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“ Jericho / UT Austin Pilot”

“ Jericho / UT Austin Pilot”. Privacy with Dynamic Patient Review. Presented by: David Staggs JD, CISSP Jericho Systems Corporation. Agenda. Administrative issues Pilot scope Pilot data flow Implementation guidance document Previously discussed sections Additional sections

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“ Jericho / UT Austin Pilot”

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  1. “Jericho / UT Austin Pilot” Privacy with Dynamic Patient Review Presented by: David Staggs JD, CISSP Jericho Systems Corporation

  2. Agenda • Administrative issues • Pilot scope • Pilot data flow • Implementation guidance document • Previously discussed sections • Additional sections • General discussion • Pilot timeline • Plan of action

  3. Pilot Administrivia • This pilot is a community led pilot • Limited support provided by the ONC • JohnathanColeman (Security Risk Solutions) • Zachary May (ESAC) • Penelope Hughes (ONC) • LibbieBuchele (ONC Sponsor) • In conjunction with DS4P bi-weekly return of an All Hands meeting • Access to DS4P Wiki, teleconference, and calendar • Meeting times: Tuesdays 11AM (ET) • Dial In: +1-650-479-3208Access code: 662 197 169URL:https://siframework1.webex.com/siframework1/onstage/g.php?t=a&d=662197169

  4. Scope of the Pilot • Define the exchange of HL7 CDA-compliant PCD between a data custodian and a PCD repository that includes a report on the outcome of the request to the healthcare consumer (subject). • Additional goal: use identifiers to identify the subject/ PCD repository for use in reporting the outcome of the “secondary user” request use case to subject by subsequent EHR custodians. • Stretch goal: mask and/or redact the clinical document based on data segmentation and PCD choices retrieved from the PCD repository.

  5. Pilot Data Flow , = Clinical data A,B = PCD data = audit record  1st Requestor And Subsequent Custodian of Data being Provided at  B Custodian of Data being Provided at   PCD Repository 2nd Requestor Patient

  6. J-UT Implementation Guidance • PCD returned to the document custodian should be specific to the document custodian and the requestor • PCD should be requested for each type of network exchange that could reveal PHI: ITI-55, ITI-38, and ITI-39 • Data labels should be passed in the PCD request if they exist in the document being requested • Document Custodian should return release decision as an ATNA audit message to the PCD repository • PCD repository should allow edit of PCD and review of release decisions through standard interfaces http://wiki.siframework.org/file/view/SIFramework_DS4P_UC_Jericho_4NOV2013.docx/466080974/SIFramework_DS4P_UC_Jericho_4NOV2013.docx

  7. Previously Discussed IG Sections • PCD should be dynamically filtered specifically for the document custodian and requestor (§2.2) • PCD should be requested for each type of data exchange that could reveal PHI (§3.0) • PCD request should include any data labels identified in the requested information (§2.3) • Release decision should be returned to the PCD repository using an ATNA audit message (§2.4) • PCD repository should be securely accessible to patients using standard interfaces • PCD alternative representation should be XACML and should be lightweight (§2.6) • PCD repository location and account information can be embedded in a CDA clinical document (§2.5)

  8. Additional Topics Added to the IG • Introduction: creation of the pilot (§1.0) • Use Case Scenario: implementation of user story 3 (§2.0) • Architecture: The J-UT data flow (§2.1) • IHE ITI-55 Transactions: diagram and data sets for patient discover request received at the gateway (§3.1) • IHE ITI-38 Transactions: diagram and data sets for document list request received at the gateway (§3.2) • IHE ITI-39 Transactions: diagram and data sets for document request received at the gateway(§3.3) • Test Participants: List of members who played roles in the test scenario (§4) • Summary of J-UT Implementation Guidance: Summary of the major guidance from the pilot (§5)

  9. General Discussion • Implementation guidance document • Do we need more time to review? • Does the content need additions / deletions? • Are there issues with the remaining artifacts? • Mapping / gap analysis of functionality to standards? • Test cases, test artifacts, and/or test video? • Additional activities • More demonstrations and/or J-UT meetings? • Approval of the implementation guidance document? • Bringing the IG to standards organizations (profiles)?

