Download Report from the Technical Committees

Document Number: HITSP 08 xxx
Date: December 18, 2008
Report from the Technical Committees
Arlington, VA | December 18, 2008
Presented by:
Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS
HITSP Technical Committee Co-Chairs
enabling healthcare interoperability
0
AHIC Use Cases 2008
Provider
Consumer
Population
Consultations
and Transfers of
Care
Remote
Monitoring
Immunizations
and Response
Management
Personalized
Healthcare
Patient –
Provider Secure
Messaging
Public Health
Case Reporting
1
Technical Committee Leadership
 Provider Perspective – 218 members
– Allen Hobbs, PhD, Kaiser Permanente
– Steve Hufnagel, PhD, DoD/Medical Health System (MHS)
– Mike Lincoln, MD, Department of Veterans Affairs
 Consumer Perspective – 197 members
– Mureen Allen, MD, FACP, ActiveHealth Management
– Charles Parisot, EHR Association
– Scott Robertson, PharmD, Kaiser Permanente
2
Technical Committee Leadership
 Population Perspective - 172 members
– Floyd Eisenberg, MD, MPH, National Quality Forum
– Anna Orlova, PhD, Public Health Data Standards Consortium
– Eileen Koski, M. Phil, Quest Diagnostics Inc.
 Administrative and Financial Domain – 50 members
– Don Bechtel, Siemens Medical Solutions
– Durwin Day, Health Care Service Corporation
– Deborah Belcher, GE Healthcare
3
Technical Committee Leadership
 Security, Privacy & Infrastructure Domain - 172
members
– Glen Marshall, Grok-A-Lot, LLC
– John Moehrke, GE Healthcare
– Walter Suarez, MD, Institute for HIPAA/HIT Education and
Research
 Care Management and Health Records Domain - 56
members
– Keith Boone, GE Healthcare
– Corey Spears, McKesson Health Solutions
Total Technical Committee Membership – 522 individuals
4
2009 Technical Committee Schedule
February 17-19
Washington, DC area
(Tuesday – Thursday)
June 9-11
Washington, DC area
(Tuesday – Thursday)
September 1-3
Chicago, IL
(Tuesday – Thursday)
November 3-5
Phoenix, AZ
(Tuesday – Thursday)
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Report from the Security, Privacy & Infrastructure
Domain Technical Committee
SPI-TC Report Topics:
 End-of-year summary of work for 2008
– List of work items
– List of revised constructs, to include editorial updates and
technical changes
 Overview of 9 New constructs developed to support
2008 use cases
 Activities planned for next year
6
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
End-of-year summary of work for 2008: Work Items

Renamed from Security and Privacy Technical Committee to Security, Privacy and
Infrastructure (SPI) Domain Technical Committee

Inherited and became responsible for 11 pre-existing Infrastructure constructs

During the year, the TC:
– Completed minor revisions and updates to 7 S&P and 11 Infrastructure Constructs
– Developed 9 new constructs
– Formed Identity Credentials Management Work Group (WG tasks now complete)
– Conducted webinars and outreach activities
– Responded to NHIN clarification requests
– Worked with Foundations Committee on Privacy and Security Matrices
– Supported FHAs Security Strategy Subgroup
– Supported National Governors Association (NGA) State Alliance for eHealth
– Supported CCHIT through various means, including Cochair/Expert Panel participation
7
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
End-of-year summary of work for 2008: Updates to Existing Constructs

*TP13 - Manage Sharing of Documents

T14 - Send Lab Result Message

*TP21 - Query for Existing Data

*TP22 - Patient ID Cross-Referencing
 C19 - Entity Identity Assertion

*T23 - Patient Demographics Query
 *TP20 - Access Control

T24 – Pseudonymize
 *C26 - Nonrepudiation of Origin

C25 - Anonymize
 TP30 - Manage Consent Directives

*T29 - Notification of Document Availability

*T31 - Document Reliable Interchange

*T33 - Transfer of Documents on Media

C44 - Secure Web Connection

*TP50 - Retrieve Form for Data Capture
 *T15 - Collect and Communicate
Security Audit Trail
 *T16 - Consistent Time
 *T17 - Secured Communication
Channel
 TN900 – S&P Technical Note
* Denotes updates requiring Panel Approval
8
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
Maintenance Updates:

C26 - Nonrepudiation of Origin Component:

Updated to reflect minor updates in underlying standard which was
republished in October, 2008.

Minor editorial changes for readability and clarity.

TP13 - Manage Sharing of Documents: Updated reference to IHE XCA Standard
to: Integrating the Healthcare Enterprise (IHE) IT Infrastructure Technical
Framework (ITI-TF) Supplement 2008-2009, Cross-Community Access (XCA),
Trial Implementation, October 10, 2008

T15 - Collect and Communicate Security Audit Trail :

Minor editorial changes

Editorial updates for standards version change to IHE ITI-TF Revision 5.

Updated quoted text from underlying standard that has been modified with
the updated standard.

T17 – Secured Communication Channel: Incorporated the updated version of the
IHE ATNA standard to IHE ITI-TF Revision 5.0 and made minor editorial changes.
9
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
Maintenance Updates:

TP21 - Query for Existing Data Transaction Package:

Major update to reference the most recent version of the IHE QED
Integration Profile supplement

Additional updates to reflect changes in the underlying standard with respect
to the technical actors that are referenced, the transactions that are used by
the technical actors, and a further refinement of the HL7 V3.0 standard

TP 22 – Patient ID Cross-Referencing:

The use of HL7 2.3.1 for the Patient Identity Feed has been clarified.

Changed the optionality for the technical actors: Patient Identifier CrossReference Manager, and Patient Identity Source in Section 2.1.2 Technical
Actors.

Provided specific standard reference for HL7 V2.3.1 and HL7 V2.5 in
Selected Standards Table 2.3.2.

T23 - Patient Demographics Query: Minor editorial changes.
10
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
Maintenance Updates:

T29 - Notification of Document Availability:

Updated name of the IHE NAV selected standard.

Update the informative reference for IHE-ITI-TF to Revision 5.0.

T31 – Document Reliable Interchange: Minor editorial changes in addition to:

Updated the document to remove the mail option. This option is no longer
specified by the underlying IHE XDR standard.

Updated Table 2.1.2-1 Technical Actors to remove mail option, and updated
Unified Modeling Language (UML) diagram to show only the ITI-41 Provide
and Register Document Set-b Transaction.

T33 - HITSP Transfer of Documents on Media: Minor editorial changes and
changes resulting from Public Comment.

