Report from the Technical Committees

1. Report from the Technical Committees Arlington, VA | June 23, 2008 Presented by Joyce Sensmeier MS, RN-BC, and the HITSP Technical Committee Co-Chairs enabling healthcare interoperability

2. In order to better conduct its new work, HITSP has implemented a new Technical Committee structure Three (3) Perspective Committees aligned with AHIC perspectives Provider Population Consumer Three (3) Domain Committees focused on healthcare domains Care Management and Health Records Security, Privacy and Infrastructure Administrative and Financial

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

4. Use Cases Year 3 Consultations and Transfers of Care -- The exchange of information between clinicians, particularly between requesting clinicians and consulting clinicians, to support consultations such as specialty services and second opinions. Personalized Healthcare -The exchange of genomic/genetic test information, family health history and the use of analytical tools in the electronic health record (EHR) to support clinical decision-making. Remote Monitoring –Focuses on the exchange of physiological and other measurements from remote monitoring devices in three candidate workflows: Measurement and Communication, Monitoring and Coordination, and Clinical Management.

5. Use Cases Year 3 Patient-Provider Secure Messaging -- Patients consult with their healthcare clinicians remotely using common computer technologies readily available in home and other settings. Immunizations and Response Management –The ability to communicate a subset of relevant information about needs for medication and prophylaxis resources, about resource availability, about their administration and about the status of treated and immunized populations. Public Health Case Reporting - Leveraging electronic clinical information to address population health data requirements.

6. Technical Committee Leadership Provider Perspective – 203 members Allen Hobbs, PhD, Kaiser Permanente Steve Hufnagel, PhD, DoD/Medical Health System (MHS) Mike Lincoln, MD, Department of Veterans Affairs Consumer Perspective – 192 members Mureen Allen, MD, FACP, ActiveHealth Management Charles Parisot, EHR Vendor Association Scott Robertson, PharmD, Kaiser Permanente

7. Technical Committee Leadership Population Perspective - 166 members Floyd Eisenberg, MD, MPH, Siemens Medical Solutions Peter Elkin, MD, Mayo Clinic College of Medicine Steve Steindel, PhD, Centers for Disease Control & Prevention Administrative and Financial Domain – 42 members Don Bechtel, Siemens Medical Solutions Durwin Day, Health Care Service Corporation Deborah Belcher, GE Healthcare

8. Technical Committee Leadership Security, Privacy & Infrastructure Domain - 161 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 - 31 members Keith Boone, GE Healthcare Corey Spears, McKesson Health Solutions Total Technical Committee Membership – 481 individuals

9. Report from the Population Perspective Technical Committee Two Use Cases Immunizations & Response Management Public Health Case Reporting Outline Overview Scope Reuse Items Identified new Constructs

11. Report from the Population Perspective Technical Committee – Immunizations & Response Management Release I: Artifacts for communication of vaccination information between patients, providers, and immunization registries, including registry-to-registry communication Allow for optionality of architectures supporting traditional legacy message-based communications, addition of support for patient identification services (TP22, T23) and the addition of support for document-centric sharing and point-to-point communications Include security and privacy constraints for implementation of the Immunization and Response Management Interoperability Specifications Release II: Identify specification and standard business workflows for supply chain and distribution management of vaccines and develop needed artifacts Incorporation of the and vaccine recall processes in the supply chain management. Availability of constructs supporting Clinical Decision Support

12. Report from the Population Perspective Technical Committee – Immunizations & Response Management New Constructs Component: Identify communication recipients Component: Vaccination message Component: Unstructured document (communicate generic information to patient) Component: Generic alert to identified providers (communicate non-patient specific information) Component: Consumer vaccination view Transaction Package: Immunization Query & Response Vaccination Component Deferred Clinical Decision Support Content (immunization schedules, reminders) Vaccination Document Component Medication Administration Terminology Services

13. Report from the Population Perspective Technical Committee – Immunizations & Response Management Reuse of Existing Constructs Transaction Package: Immunization Feed Package (PIX/PDQ, TP13) TP 50 Retrieve Form for Data Capture TP 21 Query for Existing Data TP 13 Manage Sharing of Documents C48 Encounter Document Using IHE Medical Summary C32 Summary Documents Using HL7 CCD C25 Anonymize T24 Pseudonymize T23 Patient Demographics Query T29 Notification of Document Availability T22 Patient ID Cross-Referencing T16 Consistent Time T17 Secured Communication Channel C26 Nonrepudiation of Origin C19 Entity Identity Assertion T15 Collect and Communicate Security Audit Trail TP30 Manage Consent Directives TP20 Access Control T31 Document Reliable Interchange T33 Transfer of Documents on Media

