1. Tools to Automate the S&I Platform A S&I Simplification Proposal in Collaboration with NIST and AHRQ March 29, 2013

2. Growing Portfolio of Module Based Initiatives But this has led to growing complexity and diverse designs, models and solutions Doug Fridsma to HITPC – 3/14/13 2Automating the S&I Platform3/29/2013

3. S&I Core Matrix Has Captured and Standardized S&I Initiatives...... as Shared, Reusable and Computable Components... Now we need a tool to use the Core Matrix 3Automating the S&I Platform3/29/2013

4. Components selected from S&I Initiative Use Cases Is it… Potentially Computable for… In Common? Re-Usable? Computable? Identity Accountability Permission, Consent Access, Data Use Performance/ Fulfillment Capture, Provenance Content: Struct/Unstruct Coding, Classification Completeness Signature Audit RequirementsYYY Actors, RolesYYY Events, ActionsYYY  As standards-based software services Data Objects, Elements YYY  As standards-based data objects, messages, documents… S&I Simplification Component Selection 3/29/2013Automating the S&I Platform4

5. Tools to Automate the S&I Platform USHIK Registry Repository Link to NLM NIST Test Methods S&I Core Matrix UCAT IGAT Business Requirements and SMEs Implementable Solutions CEDD/FHIM/CIMI Data Models and Mapping Standards Developers and Stewards 5Automating the S&I Platform3/29/2013

6. Automating the S&I Platform63/29/2013 R. Snelick May 8 th, 2012

7. NIST Role Experience with Use Case Authoring through SmartGrid and Model-Based standards development Developed automated test procedures, methods and tools for CEHRT and Mod Specs NIST sees the need for an implementation guide authoring tool (IGAT) which would use the UCAT for input UCAT is based on NIST SmartGrid platform with further specialization for the S&I Core Matrix by Art Griesser with LRI Use Case Automating the S&I Platform73/29/2013

8. Test System (Allow NIST/others to build tools quickly) Implementation Guide Authoring Tools (Create more “testable” specifications!) Test Cases and Testing Artifacts (e.g., Test Messages) Test Case Management Tool (Let domain experts help write the test cases!) Implementation Guides (Number is increasing rapidly— no testing tools available) HL7 v2 MU Syndromic Surveillance Implementation Guide NHIN HL7 V3 Patient Discovery Implementation Guides HL7 v2 MU incorporate Lab Results & Reportable Lab Results Implementation Guides HL7 v2 MU Immunization Reporting Implementation Guides IHE HL7 v2 PCD Technical Framework IHE HL7 v2 PIX/PDQ Technical Framework IHE HL7 v3 PIX/PDQ Technical Framework MU - 2016 Implementation Guides HL7 v2 and v3 Implementation Guides in General (HL7, CDC, PHIN, ISDS, ONC, etc.) More coming! How NIST Can Address the Increased Demand for Tools? 3/29/2013Automating the S&I Platform8 R. Snelick May 8 th, 2012

9. Implementation Guide Authoring & Management Tool The Big Picture: HL7 V2 End-to-end Testing Support HL7 v2 Standard Message Definition General Transaction Constraints (e.g., IG, TF, or user input)¹ HL7 v2 Standard Value Sets Test Case Requirements Vocabulary Library (XML) Conformance Profile (XML) Test Case Management and Authoring Tool Message Profiling Test Plan Execution Script (XML) Test Plan Template HL7 V2 Impl. Guide Template Test Plan English Document Data Sheets Impl. Guide English Document Specification Validation Context File (XML) ¹ Support existing specifications Use Cases Vocabulary Profiling Use Case Development Disposition Traceability Utilities IG Template Wizard Constraint Generator Test Case Development Test Script Generator Data Sheet and Juror Document Generator Test Plan Development Document Generator Message Maker Data Management Message Generation Testing Infrastructure Document Generator Execution Engine Validation Engine Test Agents Report Generation Communication Testing Environments Capabilities Artifact Repository Testing Tools Web Applications Testing Infrastructure Components Test Plan Integration Validation Resource Bundle Management Message Generation Engine Vocabulary Libraries (XML) Conformance Profiles (XML) Test Case Specific Context Files (XML) Domain Specific Tools Juror Documents Utilities Documentation Communication Resource Bundle Test Plan Execution Script (XML) R. Snelick May 8 th, 2012 Domain Experts Domain Experts and Test Case Developers User InputTool Generated Software Engineers Tool Developers Import Value Sets DITA XML 3/29/2013Automating the S&I Platform9