TP50 - Retrieve Form for Data Capture Transaction Package :
Edited to incorporate minor version updates of the underlying standard, IHE NAV.
11
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
Maintenance Updates: TP20: Access Control
This Transaction Package has been updated with editorial and minor updates of a
technical nature as follows:
 TN900 no longer has glossary or description of application of Security and Privacy
constructs to HITSP Interoperability Specification’s, so updated Table 1.4-1 with
this information
 Provided further clarification on the standards for which the technical actors will be
used
 Corrected the optionality of the technical actors to indicate that at least one of the
Service User or Service Provider actors is required to be implemented
 Added high level overview narrative and Figure 2.1.3-1 to provide further details on
the typical access control interactions between parties in the exchange of
healthcare information
 Reorganized the section narrative to provide clarity by moving supplemental,
supporting material from Section 2.1.3 into the appendix in Section 4.0
 Edited the narrative to improve readability and consistency
 Minor edits to the preconditions to improve readability
•
12
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
Maintenance Updates: TP20: Access Control (continued)

Selected Standards
 Moved the standard reference for OASIS WS-Federation from Table 2.3.2-1
Selected Standards to Table 2.3.3-1Informative Reference Standards
 Updated the IHE ATNA profile reference to point to Revision 5.0 or later
 Informative References
 Added informative references to the OASIS XSPA SAML, OASIS XSPA WSTrust, and OASIS XSPA XACML profiles as roadmapped references
13
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
New Constructs

C62- Unstructured Document Component

T63 - Emergency Message Distribution Element Transaction

T64 - Identify Communication Recipients Transaction

T66 - Retrieve Value Set Transaction

T67 - Clinical Referral Request Transaction

T81 - Retrieval of Medical Knowledge Transaction

T85 - Administrative Transport to Health Plan Transaction

C87 - Anonymize for PHCR Component

C88 - Anonymize for IRM Component
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Report from the Security, Privacy & Infrastructure
Domain Technical Committee
New Construct: HITSP/C62 - Unstructured Document Component

Key Capabilities: Provides the capture and storage of patient identifiable,
unstructured document content, such as text, PDF, and images rendered in PDF.

Selected Standard(s): Cross-Enterprise Sharing of Scanned Documents (XDSSD) profile from the Integrating the Healthcare Enterprise (IHE) IT Infrastructure
Technical Framework (ITI-TF).

Used by:
IS 3 V:3.1.2
IS 4 V:1.2.2
IS 5 V:1.1.2
IS 8 V:0.0.2
IS 9 V:0.0.2
IS 10 V:0.0.2
IS 11 V:0.0.2
IS 12 V:0.0.2
Consumer Empowerment
Emergency Responder Electronic Health Record
Consumer Empowerment & Access to Clinical Information via Media
Personalized Healthcare
Consultation and Transfers of Care
Immunizations and Response Management
Public Health Case Reporting
Patient-Provider Secure Messaging
15
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
New Construct: T63 Emergency Message Distribution Element Transaction

Key Capabilities: A multicast notification message sent to an identified
population (assume this is not to the general public, but to specifically identified
populations, such as emergency departments).

Selected Standard(s): Emergency Data Exchange Language (EDXL)
Distribution Element (DE) v1.0

Used by:
IS 4 V:1.2.2
Emergency Responder Electronic Health Record
IS 10 V:0.0.2 Immunizations and Response Management
IS 11 V:0.0.2 Public Health Case Reporting
16
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
New Construct: T64 - Identify Communication Recipients Transaction

Key Capabilities: Identification of communication recipients and the
subsequent purpose of delivery of alerts and bi-directional communications
(e.g., public health agencies notifying a specific group of service providers
about an event.) The method and criteria by which individuals are added to a
directory is a policy decision, which is out of scope for this construct.

Selected Standard(s): Integrating the Healthcare Enterprise (IHE) Personnel
White Pages profile which provides access to basic directory information for
identifying one or more recipients.

Used by:
IS 4 V:1.2.2
IS 8 V:0.0.2
IS 9 V:0.0.2
IS 10 V:0.0.2
IS 11 V:0.0.2
Emergency Responder Electronic Health Record
Personalized Healthcare
Consultation and Transfers of Care
Immunizations and Response Management
Public Health Case Reporting
17
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
New Construct: HITSP/T66 - Retrieve Value Set Transaction

Key Capabilities: Used to transform human or computer vocabularies. For
example, it can be used to convert the initial capture of a human-readable concept
into a computer vocabulary captured in a document or message that will be
communicated. It may also be used in the reverse, to take computer vocabulary
and convert to human-readable form.

Selected Standard(s):
- Health Level Seven (HL7) Common Terminology Services (CTS) Release 1
- IHE ITI-TF Supplement 2008-2009 Sharing Value Sets (SVS) Integration Profile

Used by:
IS 4 V:1.2.2
IS 8 V:0.0.2
IS 9 V:0.0.2
IS 10 V:0.0.2
IS 11 V:0.0.2
Emergency Responder Electronic Health Record
Personalized Healthcare
Consultation and Transfers of Care
Immunizations and Response Management
Public Health Case Reporting
18
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
New Construct: HITSP/T67 – Clinical Referral Request Transaction

Key Capabilities: Used to transport the provider to provider
(clinical) referral request interaction.

Selected Standard(s): Integrating the Healthcare Enterprise (IHE)
Document-based Referral Request (DRR) profile which is used to
bundle a referral request document with other relevant clinical
documents of interest and optionally to send a trigger message to
the receiving provider system.

Used by:
IS 4 V:1.2.2
IS 9 V:0.0.2
Emergency Responder Electronic Health Record
Consultation and Transfers of Care
19
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
New Construct: HITSP/T81 - Retrieval of Medical Knowledge Transaction

Key Capabilities: Enables the request and receipt of additional knowledge about a
medical concept based on specific context parameters. This transaction does not
prescribe the knowledge content of the message returned but provides the
specifications for the query for and receipt of additional knowledge.

Selected Standard(s): Health Level 7 (HL7) Context-Aware Information Retrieval
(Infobutton) Specification: URL Implementation Guide.

Used by:
IS 3 V:3.1.2
IS 5 V:1.1.2
IS 8 V:0.0.2
IS 10 V:0.0.2
IS 11 V:0.0.2
Consumer Empowerment
Consumer Empowerment & Access to Clinical Information via Media
Personalized Healthcare
Immunizations and Response Management
Public Health Case Reporting
20
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
New Construct:T85 - Administrative Transport to Health Plan Transaction

Key Capabilities: The transport for administrative transactions between a
provider and a health plan. Examples include a pharmacy obtaining health
plan eligibility, and a physician requesting referral or authorization information
from a health plan.

Selected Standard(s): CAQH Phase II CORE #270 Connectivity Rule
v2.0.0, which addresses the message envelope metadata, the message
envelope standards, and the submitter authentication standards for
administrative transactions, as well as communications-level errors, and
acknowledgements.

