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Joint HL7 and OMG Healthcare Services Specification Project

Joint HL7 and OMG Healthcare Services Specification Project

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Joint HL7 and OMG Healthcare Services Specification Project

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  1. Joint HL7 and OMG Healthcare Services Specification Project Interoperability at the Service Level Via a Standardized Healthcare Service Oriented Reference Architecture (H-SOA-RA) And Services Specification Framework (SDF) REQUESTED ACTION: Send Suggestions for Improvement to Stephen.Hufnagel.ctr@tma.osd.mil John Koisch, john.koisch@va.gov 18 Aug 2007 version O

  2. Contents • Management SOA Perspective • Technical SOA Perspective • Application SOA Perspective • Backup Slides

  3. Goal: Healthcare SOA Reference Architecture (H-SOA-RA) Identifying Opportunities to Leverage Technology and Alleviate Redundancy or Agency IT Overlap Key Business Driver Patient Centric Processes Key Architectural Objective Standardized Technical Solutions aligned with Core Business Processes. INTEGRATION Healthcare Industry COLLABORATION VA/ DoD Interagency DoD TMA Military Services INTER-AGENCY Joining Forces to Improve Effectiveness, Efficiency, and Service delivery 3

  4. Healthcare SOA & Standards Framework 4

  5. ANATOMY OF AN ANCILLARY SYSTEM LABORATORY RADIOLOGY PHARMACY CARDIOLOGY OT/PT/SPEECH IDENTITY TERMINOLOGY AUTHORIZATION SCHEDULING CORE BUSINESS SERVICES SUPPLY CHAIN (ORDER/CHARGE) DOCUMENT RECORDS MANAGEMENT s DECISION SUPPORT PERFORMANCE DATA MANAGEMENT 5

  6. INTEGRATED REQUIREMENTS DESIGNS: Putting the H-SOA-RA Pieces Together Ancillary Systems PT/OT/SPEECH LABORATORY SPECIALTY CARE RESPIRATORY PHARMACY CARDIOLOGY RADIOLOGY DIETARY IDENTITY TERMINOLOGY Inter-Service TEST ONLY AUTHORIZATION INPATIENT SCHEDULING Federated Business Services SUPPLY CHAIN: (ORDERS/CHARGES) Core EHR Services Inter-Agency ER DOCUMENT RECORDS MANAGEMENT ASU Federated Services, may be categorized by: -- Encounter Types -- CMS billing category -- Record type -- Care setting type -- etc. DECISION SUPPORT PERFORMANCE CLINIC Across Providers OUTPATIENT OTHER DATA MANAGEMENT ANALYTIC Federated Services SUPPORT Data sets are defined for each system functional-capability-service module IT PLATFORM 6

  7. ENTERPRISE ARCHITECTURE: THE INTEGRATION ROAD MAP s SOA EA INTEGRATION OV-6a ENTERPRISE ARCHITECTURE OV-6c SV-4 ENTERPRISE ARCHITECTURE OV-7 SV-1 OV-5 OV-2 OV-3 PLANNED, COLLABORATIVE, OPTIMIZED

  8. s SOA BUSINESS INTEGRATION Healthcare Enterprise Architecture Best Practices Portfolio Management Standards S E C U R I T Y P R O C E S S S Y S T E M S D A T A A P P L I C A T I O N S S T A F F GOALS & STRATEGIES POLICIES & GOVERNANCE

  9. INTEGRATED SOA ADVANTAGE RESPONSIVE INFORMED RE-USED NON-DUPLICATIVE STANDARDIZED WORKING SMART

  10. BENEFITS Improved Information Accuracy/Availability Safe Effective Patient-centered Timely Efficient Necessary Revenue Improvement PATIENT-CENTERED CARE Rapid Response Length of Stay Reduction Reduced IT Expenditure/ Maintenance Costs

