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Interoperability Framework Overview

Interoperability Framework Overview. HIT Standards Committee . Presented by: Douglas Fridsma, MD, PhD Acting Director, Office of Interoperability & Standards ONC. Lessons learned from HITSP. Standards are not imposed, they are adopted

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Interoperability Framework Overview

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  1. Interoperability Framework Overview HIT Standards Committee Presented by: Douglas Fridsma, MD, PhD Acting Director, Office of Interoperability & Standards ONC

  2. Lessons learned from HITSP • Standards are not imposed, they are adopted • To improve adoption, solve real problems, not abstract ones • Engage the community for a sense of ownership • Standards should be harmonized and commissioned based on clearly articulated priorities • Governance is necessary to coordinate and prioritize • Adoption is accelerated by tools including vocabulary registries and easy to use sources for implementation guidance. • Tools improve adoption • Make implementation specifications easy to use and, well, specific • Keep it as a simple as possible but no simpler - the parsimony principle • Don’t boil the ocean • Solve real focused, problems • Perfection is the enemy of the good • Iteratively improve

  3. Continuing the work of HITSP • Move toward more “computational” implementation specifications (IS) • Scalable processes • Ability to develop tools to increase the efficiency of IS development and maintenance • The importance of developing IS that are explicit and subject to less interpretation • Link use cases and standards from inception to certification • Keep the certification processes tightly linked to the standards and IS processes • Support tool development for certification testing • Develop the testing for compliance at the same time as developing the standards and IS • Integrate multiple SDOs with different expertise across the process • Transport packages • Vocabulary • Value sets • Security

  4. Bottom up use case development within a top-down coordination framework CORE PRINCIPLES Prioritization Transparency Engagement Rapid Results Focused Collaboration Commandand Control Focus Classic Trade-Off Low High A Thousand Flowers Bloom Low High Participation NHIN Direct + Interoperability Framework =Focused Collaboration

  5. Bottom Up Innovation within aCoordination Framework Pilot Demonstration Projects Standards Development Reference Implementation Harmonization ofCore Concepts (NIEM framework) Implementation Specifications Certificationand Testing Use Case Developmentand Functional Requirements Tools and Services(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)

  6. Use Case Development and Functional Requirements Standards Development Pilot Demonstration Projects Use Case Developmentand FunctionalRequirements • Example of a use case • provider wants to send a referral to a specialist electronically • Use case describes • Services • Standards (package) • Business rules, trust, policies That are necessary to satisfy the use case The process should • Engage a wide community in defining the use cases • Focus on solving a real problem • Determines scope • Able to “test” if the use case solves the problem • Prevents “analysis paralysis” • Does not model in the abstract • Open, transparent process • Establish a “use case steward” to shepherd the use cases through the entire process • Output is a clear description (in a computable form) that describes the standards, services and policies necessary to describe the use case Use Case Developmentand FunctionalRequirements Harmonization ofCore Concepts (NIEM framework) Implementation Specifications Reference Implementation Certificationand Testing Tools and Services(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)

  7. Harmonization of Core Concepts Harmonization ofCore Concepts (NIEM framework) Standards Development Pilot Demonstration Projects • Need to have a strong harmonization framework that spans different standards organizations • XML/UML computational descriptions of the use cases • Strong governance and transparent processes • Use-case driven (bottom up) with top down coordination • Harmonization processes need to describe • Standards • Services • Policies In standard ways • Multiple use cases might have overlapping standards, services or policies • E-prescribing and adverse event reporting • Clinical care summary and quality reporting • Laboratory data exchange and clinical decision support Use Case Developmentand FunctionalRequirements Harmonization ofCore Concepts (NIEM framework) Implementation Specifications Reference Implementation Certificationand Testing Tools and Services(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)

  8. Harmonization of Core Concepts Harmonization ofCore Concepts (NIEM framework) Standards Development Pilot Demonstration Projects • Standards harmonization • Leverage best practices • Use the NIEM processes • Create explicit data exchange package that describe the data elements, vocabularies and value sets • Service harmonization • Leverage services aware enterprise framework (SAEF) • Information model • Services description • Conformance description • Governance (business rules) descriptions • Policy descriptions • Harmonization of policies is a challenge • Three parts to harmonization • Description of the standards (the data that is exchanged) • Description of the services (the functions that will be supported in the exchange) • Description of the policy (trust, business rules, etc) Use Case Developmentand FunctionalRequirements Harmonization ofCore Concepts (NIEM framework) Implementation Specifications Reference Implementation Certificationand Testing Tools and Services(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)