10. Why UCAT First? Foundational to all downstream automation and tools Highest leverage is at the beginning analysis and design of an initiative COnstructive COst Model – Overall effort is doubled if analysis is shortchanged Correct is hard... but easier than later fix Ounce of prevention Measure twice, cut once “By failing to prepare, you are preparing to fail” Ben Franklin Use Cases Study how users get value from system Define how users interact with system Help subsequent efforts deliver value Are contracts between users & developers Refer to Art Griesser Presentation in Appendix Automating the S&I Platform103/29/2013

11. Use Case Authoring Tool 11Automating the S&I Platform3/29/2013 Executable Verify ▶

12. Use Case Authoring Tool Specify how user gets value from system Describe interaction of user & system Abstractly 3/29/2013Automating the S&I Platform12 Tests Ensure Verify Concretely (specific test data) Use cases

13. UCAT Demonstration Reusable “atomic” Lego blocks Navigating through Lego assemblies Creating a new use case from existing blocks Reconstructing a use case document Seeing differences between use cases Browsing change history Multi-vocabulary support Access your data your way Automating the S&I Platform133/29/2013

14. S&I Simplification – Demonstration of Concept Use Case Tool Status Current Capabilities Imported Core Matrix Captured use case template structure Populated completely for LRI Can construct new use cases from reusable components Can create human readable use cases (in UC template) Can curate underlying UC information Can use underlying info programmatically SQL query Import: CSV UCAT Native Simplification Core Matrix ISO/HL7 10781/16527 EHR/PHR System Functional Models Export: JSON, CSV Ability to clone Additional Capabilities Ability to track status of information Component Lifecycle Management Next Steps Approve automated tools and Core Matrix approach for S&I and embed in process Complete UCAT as end user product Resolve licensing Add remaining 14 S&I Use Cases to UCAT One-time manual entry Refine Core Matrix master template Resolve differences from template USHIK Integration S&I Data Integration CEDD, FHIM, or CIMI... Evaluate and design handoff to downstream tools Implementation Guide Authoring Testing Tools, MDHT, V2 … 3/29/2013Automating the S&I Platform14

15. Capture Once, Re-Use Many Times Each Re-Use Instance = x 1 Savings Facilitate Cross S&I Initiative Coordination Facilitate Cross Agency/Domain Coordination Unlocking Value of S&I (maximizes re- use, return) Experience Shows: AHIC/HITSP: 4 Years, 17 Use Cases/Initiatives (4+/year) S&I: 2 Years, 13 Use Cases/Initiatives (6+/year) With UCAT: target 1 or 2 per week depending on similarity to previous use cases With IGAT, With Test Methods? Simplification – Automating the S&I Platform Benefits UC Requirements Implementation Guides Test Methods Faster, real world adoption S&I Platform Automated Tools Automating the S&I Platform153/29/2013

16. Links Gary Dickinson Presentation - Use Case Authoring Tool - Simplification Introduction Gary Dickinson Presentation - Use Case Authoring Tool - Simplification Introduction Art Griesser Presentation - "Use Cases" Slide Set Art Griesser Presentation - "Use Cases" Slide Set Frederic de Vaulx Presentation Rob Snelick IGAT – HL7 V2 Presentation S&I Core Matrix Progression Spreadsheet USHIK S&I Pilot Site UCAT Portal TBD Automating the S&I Platform163/29/2013

17. Acknowledgements Gary DickinsonCentriHealth / S&I Simplification WG Chair Michael Fitzmaurice / Robin BarnesAHRQ / USHIK Kevin Brady / Frederic deVaulx / Rob SnelickNIST Art GriesserPrometheus / NIST Contractor Steven HufnagelMilitary Health Services Contractor Caryn Just / Ed LarsenS&I Support Staff 3/29/2013Automating the S&I Platform17