0. HSSP Practitioners Guide Volume II
Immunization and Adverse Event Reporting Prototype
From HL7 and HITSP Artifacts
For presentation at HL7 Rio Workgroup Meeting, May 2010
Six Weeks to Rio, 19 March 2010 Minutes
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Details available at
HL7 “EHR SD RM” Lead Project
Editor
GovProjects, EHR, PHER, HSSP co-sponsors

1. Agenda Item Max Time Roll Call and Introductions 3 min
Overview Agenda min
Overview of HSSP Practitioners Guide Volume I 10 min
Overview of Services Aware Interoperability Framework (SAIF) 10 min
Overview of EHR System Design Reference Model (EHR SD RM) min
Overview of candidate HSSP Services for use in HSSP Practitioners Guide Volume II 10 min
Overview of DRAFT Table of Contents for HSSP Practitioners Guide Volume II 13 min
Wrap Up min

2. The Practical Guide for SOA in Health Care A real-world approach to planning, designing, and deploying SOA. Version 1.0, December An informative reference for leaders and decision-makers. Produced by the Healthcare Services Specification Project (HSSP): A collaborative effort between Health Level Seven (HL7) and the Object Management Group.
The figure illustrates a macro-view of a SOA. It depicts five overlapping boundaries, each of which represents a context within the business and architecture:
The Inter-organisational Boundary (outermost) represents inter-organisational considerations, such as policies, sharing agreements, and business partners.
The System Boundary represents the physical platforms on which software and systems run, including servers, networks, and so on.
The Application Boundary represents the software running on those platforms, inclusive of applications and data.
The Business Process / Orchestration Boundary manages the intersection between software and workflow, and would manage coordination among multiple software components that all must interact to satisfy business needs.
Finally, the Service Implementation Boundary depicts the implementations themselves, interacting across a service bus, and realizing the architecture.

3. The Practical Guide for SOA in Health Care
Table 3. SampleHealth Business Function Map
Healthcare-Unique Services
Business Svcs
SOA Infrastructure Svcs
Business Line
Order Entry
Order Fulfillment
Patient Evaluation (DSS)
Lab Data Retrieval
Pharmacy Data Retrieval
EHR
Alert/ Event Mgmt
Master Person Index
Terminology Service
Demographics
Billing
Scheduling
Auditing Service
Exception Mgmt
Business Process Mgmt (BPM)
Authentication
Services Directory
Access Control
Pharmacy X 
Laboratory
Patient Administration
Order Entry/Mgmt
Registration
Care Management
Referrals/Referral Mgmt
Nursing
Emergency Department
Patient Billing
Imaging/Radiology
Clinical Decision Support
Facilities Management
Nutrition Mgmt (Dietetics)

4. The Practical Guide for SOA in Health Care

5. Agenda Roll Call and Introductions 3 min Overview Agenda 2 min
Overview of HSSP Practitioners Guide Volume I min
Services Aware Interoperability Framework (SAIF) 10 min
Overview of EHR System Design Reference Model (EHR SD RM) min
Overview of candidate HSSP Services for use in HSSP Practitioners Guide Volume II 10 min
Overview of DRAFT Table of Contents for HSSP Practitioners Guide Volume II 13 min
Wrap Up min

6. The HL7 Services-Aware Interoperability Framework (SAIF)
SAIF Contains:
Enterprise Conformance and Compliance Framework (ECCF) is based on RM-ODP
Behavioral Framework (BF)
Interoperability Scenarios supporting the RM-ODP Computational Viewpoint
Governance Framework (GF)
Governance is the overarching policy structure and set of related processes by which a group exercises its authority and demonstrates accountability for accepted responsibilities within a particular jurisdiction.
SAIF Principles:
Applicable within each of HL7’s three Interoperability Paradigms (IPs),
(i.e., messages, documents, and services).
Provide support for measurable conformance and compliance.
Define appropriate governance structures and processes.
Provide support for directly implementable solutions.
Address the growing disparity between the various solution sets emerging from HL7.
Utilize existing V3/RIM artifacts and expertise to the maximum degree possible.