  11. ADDRESSING REAL BUSINESS ISSUES THROUGH H-SOA-RA

  12. INTERAGENCY EA STANDARDIZATION IN SUPPORT OF THE WOUNDED WARRIOR GOAL: Seamless Uninterrupted Care Across the Continuum of Care H-SOA-RA IT Services DOD VA Civilian Specialty Care Acute and Recuperative Care Recuperative and Long Term Care DOD Purchased Care Walter Reed Integrated Care Planning involving Key Players Upfront Care Plan Acute Care Informed Decision Making with Timely Alerts Decision Support Consistent Care Oversight and Co-Ordination Case Management Landstuhl Timely Complete Information Records Management Critical Care Streamlined Referral Referral Combat Theater Joint Performance Review, Learning, Improvement Performance Warfighter Timely, Efficient Benefit Access Benefits Management Stabilization Care Improved Patient Monitoring/Epidemiological Analysis Trauma Registry 12

  13. Contents • Management SOA Perspective • Technical SOA Perspective • Application SOA Perspective • Backup Slides

  14. Joint HL7 and OMG Healthcare Services Specification Project Interoperability at the Service Level Via a Standardized Healthcare Service Oriented Reference Architecture (H-SOA-RA) And Services Specification Framework (SDF) REQUESTED ACTION: Send Suggestions for Improvement to Stephen.Hufnagel.ctr@tma.osd.mil John Koisch, john.koisch@va.gov 18 Aug 2007 version O

  15. BackgroundFederal Direction ‘2001 President’s E-Gov Initiativeresulted in Consolidated Health Informatics (CHI) and Federal Health Architecture (FHA) ‘2004 Executive Order (EO) #13335mandated “Incentives for the Use of Health IT and Establishing the Position of the National Health IT Coordinator.” It set a ‘2014 target for US EHR interoperability. ‘2006 Executive Order (EO) #13410 “Promoting Quality and Efficient healthcare in Federal Government Administered or Sponsored healthcare Programs,” starting in Jan ‘2007. Health and Human Services (HHS)is the designated Executive Agency to implement the Executive Orders (EOs). Healthcare Information Technology Standards Panel (HITSP)is chartered by HHS to define the Interoperability Specifications (IS) of standards to enable the sharing of health information in a secure environment to improve healthcare. President’s Commission on Care for America’s Returning Wounded Warriors made six patient centric recommendations to fix the MHS-VA health systems.

  16. Joint HL7-OMG Healthcare Services Specification Project (HSSP) GOAL: Faster-better-cheaper interoperable-healthcare-systems resulting from consistent enterprise architectures, system acquisitions, system developments, system tests and system certifications within and among organizations. PROBLEM: Inconsistent semantics among healthcare system users, venders, contractors and acquisition processes. APPROACH: Standardize Healthcare SOA Reference Architecture (H-SOA-RA) based on the HL7 EHR System Functional Model (EHR-S) and commercial SOA best practices. BENEFIT:Integrated EHR-S requirements linked to H-SOA-RA system design specifications and CCHIT certification tests will result in consistent, traceable and interoperable requirements-design specifications for procurements, developments & tests.

  17. Situation: HealthcareService Oriented Architecture Problem:A healthcare Service Oriented Architecture (SOA) potentially has 300-400 services and as many standards. This creates an architectural, requirements-design and configuration management challenge. Proposed Solution:H-SOA Reference Architecture (H-SOA-RA) Horizontal:EHR System (EHR-S) Function Model • Direct Care, Supportive, Information Infrastructure, Other Vertical:Service Layer Categories • Core Business: Identity, Terminology, Authorization, Scheduling, supply Chain, Documents, Records Mgmt., etc. • Composite Business value chains • Information/Data: Entity Services • Utility: Agnostic/Federated Services

  18. Objectives EHR Systems Interoperability at the Service level HITSP Compliant National Healthcare Information Exchange (NHIE) • Allow simplified Harmonization with HITSP Specifications through Compatible Architectures • Simplified differentiation between services required to be HITSP compliant and others Facilitate Analysis by Subject Matter Experts (SME)s • Functional, Technical (e.g., system engineering), Security and Privacy Harmonize with Stable De-facto Models • HL7 EHR System Functional Model (e.g., system function categorization) • Commercial SOA layers (e.g., Oasis SOA); Federal Enterprise Architecture (FEA) Support Vertical Implementation Profiles • Within business areas • Across business affinity domains

  19. Service TraceabilityEHR-S, HITSP and CCHIT 19

  20. orchestration service layer business service layer application service layer SOA LayersFocus on the Business Processes and Services [Thomas Erl] Business process layer Business Capabilities and Services Services interface layer System Components and Services Application layer Source: Service-Oriented Architecture, Thomas Erl .NET J2EE Legacy

