1. July 20, 2007 Healthcare Information Technology Standards Panel Principles for Proper Use of HITSP Interoperability Specifications And Proposal for Proper Use of IS-03 CE Registration and Medication History

2. 1 Topics  Objective  HITSP Constructs  Well-defined ways to Use HITSP Construct  Proposal for use of HITSP IS-03 CE Registration and Medication History

3. 2 HITSP Construct Proper Use Objective of this Proposed Definition of Principles for Proper Use of HITSP Constructs  To clarify principles for appropriate, consistent use of HITSP Interoperability Specifications and other HITSP construct specifications by intended users.  Intended users include, for example: –HITSP Committees (e.g., in new work efforts) –CCHIT –Health Information Exchanges –Healthcare stakeholders (e.g., during IT systems procurements) –Healthcare IT Vendors –Healthcare Information policy makers

4. 3 HITSP Construct Proper Use Component (Composite) Transaction (Composite) Transaction Pkg. (Composite) For Internal Reuse HITSP Framework Use Case or Modification Request Interoperability Specification Transaction Package (1..m transactions or composite standards) Transaction (1..n components or composite standards) Component (1..c base or composite standards) Base Standard #1 Base Standard #4 Base Standard #2 Base Standard #3 Base Standard #5 Base Standard #... Base Standard #n SDOs For External Use Interoperability Specification Component (Composite) Transaction (Composite) Transaction Pkg. (Composite) For Internal Reuse

5. 4 HITSP Construct Proper Use General Perspective on types of Proper Use  Use of a HITSP Interoperability Specification and Associated Constructs. –HITSP Technical Committees defines ways users can appropriately use an IS and associated constructs  Longer term questions that will require definition of well- defined processes –Managing "internal consistency" across HITSP constructs below construct level – e.g., consistent vocabulary value set, same micro data structure for describing an allergy, use of OIDs in certain fields –External reuse/repurposing of a HITSP Construct that is not an Interoperability Specification

6. 5 HITSP Construct Proper Use Different Types Of External Use of an I.S. and Associated Constructs  Actor Scoping  Subsetting  HITSP Optionality

7. 6 HITSP Construct Proper Use Different Types Of External Use of an I.S. and Associated Constructs - Actor Scoping  For entire Interoperability Specification (IS), meet requirements for selected subset of Business and supporting Technical Actors.  Implement set of transactions and information components involving a specific sub-set of Actor(s) in IS. –E.g., for EHR-lab, implement information exchange for the laboratory information system Business Actor

8. 7 HITSP Construct Proper Use Different Types Of External Use of an I.S. and Associated Constructs - Subset  A subset is partial implementation of an Interoperability Specification –Must include at least two actors and a transaction. –May involve all or some of the IS defined Actors. –May be defined based on a subset of scenarios, information content, or semantic richness in the Interoperability Specification  Appropriate subsets are identified by HITSP Technical Committees to notify users what is allowed for a specific IS or construct. –Note: subsets will be documented in a later release for V2.0 of EHR-Lab, Consumer Empowerment, and Biosurveillance Interoperability Specifications (IS-01, 02 and 03).

9. 8 HITSP Construct Proper Use Different ways to subset  Scenario/workflow –Implement a subset of available scenarios for the I.S. –e.g., EHR-Lab use case has two sub-workflows: lab results to ordering providers and sharing historical lab results  Information content –Implement a portion of the information content of an I.S. –e.g., implement IS 03 Consumer Empowerment with only registration information and no medication information  Semantic richness –Add a well-defined alternative to a less constrained field –e.g., use of an optional coding system in addition to textual concepts

10. 9 HITSP Construct Proper Use HITSP Optionality  External entity may elect to exercise optionality identified by a HITSP IS or construct.  HITSP identifies optionality to support a domain choice (e.g., policy) rather than an individual implementation.  Optionality may be for a field in a message (e.g. laboratory phone number in a returned lab result that is optional in C-36).

11. 10 Topics  Objective  HITSP Constructs  Well-defined ways to Use HITSP Construct  Proposal for use of HITSP IS-03 CE Registration and Medication History

12. 11 HITSP Construct Proper Use Proposal for Actor Scoping and Subsets Definition for the Normal Usage of HITSP IS-03  This proposal is under development by the HITSP CE Technical Committee.  Goals are to allow implementations of subsets of HITSP IS-03, while ensuring smooth evolution towards the implementation of the complete use case.  Address real world needs, without introducing fragmentation which would be counter to the goal of interoperability.  Further input is welcome, especially from CCHIT.

13. 12 HITSP Construct Proper Use First selection: Actor Scoping  A specific IT system selects one or more business actor(s)  Selects among the optional corresponding technical actors (those required shall be implemented).

14. 13 HITSP Construct Proper Use Example: Actor Scoping for an EHR Business Actor  An EHR shall support the following Technical Actors: –Document Source –Document Consumer  An EHR shall support either: –A Patient Identity Source and a Patient ID Cross-Referencing Consumer –A Patient Demographics Consumer –Both of the above  An EHR may support the following Technical Actor: –Document Repository Conditional: Shall support: (1) Patient Identity Source + PIX Consumer, or (2) Patient Demographics Consumer, or (3) Both

15. 14 HITSP Construct Proper Use Second selection: One or more subsets  Subsets are focused on the content of the registration and medication history document.  All rely on the same document sharing transactions (TP-13) and patient identification (TP-22 or T-23).  A specific IT system for the Technical Actor it supports shall select one or more subsets among:

16. 15 HITSP Construct Proper Use Proposed Subset Definitions for Document Source

17. 16 HITSP Construct Proper Use Actor Scoping and Subsets Definition for the Normal Usage of HITSP IS-03  This proposal is under development by the HITSP CE Technical Committee.  Goal is to include in next revision of the IS-03 and to ensure that subset definition meets market need and CCHIT certification roadmap.  Cooperation with CCHIT is welcome in the next few weeks to define and approve.