Used by:
IS 4 V:1.2.2
IS 8 V:0.0.2
IS 9 V:0.0.2
IS 77 V:0.0.2
Emergency Responder Electronic Health Record
Personalized Healthcare
Consultation and Transfers of Care
Remote Monitoring
21
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
New Construct: HITSP/C87 -Anonymize for PHCR Component

Key Capabilities: Provides specific instructions for anonymizing data that
was created as part of routine clinical care data delivery in preparation for
repurposing data for public health case reporting. This construct defines the
Component specification that provides the ability to anonymize patient
identifiable information.

Selected Standard(s): International Organization for Standardization (ISO)
Health Informatics - Pseudonymisation, Unpublished Technical Specification
# 25237

Used by:
IS 11 V:0.0.2 Public Health Case Reporting
22
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
New Construct: HITSP/C88 - Anonymize for IRM Component

Key Capabilities: Provides the ability to anonymize patient identifiable
information for Immunization and Response Management. It provides specific
instruction for anonymizing data that was created as part of routine clinical
care delivery in preparation for repurposing the data .

Selected Standard(s): International Organization for Standardization (ISO)
Health Informatics - Pseudonymisation, Unpublished Technical Specification #
25237

Used by:
IS 10 V:0.0.2 Immunizations and Response Management
23
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
Activities Planned for Next Year

TN900: Significant restructuring of the document is being undertaken to:
– Improve overall readability,
– Decrease emphasis on initial 3 use cases
– Include additional clarification resulting from user community feedback

TP20: Access Control
– Provides greater clarity of previously specified OASIS standards and explains when
standards should be used
– Specifies profiles for SAML, WsTrust, etc (Initial draft of XSPA due in May)
– TP20 will be a focus of a HITSP demo at HIMSS 2009

TP30: Manage Consent Directives
– Workgroup will be discussing transaction package upgrade based in part on the resolution of
identified gaps
– Work with SDO to update HL7 Confidentiality codes, and ontology of roles
24
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
Activities Planned for Next Year (continued)

C19: Entity Identity Assertion Component
– Update to support Level of Assurance

T24: Pseudonymize Transaction
– update to support provider and organizational pseudonyms

2009 Use Case / Gaps / Extensions work
25
Report from the Security, Privacy & Infrastructure
Domain Technical Committee
Conclusion

We continue to make progress on Privacy and Security interoperability
standards, working within the multiplicity of jurisdictional constrained
policies.

New Use-Cases were well satisfied through re-use of existing SPI
constructs.

Look forward to practical feedback from NHIN experience with SPI
constructs.

Need to continue to expand our membership and expand the base of
‘active’ members.
26
Report from the Care Management & Health Records
Domain Technical Committee
 Year end work summary
– List of CM&HR constructs
– Overview of new construct organization
 Continued activities planned for the coming year
27
Report from the Care Management & Health Records
Domain Technical Committee
New/Modified Care Management and Health Records Constructs
 C76 - Case Report Pre-Populate

C48 - Encounter Document
 C83 - CDA and CCD Content Modules

TP89 - Sharing Imaging Results
 C75 – Healthcare Associated Infection
Report

C84 - Consultation, History and Physical
Document
 C74 - Remote Monitoring Observation
(RMON)

C32 - Summary Documents Using CCD

C78 - Immunization Content

C72 – Immunization Message

C70 - Immunization Query and Response
 C80 - Clinical Document & Message
Terminology
 C90 - Clinical Genomic Decision
Support
 TN901 – Technical Note for Clinical
Documents
28
Report from the Care Management & Health Records
Domain Technical Committee
Reference Constructs

C80: Clinical Document and Message Terminology
– Clinical based terminologies and code sets for CM&HR constructs
– Terminologies/code sets for message or document based constructs
– Contains references and locations for contained terminologies
– Contains constrained code sets where applicable for certain use cases

C83: CDA Content Modules
– Defines content modules for clinical document based HITSP constructs

TN901: Technical Notes for Clinical Documents
– Describes the organization of CM&HR constructs as they relate to C80 and C83
29
New Construct Organization
30
Report from the Care Management & Health Records
Domain Technical Committee
New/Modified Constructs

C76: Case Report Pre-Populate
– Supports data mapping for public health case reports
– Currently focused on data attributes that are universal or pertain to drug safety reporting

C75: Healthcare Associated Infection Report
– construct defining the electronic submission of Healthcare Associated Infection (HAI) reports
to the National Healthcare Safety Network (NHSN) of the Centers for Disease Control and
Prevention (CDC)

C74: Remote Monitoring Observation Document
– Describes content for clinical content collected by remote healthcare monitoring devices

C90: Family History Decision Support for Genetic Risk Analysis
– Defines communication of genetic and family history information for the purposes of clinical
genomic decision support

TP89: Sharing Imaging Results
– Previously TP49 – Sharing Radiology Results, expanded to include cardiology images
31
Report from the Care Management & Health Records
Domain Technical Committee
New/Modified Constructs

C48: Encounter Document Using IHE Medical Summary
– Supports the process of communication patient encounter data (excluding lab and radiology)
– Modifications include constraints for referral and discharge summary

C84: Consult and History and Physical Note
– Support consult notes and history and physical notes.

C32: Summary Documents Using CCD
– Defines document content summarizing a consumers medical status for the purpose of
exchange
32
Report from the Care Management & Health Records
Domain Technical Committee
New/Modified Constructs

C78: Immunization Document
– immunization data content to be exchanged between healthcare entities

C72: Immunization Message
– Defines the method to communicate updates to a patient’s vaccination record

C70: Immunization Query and Response
– Specifies a message mechanism to query for immunization data as well as response
messages
33
Report from the Care Management & Health Records
Domain Technical Committee
Continued Activities

C83: CDA Content Modules
– Add CDA content modules from previously existing CDA based constructs not yet transitioned from
the new organization. C38
– Increase consistency and readability of existing content modules

C80: Clinical Document and Messaging Terminology
– Add vocabulary from previously existing constructs not yet transitioned to new organization
– Add additional code and value sets based on continuing industry developments and feedback

C35: Lab Terminology
– Move terminologies into C80 and update dependent constructs/IS (C36, C37, IS01, IS02, IS05)

C38: Patient Level Quality Data Document Using IHE Medical Summary
– Merge into C48 (requires update to IS06)

