1. Health eDecisions (HeD) All Hands Meeting June 13th, 2013

2. 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

3. 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

4. Announcements Vocabulary and Terminologies sub work will be changing their meeting date. (there is no meeting this week) – stay tuned for meeting updates HeD Meetings (By Day) WeekdayMeetingTime MondayPilots (UC 1)1-2:30 EST TuesdayCDS-HeD Working Meeting3:00-4:00 EST WednesdayStandards Sub work Group Call1:00-2:00 EST ThursdayAll Community Call11:00-12:30 EST TBDVocabulary and Terminology

5. HL7 Update We have completed a rough draft of the Implementation Guide –http://wiki.siframework.org/HeD+Pilot+Toolshttp://wiki.siframework.org/HeD+Pilot+Tools 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: http://wiki.siframework.org/HeD+Pilot+Tools http://wiki.siframework.org/HeD+Pilot+Tools We are now meeting on Tuesdays from 3-4 pm to discuss HL7 topics for both UC 1 and UC 2

6. HeD Pilots Update…ALMOST We met this week 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

7. 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

8. 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

9. 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

10. Use Case 2

11. SDS & Harmonization HeD Agenda Timeline Overview HeD UC2 vMR Mapping Template Update Sub Work Stream and Work Products review DSS Profile Update 11

12. SDS & Harmonization HeD Agenda Timeline Overview HeD UC2 vMR Mapping Template Update Sub Work Stream and Work Products review DSS Profile Update 12

13. 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 Develop Mapping Template 6/4-6/10 Update Mapping Template with vMR 6/6-6/19 Update Mapping Template with C-CDA/QRDA Semantics 6/10-7/1 Update vMR XML IG 7/12-7/19 Determine Container vs Payload Data Elements 6/19-6/22 Develop vMR Container Profiles 6/22-6/28 Update vMR DAM with Semantics 7/2-7/11 Develop vMR Payload Profiles by Functional Interaction Type 7/12-7/22 Vendor Outreach to Determine Functional Interaction Types for Inclusion 6/5-6/19 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 6/19-6/26 Update HeD UC1 IG 7/12-7/19

14. 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 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 August 27 – September 2 Submit Comments to HL7 on September 3 14

15. SDS & Harmonization HeD Agenda Timeline Overview HeD UC2 vMR Mapping Template Update Sub Work Stream and Work Products review DSS Profile Update 15

16. HeD UC2 vMR Mapping Template Dave Shields has created a tool/spreadsheet to map the UC2 data elements to vMR, aligned with CCDA and QRDA, for specific templates. Important to drive forward and meet our deadlines while staying grounded with the requirements in UC2

17. HeD UC2 vMR Mapping Template Continued… Data Element Set/ SectionData ElementsData Element DescriptionsProblem ListImmunizationsVital SignAdvanced Directives PersonTypeA type of person (e.g., Patient, Relative) PersonEvaluated Person ID The evaluated Person’s unique identifier, normally used for internal implementation tracking purposes. Does not need to be the evaluated Person’s "real" identifier, although it may be used for that purpose. PersonAddressLocation information for the evaluated person PersonBirth date/time Specific or ranges of birth dates and times of evaluated persons PersonGenderOne or more gender categories of evaluated persons PersonCurrent AgeSpecific age or age range of evaluated persons PersonDeceased Indicator Indicator of whether or not the evaluated person is alive or is deceased A tab has been created labeled “HeD UC2 Data Elements” This tab contains all UC2 Data Elements as well as the templates(tabs) contained in the spreadsheet This tab can keep track of which data elements have been mapped to specific templates Data elements not mapped to any specific template will be easily identifiable

