Report from the Technical Committees

1. Report from the Technical Committees Arlington, VA | October 6, 2008 Presented by: Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS HITSP Technical Committee Co-Chairs enabling healthcare interoperability

2. AHIC Use Cases 2008 Consumer Population Provider RemoteMonitoring Immunizationsand Response Management Consultations and Transfers of Care Patient – Provider Secure Messaging Public Health Case Reporting PersonalizedHealthcare

3. Technical Committee Leadership Provider Perspective – 210 members Allen Hobbs, PhD, Kaiser Permanente Steve Hufnagel, PhD, DoD/Medical Health System (MHS) Mike Lincoln, MD, Department of Veterans Affairs Consumer Perspective – 191 members Mureen Allen, MD, FACP, ActiveHealth Management Charles Parisot, EHR Association Scott Robertson, PharmD, Kaiser Permanente

4. Technical Committee Leadership Population Perspective - 166 members Floyd Eisenberg, MD, MPH, Siemens Medical Solutions Peter Elkin, MD, Mayo Clinic College of Medicine Anna Orlova, PhD, Public Health Data Standards Consortium Administrative and Financial Domain – 48 members Don Bechtel, Siemens Medical Solutions Durwin Day, Health Care Service Corporation Deborah Belcher, GE Healthcare

5. Technical Committee Leadership Security, Privacy & Infrastructure Domain - 166 members Glen Marshall, Siemens Medical Solutions John Moehrke, GE Healthcare Walter Suarez, MD, Institute for HIPAA/HIT Education and Research Care Management and Health Records Domain - 47 members Keith Boone, GE Healthcare Corey Spears, McKesson Health Solutions Total Technical Committee Membership – 505 individuals

6. Trending in Technical Committee Membership

7. Trending for Technical Committee Meeting Attendance

8. Report from the Population Perspective Technical Committee

9. Report from the Consumer Perspective Technical Committee IS 12 Patient-Provider Secure Messaging (PPSM) IS 77 Remote Monitoring (RMON) IS 03 & 05 Consumer Access to Clinical Information (extensions) Advance Directives Access to Consumer-Friendly Clinical Information

10. Report from the Consumer Perspective Technical Committee IS 12: PPSM Completed and submitted to IRT for review Public Comment Period Target: IS submission to panel for December 2008

11. Report from the Consumer Perspective Technical Committee PPSM Architectural Variants The most generic variant selected as foundation. First two variants are supported as simplified implementations

12. Report from the Consumer Perspective Technical Committee C62 Unstructured Document Component (new) Support for a wide variety of content (PPSM and advance directives-SOW) Simple/unstructured text Scanned Documents PDFs New component References: IHE XDS-SD, PDF/A ISO 19005-1b Coordination between CPTC, SPI, Admin & Finance Minimal document header (compatible with other HITSP CDA docs) to support wide applicability Secured Messaging Advance Directives

13. Report from the Consumer Perspective Technical Committee IS 77: Remote Monitoring Completed and submitted to IRT for review Public Comment Period Note: Access to the Continua (draft) guidelines requires to sign an NDA. Contact John Donnelly. Target: IS submission to panel for December 2008 Two main challenges: Convergence to a single interface between Device Intermediaries and Remote Monitoring Mgmt Systems (used either in Homes or in Care Delivery Organizations)  Request to IHE and Continua for harmonization Tight schedule synchronization between completion of IEEE standards, Continua Implementation Guidelines, and IS completion for panel approval in December.

14. Report from the Consumer Perspective Technical Committee Remote Monitoring Business Actors may be combined: e.g. RM Mgt Syst & EHR or RM Mgt Syst & PHR Significant reuse of existing & new constructs in Interfaces 3, 4, 5, 6 and 7 Interface #2 Interface #1 Device Intermediary Remote Monitoring Mgmt System Device Interface #3 Interface #6 Interface #4 Health Info Exchange Interface #7 Interface #5 PHR System EHR System

15. Report from the Consumer Perspective Technical Committee Devices that are being considered this cycle include: Blood pressure monitor Glucometer Pulse oximeter Thermometer Weighing scale

16. 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 Standard Implementation Guide for CDA Release 2.0 Personal Health Monitoring Report (PHMR)

17. T73 - Aggregate Device Information Communication 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 Selected Standard The Tier 2 analysis has resulted in two alternatives: 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 Public Comment is expected on the selection that should be made between these alternatives. IHE and Continua Health Alliance are currently working collaboratively to analyze the approaches and propose their recommendation to HITSP.