7. HL7 SAIF Specification Stack Views Conformance and Compliance Framework (ECCF)
Topic
Specification
Enterprise / Business View
“WHY”
Information
View
“WHAT”
Computational
“HOW”
Engineering
“WHERE”
Conceptual
Business Context, Reference Context
Domain Analysis (Information) Model
Collaboration Analysis, Functional Profile(s), Service Roles and Relationships
Existing Platform capabilities
Platform-
Independent
Business Governance
Project-oriented Domain Information Model, Constrained Information Model, Localized Information Model, Hierarchical Message Definition
Collaboration Types, Interface Specification and Functional Groups, Interaction Types and Collaboration Participations, Contracts Parts
Existing Platform models, libraries, etc.
Specific
Rules, Procedures
Localized Information Model, Transforms, Schema
Collaboration scripts, Orchestrations, Realized Interfaces
Execution Context, Platform Bindings, Deployment Model
Policy
Content
Behavior
Implementation
Traceable
Consistency

8. HL7 SAIF Responsibilities Conformance and Compliance Framework (ECCF)
Policy
“Why”
Content
“What”
Behavior
“How”
Implementation
“Where”
Traceable
Consistency

9. HITSP Within HL7 SAIF ECCF Specification Stack
Topic
Specification
Enterprise / Business View
“WHY”
Information
View
“WHAT”
Computational
“HOW”
Engineering
“WHERE”
Conceptual
Business Context, Reference Context
Domain Analysis (Information) Model
Collaboration Analysis, Functional Profile(s), Service Roles and Relationships
Existing Platform capabilities
Platform-
Independent
Business Governance
Project-oriented Domain Information Model, Constrained Information Model, Localized Information Model, Hierarchical Message Definition
Collaboration Types, Interface Specification and Functional Groups, Interaction Types and Collaboration Participations, Contracts Parts
Existing Platform models, libraries, etc.
Specific
Rules, Procedures
Localized Information Model, Transforms, Schema
Collaboration scripts, Orchestrations, Realized Interfaces
Execution Context, Platform Bindings, Deployment Model
Policy
Content
Behavior
Implementation
HITSP Harmonization Framework
HITSP DA
HITSP CAP
Harmonization Requests/ Use Case
HITSP CAP
HITSP IS
HITSP
Component
HITSP
Transaction, Transaction Package and Service Collaboration
Traceable
EHR-S FM is EHR System Functional Model
EHR SD RM is EHR System Design Reference Model
RIM is Reference Information Model
FHIMS is Federal Health Information Model & Standards
DA is Data Architecture
Consistency 9

10. HL7, HITSP, FHIMS and NHIN Within HL7 SAIF ECCF Specification Stack
Topic
Specification
Enterprise / Business View
“WHY”
Information
View
“WHAT”
Computational View
“HOW”
Engineering
“WHERE”
Conceptual
Business Context, Reference Context
Domain Analysis (Information) Model
Collaboration Analysis, Functional Profile(s), Service Roles and Relationships
Existing Platform capabilities
Platform-
Independent
Business Governance
Project-oriented Domain Information Model, Constrained Information Model, Localized Information Model, Hierarchical Message Definition
Collaboration Types, Interface Specification and Functional Groups, Interaction Types and Collaboration Participations, Contracts Parts
Existing Platform models, libraries, etc.
Specific
Rules, Procedures
Localized Information Model, Transforms, Schema
Collaboration scripts, Orchestrations, Realized Interfaces
Execution Context, Platform Bindings, Deployment Model
Policy
Content
Behavior
Implementation
HL7 EHR-S FM
HITSP Harmonization Framework
HL RIM
FHA FHIMS
HITSP DA
HITSP CAP
Harmonization Requests/ Use Case
HITSP Capability
Tomcat, JBoss, J2SE, Eclipse, GlassFish ESB, OpenSSO
HL7 EHR SD RM
HITSP IS
HITSP
Component
HITSP
Transaction, Transaction Package and Service Collaboration
NHIN Connect
Services
Traceable
EHR-S FM is EHR System Functional Model
EHR SD RM is EHR System Design Reference Model
RIM is Reference Information Model
FHIMS is Federal Health Information Model & Standards
DA is Data Architecture
Consistency 10