18. HeD UC2 vMR Mapping Template Continued…  All columns have been defined on what information to capture  20 templates have been initially chosen for mapping Ken has made a suggestion to change the tabs to “Categories” instead of “Templates” o Each category will have specific templates related to that category in one tab, with the columns repeated for each template o Each category is it’s own tab in order to divide the work. o Can combine all categories and templates into one master tab It was decided that initially, vMR data elements would be the base and would be mapped to CCDA and QRDA HeD UC2 data elements would then be mapped for each template afterwards o Bryn Rhodes has done an initial mapping of vMR data elements to HeD UC2 clinical data elements. Bryn will complete the rest of the data elements. Bryn will populate each template with the applicable data elements o The HeD Internal team will then being filling out the CCDA and QRDA columns o David Tao has provided a document with Guidance for this mapping 18

19. HeD UC2 vMR Mapping Template Bryn’s Suggestions Categories may be at too granular a level –Elements of the vMR will tend to be duplicated quite a bit –If we have a single category for each kind of data within vMR, the overall effort could be more manageable. Suggestion is for now, to collapse the categories to only those categories that map directly to concept types within the vMR –Demographics –Adverse Events –Encounters –Goals –Observations –Problems –Procedures –Medications (Substance Administration) –Supplies 19

20. HeD UC2 vMR Mapping Template Victor’s Questions on “HeD/vMR Value Restriction to Date” Column Are all of our recommendations final? Becky and Rob had noted that we were sometimes inconsistent regarding whether our “final answer” was placed in the “Proposed Values” column or the “Working Solution” column—did we ever fix that to achieve consistency? Is there a way to validate that the entries in this column accurately represent the recommendations from the VST SWG? 20

21. SDS & Harmonization HeD Agenda Timeline Overview HeD UC2 vMR Mapping Template Update Sub Work Stream and Work Products review DSS Profile Update Planned Meetings for the Week 21

22. HeD UC2 Guidance Subworkstream HeD UC2 Guidance Subworkstream vMR Extensions Subworkstream vMR Extensions Subworkstream vMR-QRDA-CCDA Alignment Subworkstream vMR-QRDA-CCDA Alignment Subworkstream DSS Subworkstream DSS Subworkstream IG and Standards Development Activities to support HeD UC2 Solution New Decision Support Service (DSS) IG Updated DSS Standard Updated vMR DAM Updated vMR XML IG Updated HeD UC1 IG DSS Profile for CDS Request with SOAP DSS Profile for CDS Response with SOAP DSS Profile for CDS Request with REST DSS Profile for CDS Response with REST vMR Container Profiles for Response & Request vMR guidance for request payload Semantics guidance, leveraging modified vMR DAM Examples based on functional interaction type Add in section detailing how DSS is intended to work with REST for general use Modify DSS to accommodate REST, as necessary Extend vMR with context (for request) and actions (for response) as specified in UC2 Modify vMR to align with QRDA & C-CDA semantics Align XML IG with updated vMR DAM as necessary Align HeD UC1 IG with updated vMR DAM as necessary HeD S/vMR guidance for response payload

23. HeD UC2 vMR Templates  Open Question:  How will the newly identified & defined templates feed into the final work products  DSS IG  vMR DAM  vMR XML IG  HeD UC2 IG 23

24. SDS & Harmonization HeD Agenda Timeline Overview Sub Work Stream and Work Products review HeD UC2 vMR Mapping Template Update DSS Profile Update 24

25. DSS Profile Update 25 TaskOwner & Resources DurationTarget Start Date Target End Date Dependencies Develop DSS Profile for Request with RESTBryn Rhodes 10 Days6/46/21DSS Update with REST guidance Develop DSS Profile for Response with RESTBryn Rhodes 10 Days6/106/24DSS Update with REST guidance 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/Dav e Shields (as needed) 15 Days6/46/24Defining model for additional elements