18. Report from the Consumer Perspective Technical Committee IS 03 & IS 05 Updates A number of items identified last year (as gaps in use cases) prioritized for possible completion this year IS03 / IS05 2008 gap items: Advance Directives  Consumer-Friendly Clinical Information  Provider Lists (2009)

19. Report from the Consumer Perspective Technical Committee Advance Directives (partial in 2008) C62: Unstructured document Consumer-Friendly Clinical Information / translations T81: Retrieval of Medical Knowledge Provider Lists Identified scope of work Generating provider lists – current efforts Setting permissions - TBD Other uses- TBD Working on identifying the key actors and interactions Given complexity, work extended to 2009

20. Report from the Consumer Perspective Technical Committee T81: Retrieval of Medical Knowledge Transaction (new) Supports the retrieval of medical knowledge References: HL7 v 3.0 Context-Aware Information Retrieval Specification: URL Implementation Guide Based on the Infobutton concept

21. Report from the Provider Perspective Technical Committee ISO-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.

22. Report from the Provider Perspective Technical Committee: PHC Roadmap

23. 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)

24. 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

25. 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

26. 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

27. Report from the Provider Perspective Technical Committee:Framework for Personalized Healthcare Personalized Health Care Integration into Clinical Practice Intervention Development and Review Health Information Technology Expansion of the Science Base Adapted from DHHS PHC, Opportunities, Pathways, Resources 2007

28. Report from the Provider Perspective Technical Committee Emergency Responder Use Case SITUATION: IS04 Version 1.0 was issued Dec 07 10 GAP/Overlap closure projects NEXT STEP: IS04 Version 1.2.1 for public review 2008 ER-EHR New Constructs for for OASIS EDXL DE and CAP Other New Constructs developed by other TCs 2009 and beyond HITSP Constructs for NEMSIS and DEEDS harmonized vocabulary pre-hospital EMS document content (e.g., field and run reports) SITREP and Patient Tracking

29. Report from the Provider Perspective Technical Committee: Emergency Responder Use Case

30. Report from Provider TC: ER-EHR Projects’ Status HITSP Nursing Terminology - done NEMSIS chaired work group: Finding a method of assigning and adopting unique identifiers for both incidents and patients so data from heterogeneous systems can be linked - pending Common approaches of delivering third party incident information such as telematics data to the Emergency Communications System (ECS) and emergency responders - actively working Reaching agreement between healthcare and other emergency responders on a common terminology (“Managed List”) for incident types - pending Harmonizing the data taxonomies of hospital (DEEDS), EMS (NEMSES), and other emergency responders to the extent necessary to implement the ER-EHR – October funding start of work at Univ. of Utah Additional gap area projects are: Decision Support Tool interoperability – monitoring external progress Core Services - monitoring external progress Situation Awareness Messaging - monitoring external progress Emergency Contact Registry (ECON) – done Life Critical Remote Monitoring - pending

31. Report from the Provider Perspective Technical Committee:Emergency Responder Use Case

32. Report from the Provider Perspective Technical Committee : Consultations and Transfers of Care IS09 was completed September 22, 2008 Produced by Provider Perspective TC Input from Admin and Finance, Care Management, Security TCs Work 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

33. What it 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 Report from the Provider Perspective Technical Committee : Consultations and Transfers of Care

34. Summary of IS09 constructs used 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) Report from the Provider Perspective Technical Committee : Consultations and Transfers of Care

35. IS09 gaps Some clinical data without a HITSP construct Example-ECG Functional status “instruments” poorly supported We need a CDA implementation guide for assessment instruments including functional status Nursing documentation Highly variable, no good standard for nursing summaries, notes, etc. CDA probably applicable here but needs development Report from the Provider Perspective Technical Committee : Consultations and Transfers of Care

36. IS09 gaps Identifying consultant and transfer setting Few tools to identify providers and facilities meeting a complex set of preferences Patient and referring/transferring provider preferences are multi-faceted Prefs include specialty, network, location, co-pay preferences… Needs Cross TC work and SDO engagement Report from the Provider Perspective Technical Committee : Consultations and Transfers of Care