TN901: Technical Notes for Clinical Documents
– Improve understandability
34
Report from the Care Management & Health Records
Domain Technical Committee
Conclusion
 Re-organization of constructs to use generalized modules will
promote re-use and consistency.
 Continue to re-use and modify existing constructs where possible to
meet new use case requirements and add new constructs where
required.
 Continued expansion and refinement of existing constructs to fill
gaps or specific areas of interest.
 Continue to have a great amount of work and looking for additional
members to assist.
35
Report from the Administrative and Financial Domain
Technical Committee
Completed editorial changes
– T40 - Patient Health Plan Generic Eligibility Verification
Transaction
 Completed new construct
– T68 - Patient Health Plan Authorization Request and Response
Transaction
– T79 - Pharmacy to Health Plan Authorization Request and
Response Transaction
 Reviewed proposed 2009 Use Cases
 Long Term - Develop a Technical Note document for
Administrative and Financial Domain TN902
36
Report from the Administrative and Financial Domain
Technical Committee
Construct Work
HITSP
Doc #
2007 Use
Case
2008 Use Cases
TITLE
RMON
PPSM
IS77
PHC
IS08
CTC
IS09
x
T40
Patient Health Plan
Eligibility Verification
Transaction
x
x
T68
Patient Health Plan
Authorization Request
and Response
Transaction
x
x
T79
Pharmacy to Health Plan
Authorization Request
and Response
x
IRM
PHCR
E-EHR
IS04
x
x
x
x
37
Report from the Administrative and Financial Domain
Technical Committee
Existing Constructs Modified to Meet New Use Case Requirements
Doc
#
T40
Construct
Patient Health Plan
Eligibility Verification
Transaction
Change Description
• Updates to support service/procedure specific inquiry
and response
• Replaced CORE Phase 1 rules with new CORE
Phase 2 rules
• Renamed to remove word “Generic” in the name
38
Report from the Administrative and Financial Domain
Technical Committee
New Construct Development Work
New Construct
Construct Description
Selected Standards
T68 – Patient Health Plan Used by a healthcare provider (other than a retail
ASC X12 278 v4010A
Authorization Request and pharmacy) to request approval from a health plan to
Response
authorize certain healthcare services, when
required by the patient’s health plan contract. The
health plan responds to the healthcare provider
authorization request.
T79 – Pharmacy to Health Used by a retail pharmacy to request approval from
Plan Authorization Request a health plan to authorize certain healthcare
and Response Transaction services, when required by the patient’s health plan
contract. The health plan responds to the healthcare
provider authorization request.
NCPDP
Telecommunication
Standard Implementation
Guide version 5.1
39
Report from the Administrative and Financial Domain
Technical Committee
Current Work Plan
Project/task
Target date
Draft Administrative and Financial Technical Note 902
02/15/2009
Preliminary Interest in Proposed 2009 Use Cases –
Ongoing
- Prior Authorization
- Scheduling
- Medications
- Maternal & Child Health
- Long Term Care
Support Provider Perspective Com. on ER-EHR HAVE In Progress
40
Report from the Population Perspective Technical
Committee
 Immunization and Response
 Public Health Case Reporting
 Planned Updates:
–Biosurveillance IS02
–Quality IS06
41
Report from the Population Perspective Technical
Committee: Immunization and Response
42
Report from the Population Perspective Technical Committee:
Immunization and Response – Privacy & Security
TP 20
HITSP Access Control Transaction Package
TP 22
HITSP Patient ID Cross-Referencing Transaction Package
TP 30
HITSP Manage Consent Directives Transaction Package
T 15
HITSP Collect and Communicate Security Audit Trail Transaction
T 17
HITSP Secured Communication Channel Transaction
T 23
HITSP Patient Demographics Query Transaction
T 24
HITSP Pseudonymize Transaction
C 19
HITSP Entity Identity Assertion Component
C 26
HITSP Nonrepudiation of Origin Component
C 88
Anonymize Immunizations and Response Management Data Component
43
Report from the Population Perspective Technical Committee:
Immunization and Response – Infrastructure
TP 13
HITSP Manage Sharing of Documents Transaction Package
T 16
HITSP Consistent Time Transaction
T 29
HITSP Notification of Document Availability Transaction
T 31
Document Reliable Interchange
T 33
HITSP Transfer of Documents on Media Transaction
T 63
Emergency Message Distribution Element Transaction
T 64
Identify Communication Recipients Transaction
T 66
Retrieve Value Set Transaction
T 81
Retrieval of Medical Knowledge Transaction
C 62
Unstructured Document Component
C 82
Emergency Common Alerting Protocol Component
44
Report from the Population Perspective Technical Committee:
Immunization and Response – Content
TP 21
HITSP Query for Existing Data Transaction Package
T 66
Retrieve Value Set Transaction
C 70
Immunization Query and Response
C 72
Immunization Message Component
C 78
Immunization Document Component
C 80
Clinical Document and Message Terminology Component
C 83
CDA Content Modules Component
45
Report from the Population Perspective Technical Committee:
Immunization and Response (IS10) – Roadmap
1. Harmonize Immunization Alerts (and Public Health Alerts) with structured
messaging standards
2. Evaluate Supply Chain Management (Scenario 2) – Deferred in IS10 v1.0
3. Evaluate Countermeasure and Response Administration – Deferred in IS10 v1.0
4. Review next steps for Clinical Decision Support – CMHR
1. Vaccine Forecast
2. Communication of immunization schedules
3. Prioritization notices
4. Alerts
46
Report from the Population Perspective Technical
Committee: Public Health Case Reporting
47
Report from the Population Perspective Technical Committee:
Public Health Case Reporting – Privacy & Security
TP 20
HITSP Access Control Transaction Package
TP 22
HITSP Patient ID Cross-Referencing Transaction Package
TP 30
HITSP Manage Consent Directives Transaction Package
T 15
HITSP Collect and Communicate Security Audit Trail Transaction
T 17
HITSP Secured Communication Channel Transaction
T 23
HITSP Patient Demographics Query Transaction
T 24
HITSP Pseudonymize Transaction
T 66
Retrieve Value Set Transaction
C 19
HITSP Entity Identity Assertion Component
C 26
HITSP Nonrepudiation of Origin Component
C 87
Anonymize Public Health Case Reporting Data Component
48
Report from the Population Perspective Technical Committee:
Public Health Case Reporting – Infrastructure
TP 13
HITSP Manage Sharing of Documents Transaction Package
TP 50
HITSP Retrieve Form for Data Capture Transaction Package
T 16
HITSP Consistent Time Transaction
T 29
HITSP Notification of Document Availability Transaction
T 31
Document Reliable Interchange
T 33
HITSP Transfer of Documents on Media Transaction
T 63
Emergency Message Distribution Element Transaction
T 64
Identify Communication Recipients Transaction
T 81
Retrieval of Medical Knowledge Transaction
C 62
Unstructured Document Component
C 82
Emergency Common Alerting Protocol Component
C 83
CDA Content Modules Component
49
Report from the Population Perspective Technical Committee:
Public Health Case Reporting – Content
TP 21
HITSP Query for Existing Data Transaction Package
T 14
HITSP Send Laboratory Result Message Transaction
C 32
HITSP Summary Documents Using HL7 Continuity of Care Document (CCD) Component
C 35
HITSP Lab Result Terminology Component
C 36
HITSP Lab Result Message Component
C 37
HITSP Lab Report Document Component
C 48
HITSP Encounter Document Using IHE Medical Summary (XDS-MS) Component
C 75
Healthcare Associated Infection (HAI) Report Component
C 76
Case Report Pre-Populate Component
C 80
Clinical Document and Message Terminology Component
C 83
CDA Content Modules Component
50
Report from the Population Perspective Technical Committee:
Public Health Case Reporting (IS11) – Roadmap
1. Complete notifiable diseases data set
•
•
Coordinate Council of State and Territorial Epidemiologists (CSTE), CDC, HITSP
Align with other HITSP data sets, e.g., Biosurveillance, Quality, etc.
2. Harmonize Public Health Alerts (and Immunization Alerts) with structured
messaging standards
3. Align Patient Safety Reporting with AHRQ Common Formats
•
•
•
Case Report Pre-populate Component <C76>
Clinical Document and Message Terminology Component <C80>
CDA and CCD Content Modules Component <C83>
4. Identify management strategy for non-EHR data required for Patient Safety
Reporting in Case Report Pre-populate Component <C76>
•
HITSP (Internal Review Taskforce) – Unaccounted data attribute
5. Update Pseudonymize Transaction <T24>
•
Practitioner and Organizational Provider Pseudonymization
6. Review next steps for Clinical Decision Support – CMHR
51
Report from the Population Perspective Technical Committee:
Biosurveillance (IS02) – Roadmap
1. Perform maintenance update IS02
52
Report from the Population Perspective Technical Committee:
Quality (IS06) – Roadmap
1. Configure 3 measure sets for EHR consumption and electronic reporting with
schematron rule testing (Stroke, Venous Thromboembolism <VTE> and
Emergency Department <ED>)
2. Update IS06 Maintenance Release
•
•
Pseudonymization <T24> update for Practitioner and Organizational Provider
Determine applicability of 2008 constructs to fill gaps for notification
• Emergency Message Distribution Element Transaction <T63> [Communication
Protocol]
• Unstructured Document Component <C62> [Patient specific alert]
• Emergency Common Alerting Protocol Component <C82> [Generic alert]
• Retrieval of Medical Knowledge <T81> [Info-button]
53
Report from the Population Perspective Technical Committee:
Quality (IS06) – Roadmap Continued
3. New Construct Considerations to fill Gaps
•
•
Specification of Measure and Value Sets
Health Quality Measures Format <HQMF>
Creation of Patient-Level Data Export (Consider QRDA)
• Update Patient-Level Quality Document <C38>
• Update Patient-Level Quality Message <C34>
• Quality Measure Document Component (Aggregate Report)
• Case Review Document (Validation with Provider)
4. Review next steps for Clinical Decision Support – CMHR
5. Update Data Set – HITEP II results (July 2009)
•
Expanded Quality Data Set and Workflow maps
54
Report from the Consumer Perspective Technical
Committee
 IS 03 & 05 Consumer Access to Clinical
Information (gap resolutions update)
 IS 12 Patient-Provider Secure Messaging
(PPSM)
 IS 77 Remote Monitoring (RMON)
55
Report from the Consumer Perspective Technical
Committee
 IS03 & IS05
–Transitioned to the 2008 template
–Updated both IS’s to address the following
gaps:
Advance Directives component
Access to Consumer-Friendly Presentation of
Medical Information
56
Report from the Consumer Perspective Technical
Committee – IS03/05
 Advance Directives
– C62: Unstructured document
– Facilitates the upload of a scanned version of an advance
directive into a PHR
– This represents a partial resolution of the identified gap
 Consumer-Friendly Clinical Information / translations
– T81: Retrieval of Medical Knowledge
– Enables consumers to obtain information about clinical term /
subject from a knowledge resource
57
Report from the Consumer Perspective Technical
Committee – IS03/05
 T81: Retrieval of Medical Knowledge Transaction (new)
– References: HL7 v 3.0 Context-Aware Information Retrieval
Specification: URL Implementation Guide
– Based on the “Infobutton” concept
58
Report from the Consumer Perspective Technical
Committee – IS03/05
IS03/05 Data Requirements (DRs)