14. Report from the Population Perspective Technical Committee – Immunizations & Response Management

16. Report from the Population Perspective Technical Committee – Public Health Case Reporting Use Case Public Health Case Reporting Content Standardization in Progress Ongoing Content Source: Council of State and Territorial Epidemiologists (CSTE) Adverse Event Reporting Content Standardization in Progress Ongoing Content Sources: Adverse Drug Events – FDA Patient Safety – TBD AHRQ Patient Safety Data Set Public Comment 9 Aug 2008 CDC Healthcare Associated Infection definitions / reporting Patient Safety Organization (PSO) instantiation

17. Report from the Population Perspective Technical Committee – Public Health Case Reporting Use Case 2008 – Trial Implementation Testing, Publication of Roadmap TP50 – Retrieve Form for Data Capture No determination regarding content structure within RFD Content can be mapped to HL7 message – CDA, C32, C48, message or other One construct for trial content component consideration HL7 Healthcare Associated Infection (HAI) report 2009 – Release 1 Content Standardization in Progress Reporting Criteria Content – Common / basic Alerts, Reporting Criteria, Transport Support Communication of non-PHI alerts and notifications

18. Report from the Population Perspective Technical Committee – Public Health Case Reporting Use Case 2010 – Release 2 FDA MedWatch, Vaccine Adverse Event Reporting System (VAERS) – Pending successful ballot of Individual Case Safety Report (ICSR)v3 through HL7, ISO, CEN – Expected Dec 2009 AHRQ Sentinel Event / Adverse Reaction Reporting Public Health Case Reporting Reporting Criteria Content – Case-specific Communications from Public Health Clinical Decision Support content, triggers

19. Report from the Population Perspective Technical Committee – Public Health Case Reporting Use Case New Constructs (Introduction timing not indicated) Digital Receipt Case Reporting Terminology Component Standard Case Report Construct Adverse Event Reports: (CDC-HAI, AHRQ, FDA, PH Cases) Reporting Criteria Content: Basic and Case-specific Clinical Decision Support Content (Trigger Events: PH, AE, AHRQ) Identify Communication Recipients Communications from Public Health Clinical Report Health Public Report Public Reporting

20. Report from the Population Perspective Technical Committee – Public Health Case Reporting Use Case Reuse of Existing Constructs TP50: Retrieve Form for Data Capture TP21: Query for Existing Data TP13: Manage Sharing of Documents C48: Encounter Document Using IHE Medical Summary C32: Summary Documents Using HL7 CCD C25: Anonymize C35: Lab Report Terminology C36: Lab Result Message C37: Lab Report Document T24: Pseudonymize T23: Patient Demographic Query T29: Notification of Document Availability T22: Patient ID Cross-Referencing T16: Consistent Time T17: Secured Communication Channel C26: Nonrepudiation of Origin C19: Entity Identity Assertion T15: Collect and Communicate Security Audit Trail TP30: Manage Consent Directives TP20: Access Control T31: Document Reliable Interchange T33: Transfer of Documents on Media

21. Report from the Consumer Perspective Technical Committee Work items year-to-date RDSS57 Patient-Provider Secure Messaging RDSS56 Remote Monitoring SOW Items Advance Directives Provider Lists Consumer-Friendly Clinical Information

22. Report from the Consumer Perspective Technical Committee Patient-Provider Secure Messaging -PPSM Coordinated work with all three Domain TCs RDSS57 complete, sent to IRT/project team Public Comment in July Will begin IS development early July. Target is IS submission to panel for December 2008.

23. 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  Selected

24. Report from the Consumer Perspective Technical Committee C62 Unstructured Document Component (new) Support for a wide variety of content (PPSM and advanced directives-SOW) Simple/unstructured text Scanned Documents PDFs New component. References IHE XDS-SD & CDA r2 Coordination between CPTC, SPI, Admin & Finance Minimal document header (compatible with other HITSP CDA docs) to support wide applicability Secured Messaging Advance Directives

25. Report from the Consumer Perspective Technical Committee Remote Monitoring Coordinated work with all three Domain TCs RDSS56 complete, sent to IRT/project team Public Comment in July Will begin IS development early July. IS submission to panel for Dec 2008 may be at risk: Requires HL7 Personal Health Monitoring (PHM) document IG. First ballot Sept 2008. Consistency with ongoing work in Continua and IHE PCD. Active partnership but completion expected Dec 2008. RDSS feedback will be used to confirm schedule.