37. IS09 gaps Decision support (IER 5) No current HITSP-defined DSS interoperability Needs cross-TC work and possibly SDO engagement (e.g., HL7) Report from the Provider Perspective Technical Committee : Consultations and Transfers of Care

38. IS09 Lessons Learned Tables relating constructs, actors, IER, and ER were very helpful to clarify/speed the work Tight timelines met by able help of the entire TC team! Particular thanks to Steve Hufnagle, Mike Glickman, & Allen Hobbs Huge debt to Suzi Hines and Gila Pyke Report from the Provider Perspective Technical Committee : Consultations and Transfers of Care

39. Questions?

40. Completed editorial changes to existing construct documents (out for Public Comment in September) Developed 10 new constructs (out for Public Comment in September) Modified 3 existing constructs (out for Public Comment in September) Worked with PTCs to ensure new constructs meet the requirements of the use cases Report from the Security, Privacy & Infrastructure Domain Technical Committee

41. Continued to work with TC-Leadership to address NHIN issues related to the use of SPI constructs in the NHIN Trial Implementations (ongoing) Longer term plan of maintenance updates to constructs and TN900 (e.g. revisions to TP30: Manage Consent Directives – to incorporate additional coding/base standards which are now available) Report from the Security, Privacy & Infrastructure Domain Technical Committee

42. New & Updated SPI constructs use in Interoperability Specifications New Interoperability Specifications Existing Interoperability Specifications

43. C62 Unstructured Document Concept Capture and storage of patient identifiable, unstructured document content, such as text, PDF, images rendered in PDF Selected Standards IHE XDS-SD ISO PDF/A 19005-1b

44. C82 Emergency Common Alerting Protocol Concept Multicast notification message sent to an identified channel Intended recipients are populations such as “all emergency departments in XXX county”, “within a geographic area”, etc Construct can only be used to transport text message alerts Selected Standards OASIS CAP v1.1

45. New Approach to Anonymize Construct Existing C25 construct contains anonymization requirements for two different use cases (Bio and Quality) Adding new requirements to same construct (from new use Public Health Care Reporting and Immunization Management) would be inefficient and less effective Would require constant updates to construct, and constant updates to IS’s that use it New Approach Dedicate separate anonymize construct to each use case Modify current anonymize construct (C25) to focus only on the IS02 – Biosurveillance Develop two new anonymize constructs, one for Public Health Case Reporting (C87) and one for Immunizations and Response Management (C88) Create a new construct for the Quality IS

46. C87 Anonymize Public Health Case Reporting Data Concept Provides specific instruction for anonymizing repurposed data created as part of routine clinical care delivery Defines anonymization requirements specific to Public Health Case Reporting data Selected Standards ISO Pseudonymisation TS# 25237

47. C88 Anonymize Immunizations and Response Management Data Concept Provides specific instruction for anonymizing repurposed data created as part of routine clinical care delivery Defines anonymization requirements specific to Immunizations and Response Management data Selected Standards ISO Pseudonymisation TS# 25237

48. TP22 Patient ID Cross-Referencing Concept Identifying and cross-referencing different attributes for the same patient. It contains following transactions: Patient ID Cross-Referencing Patient Identity Feed Updated to include an optional transaction - Patient Identity Management transaction - for Pediatrics Demographics Selected Standards IHE PIX IHE Technical Framework Supplement, Pediatric Demographics HL7 v2.5 HL7 v2.3.1

49. T23 Patient Demographics Query Concept Involves request for patient demographic information, and a response with a list of patient demographics for matching patients, if any were found Updated to include Pediatric Demographics option which makes use of six additional demographic fields to aid record matching in databases with many pediatric records Selected Standards IHE PDQ IHE Technical Framework Supplement, Pediatric Demographics HL7 v2.5/v2.5.1

50. T29 Notification of Document Availability Concept Defines mechanism for a healthcare stakeholder (e.g. provider, public health, etc) to notify providers or the patient about information that is available for retrieval pertaining to an identified patient Updated to expand the use of this construct for notifications from other contexts such as public health, or other sources Selected Standards IHE NAV