Health eDecisions (HeD) All Hands Meeting March 14th, 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 Presentation of the Vocabulary and Terminology Work Group Efforts 15 minutes Work Stream 2 Update: Pilots5 minutes Work Stream 3: Use Case 250 minutes Next Steps5 minutes Wrap up/Questions5 minutes

Announcements Vocabulary and Terminologies sub work will be meeting this week –Friday 12:30-2:30 EDT –

HL7 Update We have finalized the HeD Schema –Harmonized with HQMF where applicable HeD/QDM/vMR harmonization work continues –vMR will be submitting the HeD requested updates to the vMR on March 17 th (per HL7 ballot requirements) We are finalizing the IG based on the schema updates and harmonization activities Plans: –We will continue to use our Wednesday HeD/CDS meeting time to continue work on any the IG, harmonization efforts etc. ) –We will continue integrating comments based on the pilots into the IG

Vocabulary and Terminology Sub Work Group Update Presented by Mark Roche

HeD Vocab/Terminology WG (3) Meetings: –1x/week, Fridays/ 1-2 hrs –Meeting minutes: cts cts HeD Vocab guidance document – wnc3k3AHPB6pGW1t2kHa- 5w_tcmDHUoNQw5vA/edit?pli=1# wnc3k3AHPB6pGW1t2kHa- 5w_tcmDHUoNQw5vA/edit?pli=1# Home page: – WGhttp://wiki.siframework.org/Terminologies+and+Value+Sets+S WG Worksheet (working document used by WG) – S5NdElOTndjOGhpaEF6UmlfTm05OGVYdWc&pli=1#gid=0https://docs.google.com/spreadsheet/ccc?key=0AkVg6OcD6 S5NdElOTndjOGhpaEF6UmlfTm05OGVYdWc&pli=1#gid=0

Approach Identify Data Element (metadata) requirements that support HeD Use Case 1: –Review/Extract metadata from HeD Use Case 1 documentation –Review/Extract metadata from HL7 virtual medical record (vMR)vMR Cross-reference metadata Focus on vMR Data Elements –(leverage existing metadata standards/definitions) Identify and assign Value Sets/Codes to metadata

Mapping Resources Coding systemsValue Sets SNOMED CTHITSP c80 v2.0.1 (pdf) CPTVSAC LOINCUSHIK ICD-9-CMPHIN VADS ICD-10-CMC-CDA CDC CVXHL7 v3 CDC MVX MeSH RxNorm NDC NDF-RT

Mapping results documentation

Metadata distribution

vMR DEs

Mapping Complexity LowLow –Value sets/enumerated list readily available and clearly defined for given Data Element (DE) ModerateModerate –Examples: More than one vocabulary sources/VS Overlapping coverage of vocabulary sources/VS HighHigh –Insufficient vocabulary/VS sources or coverage –Non-existing sources

Low Example 1: Low complexity vMR DE “Administrable Substance -> Form” –Source Leveraged: HITSP C80 (.pdf) Document and Table Name + OID

Low Example 2: Low complexity vMR DE “AdverseEventBase-> affectedBodySite” –Source Leveraged: HITSP C80 (.pdf) Document and Table Name + OID

Medium Example 2: Medium complexity “Base” Data Element Groupings created: each group member represents distinct overlapping vocabulary source Groupings created: each group member represents distinct overlapping vocabulary source

Medium Example 2: Medium complexity Groupings created: each group member represents distinct complementary vocabulary source Groupings created: each group member represents distinct complementary vocabulary source “Base” Data Element

Medium Example 3: Medium complexity 18 instances

High Examples 1 and 2: High complexity

Next Steps Address remaining DE with high complexity Provide feedback to vMR update process Provide feedback to Value Set authors Get feedback from Implementers In the long run, adjust WG outcomes with other S&I initiatives and updates –Alignment between vMR and QDM –Incorporate UC1 Pilot feedback –Monitor evolution of Terminologies and Value Sets

WG Members George Robinson, PharmD (First Databank Inc,) Serafina Versggi (Eversolve) David Shields (OpenCDS) John Faughnan, MS (McKesson) Kim Nolen, PharmD (Pfizer) Ning Zhou (Intermountain Healthcare) Rob McClure, MD (MD Partners, Inc) Mark Roche, MD (Roche Consulting Inc) Victor Lee, MD (Zynx) Becky Angeles (ESAC, Inc) Aziz Boxwala, MD (Meliorix Inc) Steve Claypool (Wolters Kluwer) Claude Nanjo (Zynx) Howard Strasburg, MD (Wolters Kluwer)

Questions

Pilots Update – Work Stream 2 We will be meeting Monday March 18 th, 2013 (1-2:30 EST) Paul Arnone from Applied Pathways will be presenting The vocabulary and terminology team will be presenting The CDC will be presenting their Pilot Project Plan 2 new vendor participants (consumers) –SuccessEHS and DesignClinicals

HeD Pilots Goal - Modified 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.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. 4.Demonstrate intent of format specifically structures and semantics are communicated either by direct execution or by translation to native format 5.Ensure Completeness and consumability of artifact

Pilots Timeline 10/11/ Goal & Activities WeekDatesDeliverables 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 1-2 (4wks) 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 3-4 (2 wks.) 2/25-3/11 -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 5-10 (6 wks. or less depending on Pilot activity) 3/11 – 4/15 -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) 4/15-5/6-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.) 5/13-5/29-Documented ONC Feedback - Next Steps Action Plan We are Here

What We Covered This Week All three artifact types will be included in pilot HeD Schema Framework Tool Demo – Bryn Rhodes –Verifies HeD artifacts wrt use of expressions and vMR (generated from vMR schema) –Does not currently verify terminology usage, but could –For use during Pilot, after that – TBD Discussed idea of creating transformations to EMR system formats: include in pilot scope if possible

Next Steps Targeted to be finalized by end of this week: –Schemas –Implementation Guide –Examples At next week’s meeting (March 18): –Shu McGarvey will give CDC presentation –Work Plan Presentation –Begin mapping/harmonization and translating activities

Pilots Participants 1.Wolters Kluwer Health 2.OpenCDS 3.ZynxHealth 4.Medexter Healthcare 5.newMentor 6.CDC 7.NextGen 8.Practice Fusion 9.AllScripts 10.Visumpoint 11.Design Clinicals 12.SuccessEHS 13.Applied Pathways

Work Stream 3 -HeD Use Case 2 Development Data Element Requirements Review

Work Stream 1 – HL7: –Finalize Harmonization, Schema and IG activites –Next HL7 meeting March 13th, pm EDT (see HeD Homepage wiki for meeting details: –HL7 CQI meeting Harmonizing VMR/QDM –Next Meeting March 12 th 2013:, 3-4 pm EDT (see HeD Homepage wiki for meeting details: Work Stream 2 – Pilots: –We are beginning the work of pilots –Next Pilots meeting: March 11th, 1-2:30 pm EDT see HeD home page wiki for meeting details: –Review the posted pilot project plans Work Stream 3 – Use Case 2: –We will continue reviewing the components of Use Case 2 –Next meeting March 14th 11-12:30 EDT (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: Christina Arenas: –Use Case 2: Dave Shevlin: Virginia Rhiel: –Harmonization: Lynette Elliot: Merideth Vida: 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 –