  10. Pilot Timeline • General Timeline, conditioned on agreement of stakeholders

  11. Plan of Action • Upon agreement of the participants the POA is: • Identify the elements available from previous DS4P pilots • Scope level of effort, decide on extended scenario • Determine first draft of functional requirements • Review standards available for returning information on requests • Determine any gaps or extensions required in standards • Stand up information holders and requestors • Create XDS.b repository holding PCD • Identify remaining pieces, create test procedures • Document and update IG with results of our experience

  12. Backup Slides

  13. DS4P Standards Material • Location of DS4P Standards Inventory: http://wiki.siframework.org/Data+Segmentation+-+Standards+Inventory • Location of DS4P Standards Mapping Issues: http://wiki.siframework.org/file/view/Copy%20of%20DataMappingsIssues%2005102012.xlsx/333681710/Copy%20of%20DataMappingsIssues%2005102012.xlsx • General Standards Source List: http://wiki.siframework.org/file/view/General%20SI%20Framework%20Standards%20Analysis.xlsx/297940330/General%20SI%20Framework%20Standards%20Analysis.xlsx • Standards Crosswalk Analysis http://wiki.siframework.org/Data+Segmentation+for+Privacy+Standards+and+Harmonization (at bottom of page, exportable) • Implementation Guidance http://wiki.siframework.org/file/view/Data%20Segmentation%20Implementation%20Guidance_consensus_v1_0_4.pdf/416474106/Data%20Segmentation%20Implementation%20Guidance_consensus_v1_0_4.pdf

  14. DS4P References • Use Case: http://wiki.siframework.org/Data+Segmentation+for+Privacy+Use+Cases • Implementation Guide: http://wiki.siframework.org/Data+Segmentation+for+Privacy+IG+Consensus • Pilots Wiki Page: http://wiki.siframework.org/Data+Segmentation+for+Privacy+RI+and+Pilots+Sub-Workgroup

  15. Test Cases • Consent To Patient Discovery : No Consent • Consent To Document Query : No Consent • Consent To Document Retrieve : No Consent • Consent To Patient Discovery : 1st Requestor (1st) • Consent To Document Query : 1st To PC - Allow • Consent To Document Query with POU 1st to PC – Deny • Consent To Document Retrieve : 1st to PC - Allow • Consent To Patient Discovery : 2nd Requestor(2nd) • Consent To Document Query : 2ndTo PC - Deny • Consent To Document Retrieve : 2nd To PC – Deny • Consent To Document Query : 2ndto SC - Deny • Consent To Document Retrieve : 2ndto SC - Deny • Consent To Document Retrieve : With Segmentation

  16. Test Cases (Visual Representation) PC = Primary Custodian SC = Secondary Custodian Test Document available for review (since 9/16/2013) at: http://wiki.siframework.org/DS4P+Jericho-UT+Austin+Draft+Test+Document Video of the test will be available shortly.

  17. Test Participants Participants in the September 20, 2013 DS4P Pilot Execution Script:

  18. Pilot Data Flow , = Clinical data A,B = PCD data = audit record  1st Requestor And Subsequent Custodian of Data being Provided at  B Custodian of Data being Provided at   PCD Repository 2nd Requestor Patient

  19. Pilot Data Flow Clinical exchange # , = Clinical data A,B = PCD data = audit record 1st Requestor And Subsequent Custodian of Data being Provided at  B Fetch PCD Fetch PCD Custodian of Data being Provided at  Clinical exchange #  Send audit Send audit PCD Repository 2nd Requestor Patient

  20. Pilot Data Flow (1) , = Clinical data A,B = PCD data = audit record  1st Requestor Custodian of Data being Provided at  PCD Repository 2nd Requestor Patient

  21. Pilot Data Flow (2) , = Clinical data A,B = PCD data = audit record  1st Requestor Custodian of Data being Provided at  PCD Repository 2nd Requestor Patient

  22. Pilot Data Flow (3) , = Clinical data A,B = PCD data = audit record 1st Requestor And Subsequent Custodian of Data being Provided at  B Custodian of Data being Provided at   PCD Repository 2nd Requestor Patient

  23. Pilot Data Flow (4) , = Clinical data A,B = PCD data = audit record 1st Requestor And Subsequent Custodian of Data being Provided at  Custodian of Data being Provided at   PCD Repository 2nd Requestor Patient

  24. Pilot Data Flow (5) , = Clinical data A,B = PCD data = audit record 1st Requestor And Subsequent Custodian of Data being Provided at  Custodian of Data being Provided at  PCD Repository 2nd Requestor Patient

  25. Pilot Data Flow (updated) , = Clinical data A,B = PCD data = audit record  1st Requestor And Subsequent Custodian of Data being Provided at  B Custodian of Data being Provided at   PCD Repository 2nd Requestor Patient

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