  21. SOA Service ModelsPotential Service Layers [Thomas Erl] 21

  22. Federated Services [1] • Federation is a state achieved by extending SOA into the realm of service-oriented integration. A number of key WS-* extensions provide feature-sets that support the attainment of federation. Most notable among these are the specifications that implement the concepts of orchestration and choreography. • Establishing SOA within an enterprise does not necessarily require that you replace what you already have. One of the most attractive aspects of this architecture is its ability to introduce unity across previously non-federated environments. While web-services enable federation, SOA promotes this cause by establishing and standardizing the ability to encapsulate legacy and non-legacy application logic and by exposing it via a common, open, and standardized communications framework. • WSRP (Web Services for Remote Portals) is the cornerstone of federated services • SAML (Security Assertions Markup Language) is commonly used • ALSO: WS-Security, WS-Trust, WS-Policy, WS-Federation • Additional info at: https://www120.livemeeting.com/cc/bea/viewReg [1] SOA: Principles of Service Design, by Thomas Erl, Prentice Hall, July 07

  23. HL7 EHR System Functional Model (EHR-S)(> 230 System Functions in 4 level categorization(see attached spreadsheet for full enumeration) Business Choreography Choreography Business Entity (Information) Service Types Business System Functions Infrastructure Entity (Information) Infrastructure Infrastructure Infrastructure Business Choreography NOTE: “Other” Category - The EHR-S model does NOT include Electronic Resource Planning (ERP) / Logistics and Financial components, which are needed for completeness of a military EHR.

  24. Leveraging SOA Processing in the Enterprise Legacy SOA Business Services Application Services Information Services Infrastructure Services Choreographies (Orchestration Services)

  25. Healthcare SOA & Standards Framework

  26. EHR DATA REUSE THROUGH H-SOA-RAACROSS EPISODES OF CARE Previous Episode Of Care EHR Current Episode Of Care EHR IDENTITY Data Must Be Verified And Updated • Patient Demographics • Provider Demographics • Insurer Demographic Terminology • Chronic Diagnoses • Procedure History Reusable Services Document • Patient History • Summary Lists • - Medication List • - Allergy/Adverse Reaction List • - Immunization

  27. ANATOMY OF AN ANCILLARY SYSTEM LABORATORY RADIOLOGY PHARMACY CARDIOLOGY OT/PT/SPEECH IDENTITY TERMINOLOGY AUTHORIZATION SCHEDULING CORE BUSINESS SERVICES SUPPLY CHAIN (ORDER/CHARGE) DOCUMENT RECORDS MANAGEMENT s DECISION SUPPORT PERFORMANCE DATA MANAGEMENT

  28. INTEGRATED REQUIREMENTS DESIGNS: Putting the H-SOA-RA Pieces Together Ancillary Systems PT/OT/SPEECH LABORATORY SPECIALTY CARE RESPIRATORY PHARMACY CARDIOLOGY RADIOLOGY DIETARY IDENTITY TERMINOLOGY Inter-Service TEST ONLY AUTHORIZATION INPATIENT SCHEDULING Federated Business Services SUPPLY CHAIN: (ORDERS/CHARGES) Core Business Services Inter-Agency ER DOCUMENT RECORDS MANAGEMENT ASU Federated Services, may be categorized by: -- Encounter Types -- CMS billing category -- Record type -- Care setting type -- etc. DECISION SUPPORT PERFORMANCE CLINIC Across Providers OUTPATIENT OTHER DATA MANAGEMENT ANALYTIC Agnostic Services SUPPORT Data sets are defined for each system functional-capability-service module IT PLATFORM

  29. Ancillary Applications PHARMACY PT/OT/HSPEECH LABORATORY RESPIRATORY RADIOLOGY DIETARY SPECIALTY CARE CARDIOLOGY IDENTITY CASE MANAGEMENT TERMINOLOGY AUTHORIZATION TEST ONLY INPATIENT SCHEDULING Patient Encounter Types ER SUPPLY CHAIN: (ORDER/CHARGE) DOCUMENT Core EHR-S Services Composite Services, which may be categorized by: -- CMS billing category -- Record type -- Care setting type -- etc. ASU RECORDS MANAGEMENT DECISION SUPPORT ACROSS CARE CONTINUUM ACROSS SERVICES (SOAs) PERFORMANCE OUTPATIENT OTHER CLINIC DATA MANAGEMENT ANALYTIC SUPPORT Data sets are defined for each service – application – encounter type module Federated Services IT PLATFORM COORDINATION

