Health eDecisions RI/ Pilots Sub-Workgroup

1. Health eDecisionsRI/ Pilots Sub-Workgroup May 13th, 2013

2. Agenda • Announcements • Review and Revisit of Goals • Review of RI/Pilot Sub-WG Timeline • Insight Wanted (SOAP VS. REST) • Demo: Using the Vocab and Terminology work • Pilot Updates: • AllScripts and NewMentor (Million Hearts – MU NQF 68) • IG updates • Vocab Updates • VA and Wolters Kluwer • IG Updates • Vocab Updates • CDC and Practice Fusion • IG Updates • Vocab Updates • vMR updates – Aziz and Shu • Review Support tools • Review Action Items, Next Steps

3. Announcements • We will be continuing our work … • Next meeting May 19th, 2013 (plan for a 90 minute meeting) • Continue to work on pilot activities • Pilot updates • Working Sessions

4. Pilots

5. Support Team • Support Team: • Pilots Lead: Jamie Parker: jamie.parker@esacinc.com • Subject Matter Expert: Aziz Boxwala: aziz.boxwala@meliorix.com • Subject Matter Expert: Bryn Rhodes: bryn@veracitysolutions.com • Use Case 1: Dave Shevlin: d.s.shevlin@accenturefederal.com • Implementation Guide: Lynette Elliot: lynettte.elliott@esacinc.com • SDO Support: Anna Langhans: anna.langhans@accenture.com

6. HeD Pilots Goal • Goal • The goal of this initiative is to produce, consume and where feasible, execute implementable CDS interventions. • Event Condition Action Rules (ECA Rules) • Order Sets • Documentation Templates • Pilot Scope • Health eDecisions will apply defined aspects of the Implementation Guide in a real-world setting. • Modify the Implementation Guide to ensure it is usable • Submission of explicit feedback to sub workgroups such as vMR and vocabulary and terminology to close gaps • The real-world pilots evaluate not only the technology, standards and model (VMR), but also provide a test bed to evaluate the interaction of technology, implementation support, and operational infrastructure required to meet Health eDecisions use case 1 objectives at the stakeholder or organization levels. • Demonstrate intent of artifact (specifically structures and semantics) are communicated either by direct execution or by translation to native format • Ensure Completeness and consumability of artifact

7. Timeline We are Here

8. Vendor Engagement Discussion

9. REST vs. SOAP • Background for this discussion: HeD UC2 aims to provide implementation guidance on CDS as a service – namely, the sending of a request for CDS guidance and receiving CDS guidance in return.  • This involves implementation guidance on not only what information needs to be exchanged for each transaction, but also how the information will need to get from one system to the next.  • The transport standards being considered to support this effort are SOAP and REST.  • The HED UC2 community feels strongly that, due to the extensive use of SOAP today that the HeD UC2 should be able to work with SOAP.  However, they also feel like the industry is moving towards REST and therefore would like the implementation guidance to support both transport standards. • We would like the pilot team’s thoughts on the two transport options (pros, cons) and how much effort it would require implementers to support both transport standards.  • Do you have a preference on which standard should be supported?  • Do you have any objections to supporting both standards?  • How much additional effort do you think this would require?  • Do you think that the extra cost of supporting both standards would deter use of the UC2 IG altogether?

10. Using the Vocabulary and Terminology Work • Aziz will demo how to incorporate the extensive work done by the Vocabulary and Terminology subwork group as part of the UC 1 pilot activities

11. Pilot Updates: NewMentor – AllScripts (ECA Rule Million Hearts –NQF 68) • Team: • Julie Scherer - NewMentor • Bryn Rhodes – Internal Support • Robin Williams – AllScripts • Team Meetings • Every Monday, Tuesday, Wednesday and Friday at 11:45 EST? • Status: • Notes on the IG • Notes on the Vocab Work

12. Pilot Updates: Wolters Kluwer – VA (Documentation Template) • Team: • Christy May -Wolters Kluwer • ???? – Internal • Ken Kawamoto - VA • Status: • Notes on the IG • Notes on the Vocab and Terminology Work • ENM Code issue (maybe include them in LOINC) • Follow up with Mark (examples are in the UTI template – send to LOINC folks) • Tracking sheet has been created to track these follow up issues through the vocab and term group

13. Pilot Updates: Zynx – DesignClinicals (Order Set- Heart Failure ) • Team: • Claude Nanjo and Victor Lee Zynx • ???? – Internal Support • Dewy Howell – DesignClinicals • Status • Notes on the IG • Notes on the Vocab and Terminology Work