11. Agenda Roll Call and Introductions 3 min Overview Agenda 2 min
Overview of HSSP Practitioners Guide Volume I min
Overview of Services Aware Interoperability Framework (SAIF) 10 min
EHR System Design Reference Model (EHR SD RM) 10 min
Overview of candidate HSSP Services for use in HSSP Practitioners Guide Volume II 10 min
Overview of DRAFT Table of Contents for HSSP Practitioners Guide Volume II 13 min
Wrap Up min

12. Federal Enterprise Architecture (FEA) www.whitehouse.gov/omb/egov
Performance Reference Model - The FEA PRM is a framework to measure the performance of major IT initiatives and their contribution to program performance. The PRM leverages performance measurement best practices from the public and private sectors, including the Balanced Scorecard, Baldrige Criteria, Value Measurement Methodology, program logic models, the value chain, and the theory of constraints. There is an increased emphasis placed on linkage of investment to agency program performance and the PRM will help agencies produce enhanced performance information. Furthermore, the PRM will assist in: improving the alignment of program goals and objectives with Mission Area goals and objectives; improving communication of program contributions such as technology (input) to outputs and outcomes; and in identifying improvement opportunities that span traditional organizational boundaries.
Business Reference Model - The Business Reference Model (BRM) is a functional-driven framework for describing and organizing the day-to-day business operations of the Federal Government into Lines of Business (LOBs), independent of the agencies that perform the business operation. The BRM is the first layer of the Federal Enterprise Architecture and it is the organizing construct for the analysis of the other four reference models: performance, service components, data, and technology.
Service Component Reference Model - The Service Component Reference Model (SRM) is a functional framework to evaluate to identify government-wide opportunities to leverage IT investments and assets from a service perspective. This model helps understand the services delivered by the government and assess if there is an opportunity to group like services and create leverage opportunities, such as reuse or shared services.
Data Reference Model - The Data Reference Model (DRM) describes at an aggregate level, the data and information required to support the Lines of Business (LOBs). The three elements of data exchange that have been standardized include data description, data context, and data sharing. Establishing a common data model streamlines the information exchange process within and across the Federal Government and facilitates the ability to identify duplicative data resources.
Technical Reference Model - The Technical Reference Model (TRM) establishes a common technical framework for categorizing standards, specifications, and technologies that support and enable the delivery of services. This framework can be leveraged to support the development, delivery, and exchange of business and application components (Service Components) that may be leveraged in a Component-based or Service Oriented Architecture (SOA). Furthermore, it also serves as the foundation to advance the re-use of technology and best practices from each of the Service Components on a government-wide basis.

13. EHR Future State Reference Architecture
Functional Analysis
Object Analysis
Requirements Analysis
Interface Design Analysis
Service Analysis

14. HL7 EHR System Functional Model (EHR-S) > 160 System Functions in 4 level categorization (separate spreadsheet available for full enumeration)
EHR-S FM functions can be grouped into Service Components … aka Capabilities (e.g., Lab Order Capability, which does eligibility and authorization function as well as lab order function).
System Functions
Other
O Electronic Resource Planning (ERP)
O Finances
O Other
NOTE: “Other” Category - The EHR-S model does NOT include Electronic Resource Planning (ERP) / Logistics and Financial components, which are needed for completeness of a Health IT Enterprise. 14