DR01 Demographic data

DR67 Allergies/Medication Allergies

DR02 Patient clinical summary

DR68 Structured information request

DR03 Clinical History


DR04 Personal Genetic/Genomic
Information.
DR69 Context-aware Information
Retrieval Message

DR05 Family Genetic/Genomic
Information
DR70 Information Source
identification data

DR71 Change request data

DR08 Unstructured Data:

DR73 Provider Identification

DR27 Message Routing and
Content/Envelope/Metadata of the
secure message

DR74 Access Control Lists

DR75 Access log summary

DR29 Read/delivery confirmation

DR100 Lab Report Document

DR66 Diagnosis Codes

59
Report from the Consumer Perspective Technical
Committee – IS03/05
IS03/05 Information Exchange Requirements (IERs)

IER 1
Provide authorization and consent

IER 43 Send/Receive accept patient

IER 3
Create audit log entry

IER 61 Provide and Register Document Set

IER 5
Verify entity identity

IER 63 Request additional patient data

IER 8
Generate a delivery-receipt

IER 68 Identify PHR

IER 10 Identify patient

IER 69 Authorize release of information

IER 11 Identify provider based on patient
preference

IER 72 Send/receive audit log


IER 18 Send/receive clinical document
IER 73 Request/receive provider
information

IER 21 Receive updated clinical information 
IER 74 Access/Select provider information