  9. What is the NIEM process? Patient Discovery Lab data exchange E-prescribing Provider address lookup Future Domains Common Core Discharge Summary Quality reporting Child and Family Services PHR exchange Patient summary Harmonization ofCore Concepts (NIEM framework) Standards Development Pilot Demonstration Projects • National Information Exchange Model • Started as a DoJ initiative, but the processes have been generalized • Supported data integration and reporting for Recovery.gov • Used by HHS to support child and family services • Recommended by OMB as best practice • Used by state and local governments Use Case Developmentand FunctionalRequirements Harmonization ofCore Concepts (NIEM framework) Implementation Specifications Reference Implementation Certificationand Testing Tools and Services(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc) 9

  10. What is the NIEM framework? Patient Discovery Lab data exchange E-prescribing Provider address lookup Future Domains Common Core Discharge Summary Quality reporting Child and Family Services PHR exchange Patient summary Harmonization ofCore Concepts (NIEM framework) • A common core of concepts, explicitly defined, that are shared across different use cases or domains • Naming and modeling conventions that allow different groups to work independently but harmonize the work together • Based on the ISO-11179 metadata standard used by the NCI, NLM, and standards organizations.

  11. Additional services and tools for harmonization Use Case Model Repository Service Registry Use Case Developmentand Functional Requirements Harmonization ofCore Concepts Implementation Specifications LexGrid Based Vocabulary Services OpenMDR Based Metadata Repository

  12. Standards Development StandardsDevelopment Standards Development Pilot Demonstration Projects • Gaps in existing standards • Data package • Value sets • Services • Can be identified as part of the use case development and harmonization process • Work with SDOs (NLM, HL7 etc) to fill in gaps • Allows the standards work to proceed in parallel with development of the implementation specifications Use Case Developmentand FunctionalRequirements Harmonization ofCore Concepts (NIEM framework) Implementation Specifications Reference Implementation Certificationand Testing Tools and Services(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)

  13. Implementation Specifications ImplementationSpecifications Standards Development Pilot Demonstration Projects • If the standards, services and policies are the ingredients, then the implementation specification is the recipe • Packaged together to support use cases • Guides development of reference implementation • Interim Final Rule requires creation of Implementation Specifications where they don’t exist • An implementation specification becomes a explicit description of the • Standards • Services • Policies • That conform to adopted standards and have sufficient detail to be implemented Use Case Developmentand FunctionalRequirements Harmonization ofCore Concepts (NIEM framework) Implementation Specifications Reference Implementation Certificationand Testing Tools and Services(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)

  14. Reference Implementation Reference Implementation Standards Development Pilot Demonstration Projects • Specification must be tested to make sure they are implementable • Can be used by others to help guide their own implementation or find problems with specifications • Encourages feedback to ONC • Example: CONNECT software could potentially be the reference implementation of NHIN specifications and standards Use Case Developmentand FunctionalRequirements Harmonization ofCore Concepts (NIEM framework) Implementation Specifications Reference Implementation Certificationand Testing Tools and Services(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)

  15. Pilot Demonstration Projects Pilot Demonstration Projects Standards Development Pilot Demonstration Projects • Reference implementation in use by stakeholders • Confirms use case is being supported • ONC should provide coordination of pilot demonstrations • NHIN Trial Implementations • NHIN Limited Production Exchange • NHIN Direct Project Use Case Developmentand FunctionalRequirements Harmonization ofCore Concepts (NIEM framework) Implementation Specifications Reference Implementation Certificationand Testing Tools and Services(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)

  16. Certification and Testing Certificationand Testing Standards Development Pilot Demonstration Projects • Culmination of prior activities • NIST can help create test harnesses to ensure conformance with specifications NIST Conformance tools Tools and resources for certification processes Use Case Developmentand FunctionalRequirements Harmonization ofCore Concepts (NIEM framework) Implementation Specifications Reference Implementation Certificationand Testing Tools and Services(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)

  17. Tools and Services Standards Development Pilot Demonstration Projects • Make the process as automated and self-serve as possible • Leverage tools & services in future efforts Use Case Developmentand FunctionalRequirements Harmonization ofCore Concepts (NIEM framework) Implementation Specifications Reference Implementation Certificationand Testing Tools and Services(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)

  18. Bottom Up Innovation within aCoordination Framework Pilot Demonstration Projects Standards Development Reference Implementation Harmonization ofCore Concepts (NIEM framework) Implementation Specifications Certificationand Testing Use Case Developmentand Functional Requirements Information Model, Services, andValue Sets Harmonized/ ImplementationSpecification ReferenceCode Set Integration Testing and Implementation Tools and Services(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)

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