1. Health eDecisions RI/ Pilots Sub-Workgroup June 24th, 2013 10/11/20111

2. Agenda Announcements Review and Revisit of Goals Review of RI/Pilot Sub-WG Timeline Pilot Updates: Zynx/DesignClinicals – Order Sets Continued Findings and Discussion AllScripts and NewMentor (Million Hearts – MU NQF 68) VA and Wolters Kluwer - Demo CDC and Allscripts Planning for the Open House Review Implementation Guide Review Action Items, Next Steps

3. Announcements We will be reviewing the IG in our next 2 workgroup Meetings We need to plan an “Open House” to display our pilots work July 8 th (during our regular Pilots call) 10/11/20113

4. Pilots 10/11/20114 OrganizationPilot LeadEmailOrganization’s Role Wolters Kluwer HealthSue Johnson/Steve Claypool/Howard Strasberg/Christy May sjohnson@uptodate.com steve.claypool@wolterskluwer.com howard.strasberg@wolterskluwer.com christy.may@wolterskluwer.com Service Supplier/Artifact Supplier OpenCDSDavid Shieldsdavid.shields@opencds.orgService Supplier Zynx Health Claude Nanjo (primary) Bernadette Minton Victor Lee CNanjo@zynx.comCNanjo@zynx.com (primary) bminton@zynx.com bminton@zynx.com VLee@zynx.com Service Supplier/Artifact Supplier Medexter Healthcare Klaus-Peter Adlassnig Karsten Fehre kpa@medexter.com kf@medexter.com Service Supplier newMentor Julie Scherer Matt Pfeffer jscherer@newmentor.com mpfeffer@newmentor.com Service Supplier/Artifact Supplier CDC Shu McGarvey Laura Conn aky1@cdc.gov lbk1@cdc.govGovernment /Service Supplier/Artifact Supplier NextGen Dr. Sarah Corley Dr. Jeff Friedlin Gary Wietecha scorley@nextgen.comscorley@nextgen.com, jfriedlin@nextgen.com,jfriedlin@nextgen.com Gwietecha@nextgen.com EHR Vendor Practice Fusion Lauren Fifield Michael Poremba lfifield@practicefusion.com mporemba@practicefusion.com EHR Vendor AllScripts Douglas Gentile Robin Williams (primary) Douglas.Gentile@allscripts.com Robin.Williams3@allscripts.comRobin.Williams3@allscripts.com (primary)EHR Vendor Design ClinicalsDewy Howelldeweyhowell@designclinicals.comEHR Vendor SuccessEHSClaude Ouimet claudeo@successehs.com EHR Vendor Applied PathwaysPaul Arnonepaul.arnone@appliedpathways.comService Supplier

5. Support Team Support Team: Pilots Lead: Jamie Parker: jamie.parker@esacinc.comjamie.parker@esacinc.com Support: Ali Khan: Ali.Khan@esacinc.comAli.Khan@esacinc.com Subject Matter Expert: Aziz Boxwala: aziz.boxwala@meliorix.comaziz.boxwala@meliorix.com Subject Matter Expert: Bryn Rhodes: bryn@veracitysolutions.combryn@veracitysolutions.com Use Case 1: Dave Shevlin: d.s.shevlin@accenturefederal.comd.s.shevlin@accenturefederal.com Implementation Guide: Lynette Elliot: lynettte.elliott@esacinc.comlynettte.elliott@esacinc.com SDO Support: Anna Langhans: anna.langhans@accenture.comanna.langhans@accenture.com 10/11/20115

6. 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 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

7. Timeline 10/11/20117 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 – 5/20 -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 2wks5/20 -6/04-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.6/4 – 6/18-Documented ONC Feedback - Next Steps Action Plan We are Here

8. Vendor Engagement Discussion 10/11/20118 EHRArea of InterestPotential Match Design ClinicalsOrder SetsZynx AllScriptsECA Rules –NQMF Rule (for Ambulatory Setting) NewMentor (have catalog for rules in ambulatory setting) AllscriptsSan Diego Pertussis ECA ruleCDC VADocumentation TemplateWolters Kluwer

