Wiki, teleconference, and calendar Meeting times: Tuesdays 11AM (ET) –Dial In: Access code: URL: d= d=

408/27/2013 Scope of the Pilot 1.Define the exchange of HL7 CDA-compliant PCD between a data custodian and a PCD repository that includes a report on the outcome of the request back to the healthcare consumer. 2.Additional goal: use of identifiers that can uniquely identify the healthcare consumer and PCD repository used to report the outcome of the request back to the healthcare consumer by healthcare consumer’s provider and subsequent EHR custodians. 3.Stretch goal: mask and/or redact the clinical document based on PCD choices retrieved from the PCD repository. 4.Stretch goal: use of the PCD repository as a proxy allowing direct authentication by the healthcare consumer to the provider, subsequently reducing correlation errors.

508/27/2013 Pilot Data Flow Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor   B ,  = Clinical data A,B = PCD data = audit record And Subsequent Custodian of Data being Provided at 

608/27/2013 Previous Demonstration 1.Use Universal Client to send NwHIN messages –Patient Discovery (ITI-55), Query for Documents (ITI-38), and Request Document (ITI-39) 2.Demonstrate consent based on recipient and patient consent directive (retrieved from a PCD repository) –Show result of different policies: 1 st requestor v. 2 nd requestor 3.Demonstrate PCD applied by 1 st requestor –1 st requestor retrieves document; 2 nd requestor requests from 1 st requestor 4. Demonstrate consent based on purpose of use –change policy from “allow treatment” to “allow research,” request using “research” attribute both times

708/27/2013 Current Progress 1.Edmonds Scientific development of data segmentation functionality for identifying segments in clinical documents and redaction –Redaction demonstrated using Request Document (ITI-39). 2.UT Austin demonstrate consent based on recipient and patient consent directive (retrieved from a PCD repository) –Patient Discovery (ITI-55), Query for Documents (ITI-38), and Request Document 3.Conemaugh Health System demonstrate consent based on recipient and patient consent directive –Patient Discovery (ITI-55), Query for Documents (ITI-38), and Request Document

07/30/20138

Healthcare Classification System(HCS) 08/27/20139 Document “Facts” Document Orchestration Rules EngineDocument Transformer Rule GenerationPackaging Simplified View PCD Constraints Document Clinical/Organizational Policies Fact Administration Rules Document Actions Document, PCD (decomposed), and Org OID (FHIR Resources Supported) Redacted/Annotated/ Masked Document Event Logging

HL7 FHIR Connectathon Fast Healthcare Interoperability Resources (FHIR) Resources: –represent flexible granular clinical concepts –managed in isolation, or aggregated into complex documents –a coherent solution for a range of interoperability problems –based on thorough requirements gathering, formal analysis and extensive cross-mapping to other relevant standards –based on simple XML, with an http-based RESTful protocol where each resource has predictable URL A workflow management layer provides support for designing, procuring, and integrating solutions. 08/27/201310

1108/27/2013 FHIR Demonstration Health Level Seven (HL7) 27TH Annual Plenary & Working Group Meetings September 21-22, 2013 Hyatt Regency Cambridge (Boston) HCS – Security Labeling Services DS4P Use Cases – Share All, Share Partial, Breakglass VA/DoD iEHR Use Cases

1208/27/2013 Discussion Open forum for discussing questions: o Problems with the Universal Client? o Problems with communicating use of the PCD repository o Problems with use of OpenATNA Audit Message Viewer o Problems with how PCD is changed and the affects o Unexpected benefits/problems

1308/27/2013 Pilot Timeline General Timeline, conditioned on agreement of stakeholders

14 Plan of Action Upon agreement of the participants the POA is: Identify the elements available from previous DS4P pilots Scope level of effort, decide on extended scenario Determine first draft of functional requirements Review standards available for returning information on requests Determine any gaps or extensions required in standards Stand up information holders and requestors Create XDS.b repository holding PCD Identify remaining pieces, create test procedures Document and update IG with results of our experience 08/27/2013

15 Announcement DS4P “All Hands Meeting:” When: Wed, August 28, 11:00am – 12:30pm (ET) Where: Dial-in Access code: WebEx URL ( ​ work1.webex.com ​ /siframework1/o ​ nstage/g.php?t= ​ a& d= ) 08/27/2013

1608/27/2013 Backup Slides

DS4P Standards Material Location of DS4P Standards Inventory: Location of DS4P Standards Mapping Issues: xlsx/ /Copy%20of%20DataMappingsIssues% xlsx General Standards Source List: %20Analysis.xlsx/ /General%20SI%20Framework%20Standards%20A nalysis.xlsx Standards Crosswalk Analysis monizationhttp://wiki.siframework.org/Data+Segmentation+for+Privacy+Standards+and+Har monization (at bottom of page, exportable) Implementation Guidance 20Guidance_consensus_v1_0_4.pdf/ /Data%20Segmentation%20Impl ementation%20Guidance_consensus_v1_0_4.pdf 08/27/201317

1808/27/2013 DS4P References Use Case: ases ases Implementation Guide: nsensus nsensus Pilots Wiki Page: +Pilots+Sub-Workgroup +Pilots+Sub-Workgroup

1908/27/2013 Pilot Data Flow Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor   B ,  = Clinical data A,B = PCD data = audit record And Subsequent Custodian of Data being Provided at 

2008/27/2013 Pilot Data Flow Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor Clinical exchange #  Clinical exchange #  B ,  = Clinical data A,B = PCD data = audit record And Subsequent Custodian of Data being Provided at  Fetch PCD Send audit

2108/27/2013 Pilot Data Flow (1) Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor  ,  = Clinical data A,B = PCD data = audit record

2208/27/2013 Pilot Data Flow (2) Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor  ,  = Clinical data A,B = PCD data = audit record

2308/27/2013 Pilot Data Flow (3) Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor  B ,  = Clinical data A,B = PCD data = audit record And Subsequent Custodian of Data being Provided at 

2408/27/2013 Pilot Data Flow (4) Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor  ,  = Clinical data A,B = PCD data = audit record And Subsequent Custodian of Data being Provided at 

2508/27/2013 Pilot Data Flow (5) Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor ,  = Clinical data A,B = PCD data = audit record And Subsequent Custodian of Data being Provided at 

2608/27/2013 Pilot Data Flow (updated) Custodian of Data being Provided at  Patient PCD Repository 2 nd Requestor 1 st Requestor   B ,  = Clinical data A,B = PCD data = audit record And Subsequent Custodian of Data being Provided at 