26. Appendix

27. HeD UC2 Finalized Technical Solution Based on feedback from all proposed solutions, the HeD Leadership Team is proposing the following solution: Create implementation guidance that leverages vMR as the base model but is aligned with C-CDA and QRDA (semantics, terminologies, and templates) to the highest extent possible. –Solution will be to update the vMR model to align with the semantics of C-CDA and QRDA to the extent possible and reasonable –vMR is a streamlined data model for CDS. This model is at a similar level of granularity to models such as Green CDA Pursue both SOAP and REST for the updated DSS IG for September 2013 –Based on pilots, a choice may be made between SOAP and REST We will utilize the Functional Interaction Types to guide the IG development –Use as building blocks of data that are coordinated to meet functional interaction types –Have a section in the IG having profiles that people vote on for different interaction types if we feel confident. If we don’t feel confident, then they will strictly be examples –Leverage pilots from UC1 for functional interaction types. Can start with Immunization Forecasting and Quality Measure Evaluation. See what feedback we get and if any other interaction types would be useful

28. Long-term Industry Need HeD UC2 Scope Potential future or parallel work Updated vMR Model HeD UC2 Data Requirements QRDA Semantics C-CDA Semantics HeD UC2 Finalized Technical Solution The revised solution approach still aligns with the long-term industry need, but has been limited to a more manageable and Use Case-appropriate scope: Foundational Model (e.g. FHIM) Future Standards? QRDAC-CDA Harmonized vMR/QDM Model

29. Request Service: DSS Request Element Request Items Organizer/Container: vMR Request Item Payload: vMR Clinical Statement vMR Payload This approach would support vMR as the payload standard with mappings to CCDA and QRDA CDS Request

30. CDS Response HeD Schema/vMR Response Service: DSS Response Element Response Items Organizer/Container: Harmonized vMR/HeD Schema Response Item Payload: vMR Clinical Statements

31. New Decision Support Service (DSS) IG DSS Profile for CDS Request with SOAP DSS Profile for CDS Response with SOAP DSS Profile for CDS Request with REST DSS Profile for CDS Response with REST vMR Container Profile for Response vMR Container Profile for Request vMR guidance for request payload HeD S/vMR guidance for response payload Examples based on functional interaction type Modify vMR to align with QRDA & C-CDA semantics Updated DSS Standard Add in section detailing how DSS is intended to work with REST for general use Modify DSS to accommodate REST, as necessary Updated vMR DAM Extend vMR with additional context as specified in UC2 Extend vMR to be able to relay actions as specified in UC2 Modify vMR to align with QRDA & C-CDA semantics Updated vMR XML IG Align XML IG with updated vMR DAM as necessary Updated HeD UC1 IG Align HeD UC1 IG with updated vMR DAM as necessary IG and Standards Development Activities to support HeD UC2 Solution

32. Activities by Work Product

33. HeD UC2 Critical Harmonization Activities & Timeline Considerations: New Decision Support Service (DSS) IG TaskOwner & ResourcesDurationTarget Start Date Target End Date Dependencies Update IG template to reflect necessary sectionsSupport Team/Community 1 Week5/296/4 Write Overview of Modular Transport Solution in IGSupport Team Develop DSS Profile for Request with SOAPDave Shields Develop DSS Profile for Response with SOAPDave Shields Develop DSS Profile for Request with RESTBryn RhodesDSS Update with REST guidance (see next slide) Develop DSS Profile for Response with RESTBryn RhodesDSS Update with REST guidance (see next slide) Group UC2 Data Elements by Request vs. Response and by Container vs. Payload Rob McClure/Dave Shields/ Bryn Rhodes Develop vMR Container Profile for RequestAziz Boxwala/Dave Shields 6/36/21UC2 Data Element Grouping vMR Updates Develop vMR Container Profile for ResponseAziz Boxwala/Dave Shields 6/36/21UC2 Data Element Grouping vMR Updates Develop vMR Request Payload Profile for specific functional profile interaction types Dave Shields/Claude Nanjo/ Victor Lee/Bryn Rhodes vMR Updates Develop HeD S/vMR Response Payload Profile for specific functional profile interaction types Dave Shields/Claude Nanjo/ Victor Lee/Bryn Rhodes vMR Updates Map UC2 Payload Request & Response Data Elements to vMR modelVictor Lee/Claude Nanjo/Bryn Rhodes UC2 Data Element Grouping Align vMR with QRDA and CCDA semantics (Done by functional Interaction Type) Rob McClure/Dave Shields/Mark Roche/Claude Nanjo