9. Pilot Updates: Zynx – DesignClinicals (Order Set- Heart Failure ) Team: Claude Nanjo and Victor Lee Zynx Dewy Howell – DesignClinicals Status Expected Completion Date? Notes on the IG Notes on the Vocab and Terminology Work 10/11/20119

10. Pilot Updates: NewMentor – AllScripts (ECA Rule Million Hearts –NQF 68) Team: Julie Scherer - NewMentor Bryn Rhodes – Internal Support Robin Williams – AllScripts Team Meetings Status: Notes on the IG Notes on the Vocab Work 10/11/201110

11. Pilot Updates: Wolters Kluwer – VA (Documentation Template) Team: Christy May -Wolters Kluwer ???? – Internal Ken Kawamoto - VA Robert – Lario - VA Status: - DONE ….DEMO!!!! Notes on the IG Notes on the Vocab and Terminology Work E&M Code issue (maybe include them in LOINC) Follow up with Mark (examples are in the UTI template – send to LOINC folks) Tracking sheet has been created to track these follow up issues through the vocab and term group 10/11/201111

12. Pilot Update: CDC – AllScripts (ECA Rule) – Complete TEAM: Shu McGarvey - CDC Aziz Boxwala – Internal Support Bryn Rhodes- Internal Support Manoj Sharma- AllScripts Technical guru Status Expected Completion Date Shu to provide value sets for the Labs (general culture) We are only piloting the Clinical Rule not the Lab Rule (for stand alone labs) HL7 – act/relationship value sets (work with Terminology team to get this done - Notes on the IG Notes on the Vocab Work 10/11/201112

13. Open House Plan Working on outreach plan – are there any particular groups/individuals you all would like to have attend the “open house” Each Group will have 15 minutes to discuss pilot What did you all pilot Members of the Team How you did it Findings Lesson Learned Going forward = what can we do to make it better How can someone consume/consider doing this work Feedback: Question: What would a vendor want to know? Response: If I hadn’t done the pilot – I would want to have an idea of the tasks or analysis needed for creating the transformation for each of the artifact types. As a vendor, unless I can ‘resource’ that activity and have it repeatable, I will not be able to use content ‘off the shelf’. 10/11/201113

14. Working Session on the UC 1 IG: http://wiki.siframework.org/HeD+Pilot+Tools 10/11/201114

15. Pilot Support Tools and Feedback channels Discussion Board: http://wiki.siframework.or g/HeD+Pilot+Activities#H eD_Pilot_Discussionhttp://wiki.siframework.or g/HeD+Pilot+Activities#H eD_Pilot_Discussion Vocabulary and Terminology Feedback: http://wiki.siframework.or g/HeD+Pilot+Toolshttp://wiki.siframework.or g/HeD+Pilot+Tools 10/11/201115

16. Action Items & Next Steps Continue to work on the IG Begin to step through the UC 1 IG based on Pilot activities As needed and necessary we will be discussing issues and challenges during the pilot activities Update the IG Update the Vocabulary and Terminology work Identify additional support resources if necessary Prepare for our HeD Pilots “open house” July 8 th

17. Meeting Reminder Pilots Work stream meets (next meeting: July 1st, 2013) Every Monday 1-2:30 pm EDT See Wiki homepage for meeting details: http://wiki.siframework.org/Health+eDecisions+Homepage http://wiki.siframework.org/Health+eDecisions+Homepage 10/11/201117

18. Appendix A: Success Criteria NOTE: This is a work –in-progress we will need to re-evaluate this after Pilot Project Plans Discuss Pilot Success Criteria: Individual Criteria Initiative Criteria EHR Involvement - DONE Production (at least one of each artifact and consumption of those artifacts) –Addressed as part of the Pilot Project Plans (who will be doing which artifacts) Successful implementation of artifacts –EHR involvement »Validate artifact – perhaps Pilots focuses on this ? »Execute the artifact Cross initiative function »Potential Alignment with eDOC and esMD »SDC Alignment with MU 3 objective »10% knowledge based engine (align 402b) »ACTION ITEM: Review MU3 Criteria »Determine the delivery model we want to pilot External (i.e. cloud service) Assets are portable (can be run locally) Discuss this with the group 10/11/201118