15. Healthcare SOA Framework Based on HL7 EHR System Functional Model & Thomas Erl’s SOA Layers
HL7 System Functions 
Direct Care
Supportive
Information Infrastructure
Other
Business
Process
Value Chains
Composite
Services
Federated Composition (e.g., Choreograph or Orchestration) Within and Across Business Areas
Core Business
Functional
Areas + Focal Classes
Entity
Information
Management
Reporting and Management
Agnostic Services
C r o s s T e c h n I c a l “Common S e r v I c e s”
(e.g., Security, Privacy, Auditing, Logging…)
Application
Ambulatory Care Systems,
In Patient Care Systems
Logistics Systems
Financial Systems
Decision Support Systems
Data Marts
Repositories
Business Objects
Implementation
Profiles
Integrated Healthcare Enterprise (IHE) Profiles
Analysis Profiles
Communications Profiles/Stacks
Implementation Profiles
Re: Focal Classes:
 The issue is less the idea of a focal class than a business focal class.
The difference is that when you model the service, you are generally modeling a service that will express the state changes of a business.
For example, via analysis, you would find the states of a business focal class (canceled, new, active, signed, finalized in lab orders for
example) and the trigger events that would correspond to state changes ("a lab is ordered", "a lab is canceled", "a lab specimen is corrupted", and so on).
 You could say that a "patient" is a focal class, but a patient ID service generally doesn't express operations to modify the state of that "object". Rather, a patientID service would generally encompass operations that would express information about the class (reconcileID or lookUpID, eg) rather than tying the service functional components to changes in the state of that class.
 It is not a subtle distinction - most clinical domains are focused on a focal class (an order, an encounter, an appointment, a schedule, a lab).
A business service is focused with exposing that class to the enterprise.
 Infrastructure services (or the subset information services) are generally function calls or based on exposing sets of information. The functional profiles of the service are generally not focused on the state of the underlying information or in the trigger events that modify the state of that information. They tend to be focused along different lines - typically along the lines of an information profile (a RIM-based patient class, eg, or a CDA-based CCD).
The focal class is explicit in a business service, generally implicit in other services. 15 15

16. HL7 RIM (Reference Information Model) Six Core Classes Defining a Semantic Framework which Maintains Clinical Data Context
ENTITY
ROLE
ACT (aka ACTION)
Participation
Role link
Act relationship
ACT – something that has happened or may happen
Entity – a person, animal, organization, or thing
Role – a responsibility of, or part played by, an Entity
Participation – the involvement of a Role in an Act
Act Relationship – a relationship between two Acts
Role Link – a relationship between two Roles.
The HL7 RIM expresses the data content needed in a specific clinical or administrative context and provides an explicit representation of the semantic and lexical connections that exist between the information carried in the fields of HL7 messages.
Language /
communication
The HL7 RIM supports EHR interoperability; an EHR may needs additional foundation classes (e.g., Responsibility)

17. HITSP Harmonization FrameworkIS
Capability
Service Collaboration
Transaction, Transaction Package
Components
IS = Interoperability Specification
Addressing
Business
Needs
Available
for Independent
Implementation
Providing
Infrastructure,
Security,
Privacy
Defining
Information
Content
Data Architecture
Base and Composite Standards

18. Agenda Roll Call and Introductions 3 min Overview Agenda 2 min
Overview of HSSP Practitioners Guide Volume I min
Overview of Services Aware Interoperability Framework (SAIF) 10 min
Overview of EHR System Design Reference Model (EHR SD RM) min
Candidate HSSP Services for use in HSSP Practitioners Guide Volume II
Overview of DRAFT Table of Contents for HSSP Practitioners Guide Volume II 13 min
Wrap Up min

19. Candidate HSSP Services for use in HSSP Practitioners Guide Volume II
CTS2 (Common Terminology Services 2) CTS 2 will be a commonly accepted standard for terminology services that enhances the capabilities of the initial CTS specification for sub-setting and mapping, and extends the specification into domains such as terminology distribution, versioning, and classification.
DSS (Decision Support Service) A commonly accepted standard for the DSS would make it more attractive for service consumers to invest in the infrastructure required for using the DSS to meet its patient evaluation needs, as they would be able to use the same interface to interact with multiple service vendors.
HCPDS (Healthcare Provider and Services Directory Service) HCPDS is required to provide an online facility that will enable Practitioners, via a set of parameters, to locate other practitioners, to assist in the continuum of care.
IXS (Identity Cross-Reference Service, formerly known as Entity Identification Service) Normative In balloting to become a full HL7 standard.
PASS (Privacy, Access and Security Services) The goal of PASS is to define a suite of services that will provide a simple interface for all privacy, access control, consent, identity management and other security services that are needed in a service-oriented health information architecture.
RLUS (Retrieve, Locate and Update Service) and EIS (Entity Identification Service) The HL7 SFM has been approved by the HL7 Board as an official DSTU.