  30. c COORDINATION ` ACROSS LEVELS OF CARE, PROVIDERS and LOCATIONS Case Management Coordination Across SOAs and the Continuum Skilled Long Term Care Custodial Long Term Care Prevention/ Wellness Wartime Theater Acute Inpatient Acute Rehab. Chronic Rehab. Home Health ER Outpatient Care Continuum Coordination ACROSS SOAS ORDERS & SCHEDULING AUTHORIZATION & UTILIZATION MGT. DISCHARGE/ TRANSFER PLANNING COMMUNICATION (FACILITATION ADVOCACY) BENEFIT MANAGEMENT CARE PLANNING ASSESSMENT REFERRAL EDUCATION. TRANSPORT RECORD ROLE OF CASE MANAGER

  31. Potential Benefits from Process Improvement through H-SOA-RA Elimination of Process Obstacles would result in: • Length of Stay Reduction • Improved Patient Outcomes / Reduced Risk • Revenue Improvement • Staff Efficiencies • Improved Patient and Staff Satisfaction • Reduced IT Expenditure/Maintenance Costs • Improved Information Accuracy and Availability

  32. ADDRESSING REAL BUSINESS ISSUES THROUGH H-SOA-RA • Incomplete/Inaccurate Demographic Data (Identity Service) • Incomplete/Inaccurate Insurance Information (Authorization Service) • Unauthorized Service (Authorization Service) • Diagnosis/Procedure Coding Errors (Terminology Service) • Service Delays (Scheduling Service) • Incomplete and Inefficient Charge Capture (Supply Chain Service) • Non-indicated or Contra-indicated Services (Decision Support/ Authorization Services) • Delays in EHR Document Production and Provision (Document Service) • Billing Delays and Errors (Supply Chain/ Billing/ Collection Services) • Not fully coordinated Scheduling (Scheduling Service) • Lack of fully integrated Patient Assessment and Treatment Plan (Document Service/ Decision Support Service) • Delayed or Lack of Medical Record Access (Record Service)

  33. Service Definition Framework (SDF) As we move to federated SOA services, it is important that services across the enterprise be described using a common set of information (metadata) so that services can be consistently discovered and understood by others in the enterprise. The Service Definition Framework (SDF) shown below identifies the necessary attributes for effective description of a service. Source: Department of Defense Global Information Grid Service Strategy See www.SOA.OMG.org “UML Profile and Metamodel for Services (UPMS) "SOA“ for related information.

  34. Service Description Modelhttp://wiki.oasis-open.org/soa-rm/TheArchitecture/ServiceView/ServiceDescription

  35. Contents • Management SOA Perspective (Mary Terlep lead) • Technical SOA Perspective (Steve Hufnagel lead) • Application SOA Perspective(FHA/Laura Tillery lead) • Backup Slides

  36. MHS IM/ITProgram Goal: HITSP To enable the sharing of health information in a secure environment to improve healthcare. Standardized Healthcare Service Oriented Reference Architecture (H-SOA-RA) Goal: President’s Commission on Wounded WarriorsServe, Support, Simplify Goal: MHS & VAInteroperability at the Service Level

  37. Goal: Healthcare SOA Reference Architecture (H-SOA-RA) Identifying Opportunities to Leverage Technology and Alleviate Redundancy or Agency IT Overlap Key Business Driver Patient Centric Processes (e.g., Wounded Warriors) Key Architectural Objective Standardized Technical Solutions aligned with Core Business Processes. INTEGRATION Healthcare Industry COLLABORATION VA/ DoD Interagency DoD TMA Military Service INTER-AGENCY Joining Forces to Improve Effectiveness, Efficiency, and Service delivery