19. Appendix B In Scope/Out of Scope 10/11/201119

20. Scope of Use Case 1 This Use Case defines the requirements to build a standard for the contents of CDS Knowledge artifacts. The use case focuses on the following artifact types: Event Condition Action (ECA) Rules, Order Sets, and Documentation Templates. To support this purpose the Use Case has one scenario: A CDS Knowledge Artifact Supplier makes computable CDS Knowledge Artifact available to CDS Artifact Integrator (From HeD Use Case: CDS Artifact Sharing) 10/11/201120

21. In Scope Standards to structure medical knowledge in a shareable and executable format for use in CDS In Scope Artifact Types (definitions for these artifact types can be found in Appendix A) –Event Condition Action Rules –Order Sets –Documentation Templates 10/11/201121

22. Out of Scope Tools: –Authoring tools, source “content” management. –Terminology server and mapping tools including management of concept coordination. –Semantic processing of text, including structured string processing and natural language processing. System Functions –Messaging Layer –Means of sharing –Security Authoring, creation and maintenance of clinical decision support knowledge Knowledge Repository Design Search and query mechanisms Implementation in systems User presentation, Transport layers Market factors: regulatory incentive/mandate, liability shield, IP shield (patent/licensing litigation), certification body, marketplace design, test procedures, FDA rules Clinical Decision Support Services (this will be covered in Use Case 2 CDS Guidance Services) CDS Content Development Activities, including the distribution and sharing of artifacts Context-Aware information retrieval (HL7 Information Button) – This will be covered in UC 2 (CDS Guidance) 10/11/201122

23. Pre and Post Conditions Pre-Conditions –CDS Artifact Supplier makes CDS artifacts available for search and consumption by CDS Artifact Integrators _ ACTION ITEMS (Clarify this –what is a precondition for this to be useful) –CDS Artifact integrator has the means to obtain the knowledge artifact from a CDS Repository (e.g. they have either browsed or queried the CDS Repository for available artifacts) –CDS Artifact Integrator Selects Artifacts of Interest to Use in their CDS System Post Conditions –The CDS Knowledge Artifact Supplier has sent the CDS Knowledge Artifact to the requesting CDS Artifact Integrator –CDS Artifact has been received by CDS Integrator and is available for processing –CDS Artifact is available for mapping, structural transformations and local adaptation –Strategy 10/11/2011 23 Decision: In the pilot activities we will not directly address these as part of our pilot. We will focus the pilot activities on those tasks which occur between the pre and post condition

24. Appendix C: UC 2 Approach 10/11/201124

25. HeD UC2 Solution Plan 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

26. Request Service: DSS Request Element Request Items Organizer/Container: vMR Request Item Payload: vMR Clinical Statement vMR Payload This approach supports vMR as the payload standard with mappings to CCDA and QRDA HeD UC2 Solution Plan HeD Schema/vMR Response Service: DSS Response Element Response Items Organizer/Container: Harmonized vMR/HeD Schema Response Item Payload: vMR Clinical Statements CDS Response CDS Request

27. HeD UC2 Solution Plan We will utilize templates to guide the IG development and Functional Interaction Types as examples –vMR templates will be used as building blocks of data that are coordinated to meet template requirements –The Functional Interaction Types will be the examples that use the building blocks –Leverage pilots from UC1 for functional interaction types 27

28. Potential Functional Interaction Types 1.Disease Management 2.Drug Dosing Calculation 3.Immunization Forecasting 4.Quality Measure Evaluation 5.Transition of Care Support 6.Prediction Rule Evaluation – APACHE score, AHRQ Pneumonia Severity Index, etc. 7.Severity of Illness Assessment – Charlson index, etc. Which functional interaction types best align with current pilot efforts? Which types would be the most straight forward to test? Which types would best validate the HeD UC2 solution, or be the most widely used in the industry?