26. Report from the Consumer Perspective Technical Committee Remote Monitoring - Business Actors Business Actors may be combined:e.g. RM Mgt Syst & EHR or RM Mgt Syst & PHR Significant reuse of existing constructs in Interfaces 3, 4, 5, 6 and 7.

27. Report from the Consumer Perspective Technical Committee Statement of Work Items A number of items identified last year (as gaps in use cases) prioritized for possible completion this year IS03 / IS05 2007 gap items: Advance Directives Consumer-Friendly Clinical Information Provider Lists Planning underway for an update IS03 / IS05 with advance directives and consumer-friendly clinical info. Need to schedule reviews with the appropriate TCs

28. Report from the Consumer Perspective Technical Committee Advance Directives (partial in 2008) Unstructured document component Consumer-Friendly Clinical Information Defined the key actors and interactions 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 may extend in 2009

29. Report from the Provider Perspective Technical Committee: Consultations and Transfers of Care CTC focuses upon: “…the electronic exchange of information between clinicians…to support consultations, including specialty services and second opinions… (and) the exchange of clinical information needed during transfers of care.” Status: RDSS has been completed and submitted to IRT, following extensive feedback from other perspective and domain tech committees Gaps: For some standards (e.g., electrocardiogram) HITSP does not have a defined construct for all data types. Resolution anticipated: CTC Tech Committee (TC) to monitor emerging standards and include when available. Future work: Submit RDSS document to HITSP Panel and Public for comment Dispose of received comments: use persuasive comments to inform the Interoperability Specification; log non-persuasive comments for information TC will begin to develop the CTC Interoperability Specification

30. Report from the Provider Perspective Technical Committee: Personalized Health Care Personalized Healthcare: The exchange of genomic/genetic test information, family health history and the use of analytical tools in the electronic health record (EHR) to support clinical decision-making Status: Completed RDSS and submitted to IRT Noted Gaps: 1. There is an inability to receive a report of risk to consumer based on analysis and interpretation of genetic test results. 2. There is a need verify eligibility for payer and provide authorization of service. Next Steps: 1. Submit to the HITSP Panel and interested Public for Comment 2. Disposition the comments 3. Begin construction of Interoperability Specifications

31. Report from the Provider Perspective Technical Committee Emergency Responder EHR Use Case Status: IS04 Version 1.0 was issued Dec 07 10 GAP/Overlap closure projects (see next slide) NEXT STEPS: 2008 HITSP Transaction (Package) for OASIS-HL7 header, container and payload harmonization 2009 HITSP Constructs for NEMSIS and DEEDS harmonized vocabulary pre-hospital EMS document content (e.g., field and run reports) OASIS CAP, HAVE and RM (available now) SITREP and Patient Tracking (in progress) RECOMMENDATIONS: IS04 updates as new HITSP constructs are ready (Dec 2008 and Dec 2009) 22 page ER-EHR Status Report, dated 11-Jun-08 is available at http://hitsp.wikispaces.com/Emergency+Responder-EHR+Use+Case

32. 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 – pending October funding start of work 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) – in-progress Life Critical Remote Monitoring - monitoring HITSP RMON use case progress

33. Report from the Security, Privacy and Infrastructure Domain Technical Committee Current Work Items: Minor/Editorial changes to existing constructs and TN900 (Due 11 July) Development of 6 new constructs (for Public Comment in September) Modification of 5 existing constructs to meet 2008 Use Case requirements (for Public Comment in September) Longer term maintenance updates to constructs and TN900 (e.g. revisions to TP30: Manage Consent Directives – to incorporate additional coding/base standards which are now available) Continue to work with TC-Leadership to address NHIN issues related to the use of SPI constructs in the NHIN Trial Implementations (ongoing)

34. New SPI Constructs Under Development

35. New SPI Constructs Under Development

36. Existing Constructs to be Modified to Meet New Use Case Requirements

37. Report from the Care Management & Health Records Domain Technical Committee 12 New constructs identified 2 technical notes on HITSP Care Management framework 2 for restructuring of existing work for reuse 5 for which there are significant gaps in standards 5 in support of CTC, PHCR, PH, and ICRM use cases Tier 2 evaluations underway Significant work completed on one new construct Coordination needed with SPI TC on a few constructs Scanned/Text Documents Order/Response Messages for Referrals

38. Care Management & Health RecordsConstruct Reorganization for Reuse

39. Report from the Administrative and Financial Domain Technical Committee