20. Agenda Roll Call and Introductions 3 min Overview Agenda 2 min
Overview of HSSP Practitioners Guide Volume I min
Overview of Services Aware Interoperability Framework (SAIF) 10 min
Overview of EHR System Design Reference Model (EHR SD RM) min
Overview of candidate HSSP Services for use in HSSP Practitioners Guide Volume II 10 min
DRAFT Table of Contents for HSSP Practitioners Guide Volume II
Wrap Up min

21. DRAFT Table of Contents for HSSP Practitioners Guide Volume II
See “HSSP Practitioners Guide Volume II May 2010 – DRAFT-A.Docx”
Note that the version will change each week … A, B, C D, … till HL7 Rio
Versions available at
Weekly Agenda/Minutes
Weekly Read Ahead Slides
Weekly updated “HSSP Practitioners Guide Volume II May 2010 DRAFT-A.Docx”

22. Call for Participation – HL7 in Rio
We are inviting all interested to participate in the 11th International HL7 Interoperability Conference (IHIC-2010), to be held in Rio de Janeiro, Brazil on May This time will be the first for IHIC in South America. Following the success of previous IHIC venues in Kyoto(2009), Crete (2008), New Zealand (2007), Germany (2006), Taiwan (2005), Mexico (2004), IHIC2010 aims to serve as a meeting place for more than 30 HL7 affiliates around the world as well as individuals interested in interoperability and standards, to share their HL7 implementation experience and strengthen their shared vision. The paper submissions are invited to show to the international community successful experiences using HL7 V3 and CDA R2 interoperability between informatics applications using standards. Also, results and experiences from the collaborative use of standards are most welcome, especially if they are related to HL7 standards.
Topics of interest include but are not limited to the following:
HL7 implementation experience from regional, trans-regional, or national implementation:
• HL7 v2.x and 3.0 messages
• Clinical Document Architecture (CDA)
• Imaging Diagnostics and DICOM Standard
• Use of HL7 in IHE profiles
• Terminologies, Ontologies and Coding Systems: use of local and international
standards
• Use of other standards in combination with HL7 standards: ASTM, ISO, CEN, etc.
Business Models, regional & large scale deployment:
• Electronic Healthcare Record: from strategy to implementation
• Legal and regulatory issues.
• Epidemiology, disease surveillance and control
• Geographical information systems for population health
• Disaster medicine, emergency management and public health
This year, along with the successful “Show me your CDA!” track, IHIC will also incorporate the "Send me your CDA!" HL7 CDA Interoperability Showcase to display basic interoperability of applications using a HL7 V3 and HL7 CDA R2 standards. All submitted papers will be reviewed based on their technical quality and merit by the technical committee and reviewers. Papers that describe research and experimentation are encouraged. All paper submissions will be handled electronically using IEEE format, and detailed instructions on submission procedure will be available on IHIC2010 web pages ( Accepted papers will be published online. For other information, please contact IHIC2010,
Important Dates:
• Call For papers : November 2, 2009
• Deadline for submissions extended to February 15, 2010
• Evaluation and notification, March 15, 2010
• Camera-papers ready due : April 15, 2010

23. Agenda Roll Call and Introductions 3 min Overview Agenda 2 min
Overview of HSSP Practitioners Guide Volume I min
Overview of Services Aware Interoperability Framework (SAIF) 10 min
Overview of EHR System Design Reference Model (EHR SD RM) min
Overview of candidate HSSP Services for use in HSSP Practitioners Guide Volume II 10 min
Overview of DRAFT Table of Contents for HSSP Practitioners Guide Volume II 13 min
Wrap Up min

24. Wrap Up Any new attendees? Agenda Time Metrics
Volunteers to help prepare for next week’s meeting?
Do we need one-on-one working meetings?
Suggestions for Improvement
Next Meeting March 26, 2010 at 12:30 Eastern Time
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