Health eDecisions (HeD) All Hands Meeting June 20th, 2013

Meeting Etiquette Remember: If you are not speaking, please keep your phone on mute Do not put your phone on hold. If you need to take a call, hang up and dial in again when finished with your other call Hold = Elevator Music = frustrated speakers and participants This meeting is being recorded Another reason to keep your phone on mute when not speaking Use the “Chat” feature for questions, comments and items you would like the moderator or other participants to know. Send comments to All Panelists so they can be addressed publically in the chat, or discussed in the meeting (as appropriate). From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute All Panelists

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 2 IG discussion 65 minutes Wrap up/Questions10 minutes

Announcements We are planning a pilots open house July 8 th from 1-2:30 –Chance for the community and other federal partners, business community, vendors and FACA leads to virtually come see what we have accomplished HeD Meetings (By Day) WeekdayMeetingTime MondayPilots (UC 1)1-2:30 ET MondayVocabulary and Terminolgy12-1:00 ET TuesdayCDS-HeD Working Meeting3:00-4:00 ET TuesdayVocabulary and Terminology4:00-5:00 ET WednesdayStandards Sub work Group Call1:00-2:00 ET ThursdayAll Community Call11:00-12:30 ET

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 are now meeting on Tuesdays from 3-4 pm to discuss HL7 topics for both UC 1 and UC 2

HeD Pilots Update – WE ARE DONE!!!!!!!!!!!!!!!! We met this week to review findings Pilots Update –CDC and AllScripts–ECA Rule --- DONE –NewMentor and AllScripts – ECA Rule DONE –Zynx and DesignClinicals - Order Set DONE –VA and Wolters Kluwer - Documentation Template DONE

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 2wks (In Reality this was closer to 10 weeks 5/6 -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.6/10– 6/24-Documented ONC Feedback - Next Steps Action Plan

Vendor Partners 10/11/20119 EHRArea of InterestMatches Design ClinicalsOrder SetsZynx AllScriptsNQF – 068 Million Hearts ECA Rule NewMentor AllScriptsSan Diego Pertussis ECA RuleCDC VAUTI Documentation Template Wolters Kluwer

Use Case 2

SDS & Harmonization HeD Agenda Timeline Overview HeD UC2 vMR Mapping Update Functional Interaction Types DSS Profile Update vMR Profile Update 11

SDS & Harmonization HeD Agenda Timeline Overview HeD UC2 vMR Mapping Update Functional Interaction Types DSS Profile Update vMR Profile Update 12

13 HeD Use Case 2 Timeline vMR Extension & Alignment DSS HeD UC2 Guidance Community Review & Ballot Preparations DSS Update & Profile Development 6/4-6/25 Jun ‘13Jul ‘13Aug ‘13 Update Mapping with vMR data elements, cardinality, data types 6/10-6/21 Update Mapping with C-CDA/QRDA data elements, cardinality, data type, value restrictions 6/17-7/1 Update vMR XML IG 7/12-7/19 Develop vMR Container/Payload Profiles 6/19-6/28 Update vMR DAM with Semantics 7/1-7/18 Include vMR templates and mapping in DSS IG 7/12-7/22 Determine Functional Interaction Type Examples 6/17-6/19 DSS Update & Profile Review & Packaging 6/25-7/9 vMR XML HeD UC1 IG Review & Packaging 7/22-8/2 New DSS IG Review & Packaging 7/22-8/2 vMR DAM Review & Packaging 7/12-7/25 vMR XML IG Review & Packaging 7/22-8/2 Extend vMR for HeD UC2 7/1-7/18 Update HeD UC1 IG 7/12-7/19 Update Mapping with vMR/HeD Value restrictions 6/18-6/26 Develop Mapping Template 6/4-6/13 Harmonize vMR with CCDA/QRDA 6/26-7/10 Update Mapping with HeD UC2 data elements, cardinality 6/17-6/25 Today (6/20)

Key Milestone Dates for September Ballot Administrative Deadlines: HL7 Notification of Intent to Ballot: July 7 HL7 Initial Content Deadline: July 14 Content Deadlines: End-to-End Review Period: –Initial DSS Update & Profile Review & Packaging : 6/25 – 7/9 –Initial vMR DAM Review & Packaging: 7/12 – 7/25 –Initial vMR XML IG Review & Packaging : 7/22 – 8/2 –Initial vMR XML HeD UC1 IG Review & Packaging: 7/22 – 8/2 –New DSS IG Review & Packaging: 7/22 – 8/2 There will be end to end reviews of each section as they are completed at earlier dates HL7 Final Content Deadline: August 4 HL7 Examples Deadline: August 19 HL7 Final Content Deadline: August 4 HeD Consensus Review Period: August 19 – September 2 –Comments will be received during balloting from August 19 – August 26 –Comments will be vetted by the community Submit Comments to HL7 on September 3 14