  38. Objectives: Joint MHS & VA Healthcare SOA Reference Architecture (H-SOA-RA) EHR Executive Orders: • MHS-VA Electronic Medical Record (EMR) Interoperability • Purchased Care Interoperability • HITSP Compliance Care for America’s Returning Wounded Warriors Executive Order: “care provided to America’s returning Global War on Terror service men and women from the time they leave the battlefield through their return to civilian life.” … President Commission’s Recommendations[www.pccww.gov/]: • Implement comprehensive Recovery Plans • Restructure disability and compensation systems • Improve care for people with post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) • Strengthen support for families • Transfer patient information across systems • Support Walter Reed until closure

  39. Roadmap for Healthcare Service and Standards Categorization using H-SOA-RA Recommended Roadmap (not in order; concurrency is desirable) • Harmonize SOA&SC with Federal Enterprise Architecture (FEA) done • Service Component Reference Model (SCRM) Individual agencies should map their architectures to the other FEA views: • Performance Reference Model (PRM) • Business Reference Model (BRM) • Data Reference Model (DRM) • Technical Reference Architecture (TRM) • Validate with Open/IBM & Microsoft Healthcare Frameworks (slides 43-48) done • Test the SOA&SC framework done • Map HL7/OMG HSSP services and standards to framework • Map HITSP implied services & standards & CHI standards to framework • Map IHE implied services & standards to framework • Map candidate MHS & VA services & standards to framework • Wounded Warrior (WW) Integrated Requirements-Design (IRD) for MHS-VA NHIE Gateway • Validate WW NHIE IRD with MHS & VA Subject Matter Experts (SME) • Standardize H-SOA-RA as guideline through HL7 SOA SIG • Joint MHS-VA WW NHIE Gateway standardized as Federal Health Architecture (FHA)

  40. Roadmap to HITSP Compliant EA IRDSolution Set for Wounded Warriors (WW)National Health Information Exchange (NHIE) • Define Healthcare SOA Reference Architecture (H-SOA-RA) candidate service blueprint, based on Electronic Healthcare Record System Functional Model (EHR-S) categories and Service Oriented Architecture (SOA) system layers. • Map & Gap AHLTA & VISTA clinical system functions to EHR-S service functions. • Define and analyze wounded warrior (WW) use cases using AHIC & HITSP processes. • Define HITSP compliant WW National Healthcare Information Exchange (NHIE) Gateway • Define AHLTA & VISTA application and federated services • Define Integrated Requirements-Design (IRD) Solution Sets from H-SOA-RA • Build Strategic Enterprise Architecture (EA) Transition Plan • Include EHR-S system functions, H-SOA-RA and CCHIT Test Specifications in • Investment Portfolio (e.g., POM processes) • Procurement Contracts and Acceptance Test & Evaluation Master Plans • Use EHR-S & H-SOA-RA as the key to CM traceability • Functional proponents, Investment Portfolio, OMB & IG reviews, NHIE Gateway • Capabilities/requirements, designs, standards, and test • CCHIT Certification (e.g., 2006, 2009, 2012)

  41. Next StepsMHS-VA Joint H-SOA-RAIntegrated Requirements Design (IRD) Solution Set for Wounded Warriors (WW) • Construct Use Case Scenarios focused on President’s Commission's WW recommendations • Start with AHIC Emergency Responder use case • Emphasize recommendation #5 ” transfer information among systems” [See www.pccww.gov/] • Add benefits determination and shared MHS-VA benefits repository • Build UML Models for WW scenarios FY07Q4 • AHIC-HITSP style Use Cases and Interaction diagrams • H-SOA-RA System Solution UML Deployment diagrams • HITSP Interoperability Specification Constructs • Pre-Coordinate with MHS CIO, VHA & FHA FY08Q1 • FHA (WW Line of Action #4 proponent) request ONC to verify & validate scenarios & models • FHA specify WW National Healthcare Information Exchange (NHIE) Gateway • based on EHR-S • based on H-SOA-RA • based on HITSP Interoperability Specifications • Build MHS & VA Strategic Architecture Transition Plan • based on WW NHIE Gateway IRD vision • Implement Strategic Architecture Transition Plan in Investment Portfolios

