1. Basic Data Provenance April 22, 2019
HL7 Security Work Group working session

2. Montreal WGM Preferred quarter to discuss Basic Provenance
Tuesday Q4 + Wednesday Q1 (joint with EHR)
Items to cover
Review selected use cases
Recap key basic provenance fields to display (discussion starts on this call!)
Handling of more detailed provenance when provided
Summer plans
Latest developments from USCDI
Continue alignment with broader provenance efforts

3. Timelines Task Date Develop priority use cases 2019 May WGM
Submit for Informative Ballot(First Ballot Cycle)
2019 Sep Ballot
Complete Informative Reconciliation
2019 November WGM
Request Informative Publication
2019 Dec
Project End Date
2020 Feb

4. What is purpose of the Provenance Information?
Help a clinician

5. Thoughts from the DoD and VA
DoD and VA have a special viewer (JLV) that shows HIE data provenance
Primary clinical use of this provenance info is to quickly find the right data
Secondary clinical use is as provide context for the data
Provenance data is extracted from various XPaths in CDAs (document, section, entry), but always from an author.assignedAuthor.representedOrganization

6. A Key Purpose of Basic Provenance Project
Provide organizational context for external patient data, when displayed to the Clinician.
-Source organization

7. Scenario 1: “Fax” What should be displayed to the user?
Point to point exchange between two sites. (e.g. DIRECT, patient provided upload). Not ‘imported’ yet.
Assumption throughout, only Author at header for discussion today. Will adjust in future.
Who
- Author of the information (could
What
- Action taking – lab report?
When
- Date/time stamp – possibly many but intended to match the particular exchange.
Where
- could be physical location, or network location, etc.
Why
- rationale for the test

8. Scenario 2: HIE Redistribution Is additional information beyond Scenario 1 required for the end-user?
Information is received by a provider from a HIE. The HIE received the information, stored it, and then passed with no content change.
HIE
Information could be stored – Not changed!
Query/retrieve
Push

9. Scenario 3: HIE Transformation What does the receiving end-user expect to see?
Information is received (e.g. v2 lab, other CCDs) and transformed by an HIE, stored, and then passed in a new format (CCD). Source data is not manipulated beyond transforming into a new format.
HIE
Consider
*3a – Change translations, code systems, automated deduplication.
*3b – ‘Data enrichment’ – Care gaps, potential manual deduplication.
What additional information is captured when HIE transforms the information into a new format?
Includes:
- Automated deduplication
- Adding translations

10. Scenario 4: “Clinical Information Reconciliation and Incorporation (CIRI)”
Provider stores information in their system – may have made changes.
Provider sends information to another provider (e.g. DIRECT).

11. Backup

12. Out of Scope Items
Content Scope: “Data Classes” NOT listed in draft USCDI
Full chain of custody
Provenance of how information is created, and managed within an EHR
Organizational policies on which individual authors to include
Blockchain
Assigning a level of trust to the person/system assigning the provenance
Additional metadata elements to support data reconciliation

13. Prior Provenance Efforts
Data Segmentation for Privacy (DS4P)
FHIR Provenance Resource
FHIR Provenance Profile directly in FHIR core
HL7 Version 3 Standard: Privacy and Security Architecture Framework - Volume 3 Provenance, Release 1 (recent ballot)
EHR Functional Model (profile on the FHIR Provenance resource)
IHE set of profiles - MHD profiles, QEDM, RECON profile
ONC Challenge for tracking provenance
ONC S&I Initiative on Data Provenance (led to CDA IG)
HL7 CDA R2 Data Provenance (written by CBCP)
EHR Lifecycle events – how an EHR manages a record over lifecycle events – focused on CRUD (27 lifecycle events)