14. Pilot Update: CDC – Practice Fusion (ECA Rule) • TEAM: • Shu McGarvey - CDC • Aziz Boxwala – Internal Support • Jamie Parker– Standing in for Practice Fusion • Status • Notes on the IG • Notes on the Vocab Work • Updates to the vMR – (based on converting the rule from HQMF to HeD and the needs of the CDC) • We met with the CDS Work Group(HL7) and they agreed with the proposed changes needed to finalize the CDC rule

15. Pilot Support Tools and Feedback channels • Discussion Board: • http://wiki.siframework.org/HeD+Pilot+Activities#HeD_Pilot_Discussion • Vocabulary and Terminology Feedback: • http://wiki.siframework.org/HeD+Pilot+Tools

16. Action Items & Next Steps • Continue to monitor timeline • Continue pilot work • Going forward each pilot group will be giving a report out at each meeting • As needed and necessary we will be discussing issues and challenges during the pilot activities • Update the IG • Update the Vocabulary and Terminology work • Identify additional support resources if necessary

17. Meeting Reminder • Pilots Work stream meets (next meeting: May 19th, 2013) • Every Monday • 1-2:30 pm EDT See Wiki homepage for meeting details: http://wiki.siframework.org/Health+eDecisions+Homepage

18. Appendix A: Success Criteria • NOTE: This is a work –in-progress we will need to re-evaluate this after Pilot Project Plans • Discuss Pilot Success Criteria: • Individual Criteria • Initiative Criteria • EHR Involvement - DONE • Production (at least one of each artifact and consumption of those artifacts) • Addressed as part of the Pilot Project Plans (who will be doing which artifacts) • Successful implementation of artifacts • EHR involvement • Validate artifact – perhaps Pilots focuses on this ? • Execute the artifact • Cross initiative function • Potential Alignment with eDOC and esMD • SDC • Alignment with MU 3 objective • 10% knowledge based engine (align 402b) • ACTION ITEM: Review MU3 Criteria • Determine the delivery model we want to pilot • External (i.e. cloud service) • Assets are portable (can be run locally) • Discuss this with the group

19. Appendix B • In Scope/Out of Scope

20. Scope of Use Case 1 • This Use Case defines the requirements to build a standard for the contents of CDS Knowledge artifacts.  The use case focuses on the following artifact types: Event Condition Action (ECA) Rules, Order Sets, and Documentation Templates. To support this purpose the Use Case has one scenario:  A CDS Knowledge Artifact Supplier makes computable CDS Knowledge Artifact available to CDS Artifact Integrator (From HeD Use Case: CDS Artifact Sharing)

21. In Scope • Standards to structure medical knowledge in a shareable and executable format for use in CDS • In Scope Artifact Types (definitions for these artifact types can be found in Appendix A) • Event Condition Action Rules • Order Sets • Documentation Templates

22. Out of Scope • Tools: • Authoring tools, source “content” management. • Terminology server and mapping tools including management of concept coordination. • Semantic processing of text, including structured string processing and natural language processing. • System Functions • Messaging Layer • Means of sharing • Security • Authoring, creation and maintenance of clinical decision support knowledge • Knowledge Repository Design • Search and query mechanisms • Implementation in systems • User presentation, Transport layers • Market factors: regulatory incentive/mandate, liability shield, IP shield (patent/licensing litigation), certification body, marketplace design, test procedures, FDA rules • Clinical Decision Support Services (this will be covered in Use Case 2 CDS Guidance Services) • CDS Content Development Activities, including the distribution and sharing of artifacts • Context-Aware information retrieval (HL7 Information Button) – This will be covered in UC 2 (CDS Guidance)

23. Pre and Post Conditions • Pre-Conditions • CDS Artifact Supplier makes CDS artifacts available for search and consumption by CDS Artifact Integrators _ ACTION ITEMS (Clarify this –what is a precondition for this to be useful) • CDS Artifact integrator has the means to obtain the knowledge artifact from a CDS Repository (e.g. they have either browsed or queried the CDS Repository for available artifacts) • CDS Artifact Integrator Selects Artifacts of Interest to Use in their CDS System • Post Conditions • The CDS Knowledge Artifact Supplier has sent the CDS Knowledge Artifact to the requesting CDS Artifact Integrator • CDS Artifact has been received by CDS Integrator and is available for processing • CDS Artifact is available for mapping, structural transformations and local adaptation • Strategy Decision: In the pilot activities we will not directly address these as part of our pilot. We will focus the pilot activities on those tasks which occur between the pre and post condition