  42. Optimistic Internal TimelineJoint MHS-VA using H-SOA-RAIntegrated Requirements Design (IRD)Solution Set for Wounded Warriors (WW) National Health Information (NHIE) Gateway FY07Q4 FY08Q1 FY08Q2 FY08Q3 FY08Q4 OV-6C Enterprise (Business Value Chains) Process Flows OV-7 Enterprise Logical Data Model Data Sets SV-1/SV-2 Enterprise System Interface / Communication Descriptions SV-4 Enterprise System Functions Descriptions SV-4 Enterprise System Data Flows SV-5 Enterprise Activity (OV-5) to System Function (SV-4) Mapping SV-3/SV-6 Enterprise System to System Interface / Data Exchange Matrix SV-8/SV-9 Enterprise System Evolution / Technology Forecast SV-10C Enterprise Systems Event Trace Descriptions (e.g., Wounded Warrior) TV-1 Enterprise System Standards Categorization TV-2 Enterprise System Standards Forecast Schedule is dependent on available resources!

  43. Wounded Warrior Scenarios Source: www.pccww.gov/ )

  44. HEALTHY & FIT FORCE Wounded WarriorContinuum of Care AHLTA (Medical Treatment Facilities) AHLTA (Wounded Warrior) CASUALTY PREVENTION DEPLOY TRAIN BATTALION AID STATION AHLTA Clinical Data Repository Theater Medical Data Store Medical Surveillance FORWARD RESUSCITATIVE SURGERY GARRISON THEATER FORCE HEALTH PROTECTION CARE OUTSIDE THEATER DISCHARGE Medical Situation Awareness THEATER HOSPITALIZATION VISTA Clinical Data Repository ENROUTE CARE VHA CARE TRAC2ES VISTA (Medical Treatment Facilities)

  45. INTERAGENCY EA STANDARDIZATION IN SUPPORT OF THE WOUNDED WARRIOR DOD VA Civilian Specialty Care Acute and Recuperative Care Recuperative and Long Term Care DOD Walter Reed Purchased Care GOAL: Seamless Uninterrupted Care Across the Continuum of Care Integrated Care Planning involving Key Players Upfront Care Plan Acute Care Informed Decision Making with Timely Alerts Decision Support Consistent Care Oversight and Co-Ordination Landstuhl Case Management H-SOA-RA IT Services Timely Complete Information Records Management Critical Care Streamlined Referral Referral Combat Theater Joint Performance Review, Learning, Improvement Performance Warfighter Timely, Efficient Benefit Access Benefits Management Stabilization Care Patient Monitoring and Epidemiological Analysis. Trauma Registry

  46. WOUNDED WARRIOR RECOMMENDATIONS: SOA VIEW ASSESSMENT CARE PLAN ORDERS SCHEDULING • Develop integrated Care Teams • -Create Recovery Plans DISCHARGE/TRANSFER PLANNING REFERRAL TRANSPORTATION EDUCATION • Expand training regarding PTSD and TBI • Expand Caregiver Training for families COMMUNICATION BENEFIT MANAGEMENT AUTHORIZATION & UTILIZATION REVIEW DOCUMENT • Clarify Objectives of DoD/VA Disability Programs • Provide lifetime TRICARE benefits for combat-injured • Restructure VA disability payments • Determine appropriate length and amounts of transition • payments • Update and keep current the disability rating & • Education Program • Provide VA PTSD care for Iraq and Afghanistan veterans • Cover family members under the Family Medical Leave • Create a single, comprehensive medical • exam IT SERVICES RECORD • Make patient information available to • all who need it in readable form DECISION SUPPORT IDENTITY TERMINOLOGY • HUMAN RESOURCE MANAGEMENT • Develop Corp of Recovery Coordinators • Address the shortage in medical health professionals • Expand network of experts in PTSD and TBI • Recruit and Retain Clerical/Admin. Staff • Assure adequate resources • Address shortage of mental health professionals • Develop or disseminate clinical practice • guidelines

  47. Backup Slides • Abbreviations • HA DASD Traceability to HL7 EHR-S Functional Model • SOA Background Slides • SOA Framework, Inventory, Design • SOA Principle Interaction • SOA Service Models (e.g., potential layers) • Service Elicitation Process • Service Categorization • Entity Services, Task Services, Utility Services • Focal Classes • Alternative Healthcare SOA & Standards Framework Representation • Federal Enterprise Architecture (FEA) • Technical Reference Architecture (TRM) • Performance Reference Model (PRM) • Business Reference Model (BRM) • Service Component Reference Model (SCRM) • Data Reference Model (DRM) • Other Healthcare Frameworks • Open Health (formerly IBM) • Microsoft • Global Justice Reference Architecture (SOA-TRM integration)