SDS & Harmonization HeD Agenda Timeline Overview HeD UC2 vMR Mapping Update Functional Interaction Types DSS Profile Update vMR Profile Update 15

HeD UC2 vMR Mapping 16 WorkstreamOwner & ResourcesCurrent StatusUpdate vMR MappingHeD Internal Team and Vocab and Terminology Work Group Data Elements, Cardinality, and Data Types have been populated and need to be reviewed HeD/vMR Value restrictions are being reviewed for quality and accuracy Victor Lee is populating the “HeD/vMR Value Restriction” columns CCDA MappingHeD Internal Team CCDA mapping has begun. Problems, Demographics, and Encounters tab are near completion Looking to have complete early next week QRDA MappingMark Roche QRDA mapping has begun Wil receive update next week HeD UC2 MappingBryn Rhodes and HeD Internal Team Bryn Rhodes has done an initial mapping of vMR data elements to HeD UC2 clinical data elements. Bryn will complete mapping for rest of the HeD UC2 data elements Once this is complete, we can start identifying how the vMR needs to be extended to meet requirements for UC2 Internal team has begun mapping each tab and master tab based on Bryn’s spreadsheet Proposed Templates Dave Shields Dave Shields has begun populating the proposed template tab with potential templates for each category Each tab will then be populated with these templates This is where the actual harmonization effort will take place This effort could begin on individual tabs as the mapping those categories are completed

SDS & Harmonization HeD Agenda Timeline Overview HeD UC2 vMR Mapping Update Functional Interaction Types DSS Profile Update vMR Profile Update 17

Potential Functional Interaction Types 1.Disease Management 2.Drug Dosing Calculation 3.Immunization Forecasting 4.Quality Measure Evaluation 5.Transition of Care Support 6.Prediction Rule Evaluation – APACHE score, AHRQ Pneumonia Severity Index, etc. 7.Severity of Illness Assessment – Charlson index, etc. Talking points from Pilots discussion on functional interaction types: Questions Asked: –Which functional interaction types best align with current pilot efforts? –Which types would be the most straight forward to test? –Which types would best validate the HeD UC2 solution, or be the most widely used in the industry? Feedback: –The top three are “safe” examples – they are aligned with UC2 scope, could leverage UC1 pilots and would be easy to test/validate, but they aren’t innovative –Quality Measure Evaluation and Transition of Care Support would be more innovative – they aren’t currently physician-driven activities, but could be by leveraging a CDS-like system How do we want to include Quality Measure Evaluation and Transition of Care Support given that they don’t align directly with UC2 scope?

SDS & Harmonization HeD Agenda Timeline Overview HeD UC2 vMR Mapping Update Functional Interaction Types DSS Profile Update vMR Profile Update 19

DSS Profile Update 20 TaskOwner & ResourcesUpdate Develop DSS Profile for Request with RESTBryn Rhodes Develop DSS Profile for Response with RESTBryn Rhodes Develop DSS Profile for Request with SOAPDave Shields Develop DSS Profile for Response with SOAP Dave Shields Update DSS Standard with REST guidance, including modifications to the standard itself (as necessary) and guidance on use of REST for general use cases (not HeD UC2-specific) Bryn Rhodes/Dave Shields (as needed)

SDS & Harmonization HeD Agenda Timeline Overview HeD UC2 vMR Mapping Update Functional Interaction Types DSS Profile Update vMR Profile Update 21

vMR Profile Update 22 TaskOwner & ResourcesUpdate Develop vMR Container Profile for RequestAziz Boxwala/Dave Shields Develop vMR Container Profile for ResponseAziz Boxwala/Dave Shields Develop vMR Request Payload Profile for specific functional profile interaction types Dave Shields/Claude Nanjo/ Victor Lee/Bryn Rhodes Develop HeD S/vMR Response Payload Profile for specific functional profile interaction types Dave Shields/Claude Nanjo/ Victor Lee/Bryn Rhodes

Next Steps WeekdayMeetingTimeTopicsDetails June 24 th Pilots (UC 1)1-2:30 ETReview additional Pilot findings Review IG alth+eDecisions+Homepag June 24 th Vocabulary and Terminology 12-1:00 EThttp://wiki.siframework.org/He alth+eDecisions+Homepage June 25thCDS-HeD Working Meeting 3:00-4:00 EThttp://wiki.siframework.org/He alth+eDecisions+Homepage June 25thVocabulary and Terminology 4:00-5:00 EThttp://wiki.siframework.org/He alth+eDecisions+Homepage June 26thStandards Sub work Group Call 1:00-2:00 EThttp://wiki.siframework.org/He alth+eDecisions+Homepage June 27thAll Community Call 11:00-12:30 ET alth+eDecisions+Homepage

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 –