34. HeD UC2 Critical Harmonization Activities & Timeline Considerations: Decision Support Service Standard Updates Decision Support Service Standard TaskOwner & Resources DurationTarget Start Date Target End Date Dependencies 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) Defining model for additional elements

35. HeD UC2 Critical Harmonization Activities & Timeline Considerations: vMR Domain Analysis Model Updates vMR Domain Analysis Model TaskOwner & Resources DurationTarget Start Date Target End Date Dependencies Map UC2 Payload Request & Response Data Elements to vMR modelClaude NanjoUC2 Data Element Grouping Map vMR DAM to semantics, terminologies and templates used by QRDA, C-CDA Claude Nanjo/Victor Lee/Rob McClure Extend vMR to include additional context as specified in UC2 for request Claude Nanjo Extend vMR capability to support communication of “actions” in response Claude Nanjo Update vMR with any required changes to semantics, terminologies and/or templates based on harmonization effort Claude Nanjo/Victor Lee/Rob McClure vMR DAM mapping to QRDA, C-CDA

36. HeD UC2 Critical Harmonization Activities & Timeline Considerations: New Decision Support Service (DSS) IG TaskOwner & Resources DurationTarget Start Date Target End Date Dependencies Introduction Introduction: Purpose Introduction: Approach Introduction: Intended Audience Introduction: Intended Audience – Requisite Knowledge Introduction: Organization of this Guide Introduction: Organization of this Guide – Conformance Verbs (Key Words) Introduction: Organization of this Guide – Cardinality Introduction: Organization of this Guide – Definition of Actors Implementation Approach Implementation Approach: Pre Conditions Implementation Approach: Constraints Suggested Enhancements Appendices: Definition of Acronyms and Key Terms Appendices: Conformance Statement List Appendices: Templates List Appendices: Specifications References

37. Work Stream 1 – HL7: –Tuesday June 18 th, 2013: http://wiki.siframework.org/Health+eDecisions+Homepage http://wiki.siframework.org/Health+eDecisions+Homepage Work Stream 2 – Pilots: –Next Pilots meeting: June 17th, 1-2:30 pm EDT see HeD home page wiki for meeting details: http://wiki.siframework.org/Health+eDecisions+Homepage http://wiki.siframework.org/Health+eDecisions+Homepage –Updates on Pilot Activities, Review of Use Case Work Stream 3 – Use Case 2: –Data Elements and Standards Sub Work Group Next Meeting: June 19 th, 2013 Homepage wiki for meetings: http://wiki.siframework.org/Health+eDecisions+Homepage http://wiki.siframework.org/Health+eDecisions+Homepage All Hands Community Meeting –Next meeting June 20th, 2013(see the HeD Homepage wiki for meeting details: http://wiki.siframework.org/Health+eDecisions+Homepage http://wiki.siframework.org/Health+eDecisions+Homepage Next Steps

38. Questions?

39. Contact Information For questions, please contact your support leads –Coordinator: Ken Kawamoto: kensaku.kawamoto@utah.edukensaku.kawamoto@utah.edu –Co-Coordinators: Aziz Boxwala: aziz.boxwala@meliorix.comaziz.boxwala@meliorix.com Bryn Rhodes: bryn@veracitysolutions.combryn@veracitysolutions.com –ONC Leadership: Alicia Morton: alicia.morton@hhs.govalicia.morton@hhs.gov –Project Management: Jamie Parker: jamie.parker@esacinc.comjamie.parker@esacinc.com –Use Case 2: Dave Shevlin: d.s.shevlin@accenturefederal.comd.s.shevlin@accenturefederal.com Virginia Rhiel: virginia.riehl@verizon.netvirginia.riehl@verizon.net –Harmonization: Lynette Elliot: lynette.elliott@esacinc.comlynette.elliott@esacinc.com Anna Langhans: anna.langhans@accenture.comanna.langhans@accenture.com

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