IER 23 Request/provide additional
information

IER 28 Download historical health data

IER 38 Query/retrieve document set

IER 42 Request/receive medical concept
knowledge

IER 75 Designate provider permissions

IER 76 Request modification to clinical data

IER 77 Identification of information sources
= IS03 only
= IS05 only
60
Report from the Consumer Perspective Technical
Committee
 IS 12: Patient-Provider Secure Messaging
(PPSM)
– Simple in concept
Exchange a document
– Complex in realization
Three design alternatives
Workflow variants
Security requirements
Patient identity management
Linked to Clinical Decision Support
Many Cognitive Processes
Internal & Workflow operations
61
Report from the Consumer Perspective Technical
Committee - IS12 PPSM
 PPSM Architectural Variants
Third variant
selected as
foundation.
First two
variants are
supported as
simplified
implementations
62
Report from the Consumer Perspective Technical
Committee - IS12 PPSM
 C62 Unstructured Document
– The “body” of the secure message
– Care Management & Health Records
Primary Author
Input from CPTC and other committees
– Compatible with other HITSP CDA documents
– Supports a wide variety of content
Simple/unstructured text
Scanned Documents
PDFs
Structured Documents
63
Report from the Consumer Perspective Technical
Committee - IS12 PPSM
 T31 Document Reliable Interchange
–the means to move the message content from
the sender to the receiver
–Security, Privacy & Infrastructure
Primary Author
–Point-to-point exchange
No document repository required
64
Report from the Consumer Perspective Technical
Committee - IS12 PPSM
PPSM Data Requirements
 DR17 Decision Support Data
 DR27 Message Routing and Content/
Envelope/ Metadata
 DR28 Secure Message Integrity
 DR29 Read/Delivery Confirmation
65
Report from the Consumer Perspective Technical
Committee - IS12 PPSM
PPSM Information Exchange Requirements
 IER01
Provide authorization and consent
 IER02
Send data over secured communication channel
 IER03
Create audit log entry
 IER05
Verify entity identity
 IER07
Verify message integrity
 IER08
Generate a delivery-receipt
 IER09
Generate a read-receipt
 IER10
Identify patient
 IER30
Compose message
 IER31
Provide message routing/description information
 IER32
Request message
 IER33
Send/receive message
 IER34
Retrieve message ‘envelope’ data
 IER35
Store Message into PHR
= Security/Privacy
= Message en route
66
Report from the Consumer Perspective Technical
Committee
 IS77: Remote Monitoring (RMON)
– Access to remote monitoring information within an EHR or PHR
– Clinician monitoring information captured remotely in an ambulatory
setting
– Measurements such as physiological, diagnostic, medication tracking,
and patient sensor monitoring (e.g. activities of daily living)
– Enables management of chronic health problems and initial
management of new conditions
– A component of maintaining wellness for the aging population
– Devices designed for use by the patient or a patient caregiver
– Communication of interoperable ambulatory remote monitoring
information to the EHR and the PHR
– Not the communication/process by which data are captured and
transmitted from the device
67
Report from the Consumer Perspective Technical
Committee – IS77 RMON
High Level Diagram
Interface #1
Device
System Data
Exchange #2
Device
Intermediary
Business Actors may be combined:
e.g. RM Mgt Syst & EHR
or RM Mgt Syst & PHR
Significant reuse of existing & new
constructs in SDE’s # 3, 4, 5, 6 and 7
Remote
Monitoring
Mgmt System
System Data
Exchange #6
System Data
Exchange #7
PHR
System
System Data
Exchange #3
System Data
Exchange #4
Health Info
Exchange
System Data
Exchange #5
EHR System
68
Report from the Consumer Perspective Technical
Committee – IS77 RMON
 Challenges
– Convergence to a single interface between Device
Intermediaries (used either in Homes or in Care
Delivery Organizations) and Remote Monitoring Mgmt
Systems
– Request to IHE and Continua for harmonization
– Tight schedule synchronization
IEEE standards
Continua Implementation Guidelines
IHE Implementation Guides
HITSP IS completion
69
Report from the Consumer Perspective Technical
Committee – IS77 RMON
RMON Data Requirements (DRs)

DR06 Health Plan Eligibility
Information

DR81 Physiological measurement
data - Blood Pressure Monitor

DR30 Identification/Remote
Monitoring Registration Data


DR87 Physiological measurement
data - Implantable Cardioverter
Defibrillator (ICD) Monitoring
DR35 Free Text Notes


DR36 Care Coordination Notes .

DR37 Alerts, Alarms and Notices
DR89 Physiological measurement
data - Oxygen Saturation (Pulse
Oximeter)

DR38 Health plan authorization

DR91 Physiological measurement
data - Temperature (Thermometer)

DR39 Remote Monitoring Services
Order

DR92 Physiological measurement
data - Weight (Weighing Scale)

DR40 Structured Treatment Plan


DR74 Access control lists
DR97 Device and measurement
descriptive data – Generic Device
Data

DR80 Physiological measurement
data - Blood Glucose Meter

See IS77 RMON Device Roadmap for
additional DR’s
70
Report from the Consumer Perspective Technical
Committee – IS77 RMON
RMON Information Exchange Requirements
 IER01
Provide authorization and consent
 IER02
Send data over secured communication channel
 IER03
Create audit log entry
 IER04
Synchronize system time
 IER05
Verify Entity Identity
 IER10
Identify patient
 IER14
Send/receive health plan eligibility
 IER15
Send/receive health plan authorization
 IER18
Send/receive clinical document
 IER24
Send/receive structured treatment plan
 IER36
Send/receive remote monitoring service order:
 IER38
Query/retrieve document set
 IER39
Send/receive device observation data
 IER61
Provide and register document set
= Security/Privacy
= SDE #2
71
Report from the Consumer Perspective Technical
Committee – IS77 RMON

Send/receive device observation data : From Device Intermediary to Remote
Monitoring Mgt System
– Shall support conventional networks (e.g., POTS, Cable, DSL, GPRS, CDMA).
– Must support “always on” (e.g., Internet) and “intermittent” connections (e.g.,
POTS)
– Shall support conventional Device Intermediaries (e.g., Cell Phone, PC, Set Top
Boxes, PDA)
– Device data values shall not be modified, a sufficient data integrity (i.e., must not
be altered or destroyed either by attack or accident while in transmission)
– A tamper-resistant audit log file should record security-relevant actions
– A mechanism must be provided to synchronize clocks with the Remote Monitoring
Mgmt System
– Sufficient Security/Privacy based on a reasonable level of risk
– Transport sessions must be initiated from within the home or from the patient-side
device
– Message size should be reasonable (but not minimized more than lossless
compression) due to bandwidth limitation and/or transmission cost
72
Report from the Consumer Perspective Technical
Committee – IS77 RMON
 HITSP/IS77 [current release]
– IHE, Continua, and HITSP have achieved consensus on most system data exchanges
– Work needed on System Data Exchange #2, Device Intermediary to the Remote Monitoring
System
– For Consumer Grade and Clinical Grade applications, the IEEE 11073 PHD nomenclature
provides semantic interoperability and has been concluded as the resolution of the data
requirements for the devices being addressed in this release of the IS77 document.
 HITSP/IS77 future – extended clinical-grade device
nomenclature drawn from :
– ISO/IEEE 11073-10101:2004(E) – Health Informatics – Point-of-care medical device
communication Part 10101: Nomenclature, First Edition
– IHE Patient Care Device Technical Framework Supplement 2008-2009 – Rosetta
Terminology Mapping (RTM) – Defines observation identifiers and co-constraints such as
units-of-measure, enumerations, external measurement site identifiers and instrumentation
hierarchy which also defines IEEE 11073 to UCUM Units-Of-Measure Mapping
– Ultimately all new terms used in IS77 will be merged into ISO/IEEE 11073-10101 base
nomenclature standards.
73
T73 - Aggregate Device Information Communication
[Construct Release Planned for Mid-2009]