  48. ASU Ambulatory Surgery Unit CCHIT Certification Commission for Healthcare Information Technology EA Enterprise Architecture EHR Electronic Healthcare Record EHR-S Electronic Health Record-System Functional Model HIT Healthcare Information Technology HITSP Health IT Standards Panel HITSP Health IT Standards Panel HRA Healthcare Reference Architecture IHE Integrating the Healthcare Enterprise NHIE National Health Information Exchange PPBES Planning, Programming, Budgeting and Execution System (DoD) SOA Service Oriented Architecture VA Veterans Administration Abbreviations

  49. Resources UsedDetailed list of H-SOA-RA Services are listed, described and referenced in a separate Excel Spreadsheet . They were developed using the following resources • FEA CONSOLIDATED REFERENCE MODEL VERSION 2.1 • FEA Business Reference Model (BRM) • FEA Service Reference Model (SRM) • FEA Technical Reference Model (TRM) • HL7 EHR-S Model • MHS Enterprise Architecture • Open Healthcare Framework (OHF) (Formerly IBM Health Framework • Microsoft Connected Health Framework Architecture and Design Blueprint • HITSP /HL7 SOA Task Force • Other Resources considered included: • Joint Commission on Accreditation of Hospital Standards (JCAHO) • First Consulting Group Yellow Brick Road Document • AMEDD Activity Mappings • UJTLS Activity Mappings • OASIS SOA Reference Model http://wiki.oasis-open.org/soa-rm/TheArchitecture

  50. Integrated Requirements-Design Lexical & Semantic Consistency = EA Traceability resulting from EHR-S as H-SOA-RA Foundation Ancillary Applications LABORATORY PT/OT/HSPEECH RESPIRATORY RADIOLOGY CARDIOLOGY PHARMACY SPECIALTY CARE DIETARY IDENTITY TERMINOLOGY TEST ONLY • Strategic capabilities map to EHR-S system functions • EHR-S Functions map to Operational Activities (OV-5) • EHR-S Functions map to Functional Requirements • EHR-S Functions map to H-SOA-RA Services • Systems decompose into consistent & traceable sets of • -- EHR-S System Functional Capabilities • -- H-SOA-RA services AUTHORIZATION INPATIENT SCHEDULING ER Patient Encounter Types SUPPLY CHAIN: (ORDER/CHARGE) Core EHR-S Services ASU DOCUMENT Composite Services, which may be categorized by: -- CMS billing category -- Record type -- Care setting type -- etc. DODAF Enterprise Architecture View BASED ON OV-6C Enterprise (Business Value Chains) Process Flows EHR-S lexicon OV-7 Enterprise Logical Data Model Data Sets EHR-S SV-1/SV-2 Enterprise System Interface / Communication Descriptions H-SOA-RA & HITSP SV-4 Enterprise System Functions Descriptions EHR-S SV-4 Enterprise System Data Flows H-SOA-RA & OV-3 info flows SV-5 Enterprise Activity (OV-5) to System Function (SV-4) Mapping EHR-S & H-SOA-RA SV-3/SV-6 Enterprise System to System Interface / Data Exchange Matrix SV-1, SV-4, OV-7 & HITSP IS SV-8/SV-9 Enterprise System Evolution / Technology Forecast H-SOA-RA & CCHIT, EA Plan SV-10C Enterprise Systems Event Trace Descriptions (e.g., Wounded Warrior) OV-6C, SV-5 & SV-6 TV-1 Enterprise System Standards Categorization H-SOA-RA TV-2 Enterprise System Standards Forecast H-SOA-RA & EA Transition Plan RECORDS MANAGEMENT DECISION SUPPORT OUTPATIENT OTHER CLINIC PERFORMANCE DATA MANAGEMENT ANALYTIC Federated Services SUPPORT Data sets are defined for each service – application – encounter type module IT PLATFORM