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 2 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