–

–
Concept
Allows a system (such as a home hub, a cell phone, a set top box, a
monitoring station) to report device observations through a local or
remote connection to an information management system
Standards Selection Work
The Tier 2 analysis has resulted in two alternatives for SDE#2
transport:
 One approach is based on the use of the IHE DEC Integration Profile (HL7 V2.x).
This approach is widely used today within Hospitals to connect clusters of devices
to EHRs
 The other approach is based on the use of IEEE Device Specialization conveyed
as a document (ASN1 encoded with MDER or XER)) by HITSP T31 (IHE-XDR).
This approach is primarily targeted at home monitoring
 HITSP has obtained convergence on one approach by IHE & Continua for June
2009 (Transport and message structure).
–
Data Vocabulary standards selected using IEEE 11073 Device
Specializations nomenclature
74
C74 - Remote Monitoring Observation Document
 Concept
– Specifies the medical information collected by remote health monitoring devices,
based upon HL7 CDA
– Measurements captured by devices; notes, summaries, and other kinds of
narrative information that may be added by caregivers or by the users
– Graphs that may be added by intermediary devices that represent trends of
users’ health
– Example systems include PHRs, EHRs, Practice Management Applications and
other stakeholders
 Selected Standards
– Implementation Guide for CDA Release 2.0 Personal Health Monitoring Report
(PHMR)
 Uses SNOMED CT nomenclature mapped to IEEE 11073 nomenclature used in
HITSP/T73 for data vocabulary
75
Report from the Consumer Perspective Technical
Committee - Strategy for IS77 and IER39 (i.e. T73/SDE#2)
 HITSP 2009 Work for IER39
– IHE, Continua and HITSP TC’s are highly motivated to work together
– IHE and Continua have signed an MOU
– To converge on a single solution for System Data Exchange #2,
additional work will be needed to achieve consensus. IHE, Continua
and HITSP will make their best effort to complete this work by June
2009
– In the event that this does not happen, it is recommended that HITSP
convene an interim cross-organizational team of HITSP TC members
to review the progress, collect information (e.g., industry survey of
manufacturers/consumers of RMON Device Intermediary), and
provide a recommendation to the HITSP Board.
 We used a similar approach to achieve consensus with regards
to CCD
 HITSP RMON Device Road Map
76
Report from the Consumer Perspective Technical
Committee – IS77 RMON Device Roadmap
AHIC March 2008 Remote Monitoring Use Case
IS77-Dec 2008
IS77- Dec 2009
Physiological Measurement Data Types and Devices (Examples
provided below are not comprehensive)

Blood Glucose [DR80]
Yes
2008

Blood Pressure [DR81]
Yes
2008

Brain Activity (e.g., Ambulatory EEG) [DR82]
No

Cholesterol [DR83]
Yes

Esophageal pH [DR84]
No

Heart Rate [DR85]

Heart Rhythm (e.g., AECG, Holter Monitor, Cardiac Implants) [DR86]

Implantable Cardioverter Defibrillator (ICD) Monitoring (e.g., Intercardiac
Pressure, Intrathoracic Fluid, EGM Waveforms) [DR87]
No

Lung Function [e.g., FEV1 (forced expiratory in 1 sec), FVC (forced vital
capacity), PEV(peak expiratory volume), PEFR (peak expiratory flow
rate)], i.e. Spirometry measures [DR88]
Yes

Oxygen Saturation [DR89]

Respiration Rhythm [DR90]

Temperature [DR91]
Yes
2008

Weight [DR92]
Yes
2008
Yes
2008
Yes (1-3 Channel ECG and rhythm)
No (Cardiac Implants, Holter Monitor)
Yes
2008
Yes (Respiration rate through ECG)
77
Report from the Consumer Perspective Technical
Committee – IS77 RMON Device Roadmap
AHIC March 2008 Remote Monitoring Use Case
IS77-Dec 2008
IS77- Dec 2009
Medication Management and Administration
Data and Device Types:
Electronic Pillbox – Patient Alerts and Medication
Administration Tracking [DR93]
Medication Pumps – Medication Administration
[DR94]
Medication Infusion Devices – Medication
Administration [DR95]
Yes
Yes (Reporting Pump activity)
No (Pump Programming)
Yes (Reporting Infusion Pump
activity)
No (Infusion Pump Programming)
Patient Sensor Monitoring Data: [DR96]
ADL Biosensors and Detection Devices
Emergency Alerting, Global Positioning System
(GPS)
Fall Detection
Pedometer (Steps Moved)
Sleep Actigraphy
Yes
Yes (Emergency alerting)
Yes (Simple fall)
Yes
Yes (Simple)
78
Report from the Consumer Perspective Technical
Committee – IS77 RMON Device Roadmap
AHIC March 2008 Remote Monitoring Use Case
IS77-Dec 2008
IS77- Dec 2009
Device Identification Information
Yes
2008
Patient Identification Data
Yes
2008
Device Type
Yes
2008
Measurement Metadata – Device/Device
Intermediary-Generated: [DR97]
Device Setting Information
Date/Time of Measurement
Yes
Yes
2008
Data Source (Device-generated vs. Patient-entered)
Yes
Measurement Characteristics (Raw vs. Summary Data)
Yes
Measurement Scale/Units
Yes
2008
Device Calibration/Programming Data
Yes
2008
Yes
2008
Error Details: [DR98]
Device Malfunction
User Error During Measurement
Measurement Cancelled by Patient (Stopped
measurement process or marked measurement as invalid)
Yes
Yes
2008
79
Report from the Consumer Perspective Technical
Committee – IS77 RMON Device Roadmap
AHIC March 2008 Remote Monitoring Use Case
IS77-Dec 2008
IS77- Dec 2009
Patient-Entered Measurement Descriptive data:
[DR99]
Measurement-Instance Specific Details (e.g.,
patient-entered accompanying the measurement
such as stress level, position)
Yes
Measurement Error Details
Yes
Alerts, Alarms and Notices [DR37]
Normal Range
Normal Range for Patient
Alert (Low Value, High Value, Change in Trend)
Yes
Yes (potential for remote patientspecific setting of normal
ranges)
Yes
80
Report from the Provider Perspective Technical
Committee
IS0-8 Personalized Health Care
Use case Scenario's

Clinical Assessment. A family health history is gathered from or by the
consumer in an interoperable form to be used by consumers and clinicians.
This information is accessed by clinicians and used in conjunction with
personal medical history, current health status, and personal preferences to
develop a diagnostic plan.

Genetic Testing, Reporting, and Clinical Management. A medical
testing laboratory performs genetic or genomic testing after it receives
genetic/genomic test orders and any accompanying information necessary
for the testing in an interoperable form. The testing laboratory performs the
tests, develops the patient report, and transmits this information back to
authorized providers. Clinicians utilize this new diagnostic information for
the management of their patients. Both clinicians and consumers have
access to this information via the PHR.
81
Report from the Provider Perspective Technical
Committee
Current Status
 IRT review passed; all formatting and
tables updated to latest standards
 Gaps identified
 Submitting for Panel Approval
82
Report from the Provider Perspective Technical
Committee: Identified Constructs
 HITSP/C19 - Entity Identity Assertion
 HITSP/C32 - Summary Documents Using HL7 Continuity of Care
Document (CCD)
 HITSP/C36 - Lab Result Message Component
 HITSP/C37 - Lab Report Document
 HITSP/C48 - Encounter Document Using IHE Medical Summary
(XDS-MS)
83
Report from the Provider Perspective Technical
Committee: Identified Constructs
 HITSP/C62 Unstructured Document Component
 HITSP/C69 - Generic Order Component
 HITSP/C80 - Clinical Document and Message Terminology
Component
 HITSP/C84 - Consult and History and Physical Note Component
 HITSP/C90 – Clinical Genomic Decision Support Component
84
Report from the Provider Perspective Technical
Committee: Identified Constructs
 HITSP/T15 - Collect and Communicate Security Audit Trail
 HITSP/T16 - Consistent Time
 HITSP/T17 - Secured Communication Channel
 HITSP/T23 - Patient Demographics Query
 HITSP/T29 - Notification of Document Availability
 HITSP/T31 - Document Reliable Interchange
 HITSP/T33 - Transfer of Documents on Media
 HITSP/T40 - Patient Generic Health Plan Eligibility Verification
Transaction
85
Report from the Provider Perspective Technical
Committee: Identified Constructs
 HITSP/T68 - Health Plan Authorization/Referral Request and
Response
 HITSP/T85 – Administrative Transport to Health Plan
 HITSP/TP13 - Manage Sharing of Documents
 HITSP/TP20 - Access Control
 HITSP/TP22 - Patient ID Cross-Referencing
 HITSP/TP30 - Manage Consent Directives
 HITSP/TP89 – Sharing Imaging Results
86
Report from the Provider Perspective Technical
Committee
Gaps Identified
 Ability to receive report including analysis of risk from a
Genetic Clinical Decision Support System
 Ability to send and receive updated Genomic Test
Orders and Clarification of Orders
 C36 is necessary but not sufficient to communicate
genomic lab results. More detailed implementation
guidance is necessary to satisfy the requirements.
87
Report from the Provider Perspective Technical
Committee
 Next Steps
 Address Clinical Decision Support and
Family History
 Introduce W3C Standards pertinent to Life
Sciences and Interoperability for
Personalized Health Care
88
Report from the Provider Perspective Technical
Committee
Personalized Health Care
Integration into Clinical Practice
Intervention Development and Review
Expansion of the
Science Base
Health Information
Technology
Adapted from DHHS:
“PHC, Opportunities, Pathways, Resources,” 2007
89
Report from the Provider Perspective Technical
Committee – Emergency Responder EHR
90
Report from the Provider Perspective Technical
Committee – Emergency Responder EHR
91
Report from the Provider Perspective Technical
Committee – Emergency Responder EHR
92
Report from the Provider Perspective Technical
Committee – Emergency Responder EHR

What we added
– C82 Emergency Common Alerting Protocol
– C47 Resource Utilization Message Component
– C62 Unstructured Document
– T40 Patient Generic Health Plan Eligibility Verification Transaction
– T63 Emergency Message Distribution Element Transaction
– T64 Identify Communication Recipients
– T66 - Retrieve Value Set
– T67 - Clinical Referral Request Transport
– T68 Patient Health Plan Authorization Request and Response Transaction
– T85 Administrative Transport to Health Plan
– Harmonized Information Exchange (IERs) and Data Requirements (DRs)
– UML Component data flow diagrams
93
Report from the Provider Perspective Technical
Committee – Emergency Responder EHR
 The NEMSIS chaired work group will report back to the TC in 2009 on:
– Finding a method of assigning and adopting unique identifiers for
both incidents and patients so data from heterogeneous systems
can be linked
– Exploring common approaches of delivering third party incident
information such as telematics data to the ECS and other
emergency responders
– Reaching agreement between healthcare and other emergency
responders on a common terminology (“Managed List”) for incident
types
– Harmonizing the data taxonomies of hospital, EMS, and other
emergency responders to the extent necessary to implement the
ER-EHR
94
Report from the Provider Perspective Technical
Committee – Emergency Responder EHR
 There are additional gap area projects, which are:
– Decision Support Tools – pending HITSP wide solution
– Core Services – watch industry
– Situation Awareness Messaging – Need construct for
Oasis SA
– Resource Management messaging – Need construct for
Oasis RM
– Emergency Contact Registry (ECON) - working through
IHE
– Life critical monitoring – will build upon IS 77 Remote
Monitoring
95
Report from the Provider Perspective Technical
Committee
 Consultations and Transfers of Care
(CTC) based upon
–Consultation and Transfers of Care Detailed
Use Case, March 21, 2008
–TN900, Security and Privacy Technical Note
–TN901, Technical Note for Clinical
Documents
96
Report from the Provider Perspective Technical
Committee
 CTC covers:
–Consultations: information exchange supporting
consult request, performance and resulting
–Transfers of care: information exchange for
request and actual transfer
 For both consults and transfers
–Supports information exchange to verify
eligibility and authorization for services.
97
Report from the Provider Perspective Technical
Committee
 Summary of CTC/IS09 constructs
–Lab-related (C35, C36, C37, T14)
–Document-related (C32, C48 , C62, C84, T29, T31, T33, TP13,
TP22)
–Radiology-related (C41, TP89)
–Security/infrastructure-related (T15, T16, T17, T85, TP20)
–Eligibility/referral-related (T40, T67, T68, T79)
–Entity/identity-related (C19, T23, TP22)
98
Report from the Provider Perspective Technical
Committee
 CTC progress report
–As of our last report in September …
oWe were finishing IS09 draft for public comment
oAddressing a few last minute gaps and issues
oGetting ready for public comment
99
Report from the Provider Perspective Technical
Committee
 CTC present status:
–Public comment was vigorous, intensively
reviewed, and mostly incorporated in present
document
–IRT review passed; all formatting and tables
updated to latest standards
–Gaps identified (mostly requiring external work)
100
Report from the Provider Perspective Technical
Committee
 Public Comment Details
–CTC draft completed on Sept 22, 2008
–Public comment period Sept 29 – Oct 24th
–86 Comment received and reviewed
o40 accepted, all implemented
o30 accepted with modification, all implemented
o15 rejected (not implemented)
o1 gap (need to develop registries for DR5 and
IER18)
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Report from the Provider Perspective Technical
Committee
 CTC IRT Review and Results
–Sent to IRT on Nov 18, 2008
–Steve Hufnagel and David Tao revised
component diagrams
–IRT revealed cut-paste errors and naming
revision issues that had not been detected
oDemonstrates need for more robust tooling in
future efforts
102
Report from the Provider Perspective Technical
Committee
 Remaining Gaps
–Some important clinical data lack a HITSP construct
(e.g., ECG)
–Functional status instruments need CDA constructs
–Nursing documentation (may need CDA work plus more
definition of professional standards)
–Identifying provider/facilities by patient preferences is an
area needing 2009 work
–Decision support needs more field work, standards
creations, and cross-TC engagement to incorporate
103