IHEs contribution to standards harmonization for the NHIN

1. 1 IHE's contribution to standards harmonization for the NHIN

2. 2 There are many industry-wide efforts supporting the future viability and success of the NHIN: AHIC: Public-Private Effort coordinating interoperability framework HITSP: Release of 30 standards in 3 Interoperability Specifications HISPC: State-level Security and Privacy Harmonization CCHIT: EHR and NHIN Infrastructure Certification NCVHS: Consolidated Minimum Functional NHIN Requirements IHE: Global initiative creating a framework for exchanging health information seamlessly State Health Alliance for eHealth Other standards body organizations work efforts ����..All to be accomplished in a phased approached U.S. Efforts Supporting the NHIN

3. 3 The Community is the hub that drives opportunities for increasing nation wide health information interoperability

4. 4 First Round of Standards Harmonization AHIC breakthroughs Use cases Context Processes Data HITSP Harmonization of standards Gaps and needs Specificity as to how to use the standard in implementation level guidance � �Interoperability Specifications�

5. 5 Purpose: develop prototype and evaluate Goal: achieve widely accepted set of standardsPurpose: develop prototype and evaluate Goal: achieve widely accepted set of standards

6. 6 HITSP Framework: Basis for Interoperability Specification Development HITSP receives Use Cases and Harmonization Requests from external sources, such as AHIC and ONC. The Use Case or Request defines scenarios, business actors, and business and functional/interoperability requirements. HITSP develops Interoperability Specifications supporting the UseCases: technical actors, transactions, content and terminology. HITSP identifies constructs which are logical groupings of base standards that work together, such as message and terminology. These constructs can be reused like building blocks. While reuse is a HITSP goal, it is established in the context of a use case and its functional/interoperability requirements. HITSP constructs are version controlled and, if reused, will be uniquely identified.

7. 7 The HITSP process results in creation of Interoperability Specifications used to promote nationwide interoperable health information exchange

8. 8 Breakthrough Areas Biosurveillance -- Transmit essential ambulatory care and emergency department visit, utilization, and lab result data from electronically enabled health care delivery and public health systems in standardized and anonymized format to authorized public health agencies with less than one day lag time. Consumer Empowerment -- Deploy to targeted populations a pre-populated, consumer-directed and secure electronic registration summary. Deploy a widely available pre-populated medication history linked to the registration summary. Electronic Health Records -- Deploy standardized, widely available, secure solutions for accessing laboratory results and interpretations in a patient-centric manner for clinical care by authorized parties. Chronic Care � Ensure that widespread use of secure messaging, as appropriate, is fostered as a means of communication between clinicians and patients about care delivery

9. 9 The three HITSP Technical Committees have published Interoperability Specifications in October 2006

10. 10 HITSP Recommended Standards Biosurveillance ICD-9CM � International Classification of Diseases v. 9 Clinical Modifications ICD-10 CM � Diagnoses and Procedures IHE-XDS � Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing IHE-XDS Lab � IHE Laboratory Report Document Sharing IHE-RFD � IHE Retrieve Form for Data Capture IHE-PIX � IHE Patient Identification Cross-Referencing IHE-RAD � XDS-I � IHE Cross-Enterprise Sharing of Images IHE-NAV � IHE Notification of Document Availability IHE-XDS-MS � IHE Medical Summary Document Sharing ISO/TC215 -DTS 25237 - Health Informatics Pseudonymisation LOINC � Logical Observation Identifiers Names and Codes NCCLS � National Committee for Clinical Laboratory Standards RxNorm � National Library of Medicine RxNorm

11. 11 HITSP Recommended Standards Consumer Empowerment IHE-XDS � Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing IHE-PIX � IHE Patient Identification Cross-Referencing IHE-PDQ � IHE Patient Demographics Query Health Level Seven (HL7) CDA R2 � HL7 Clinical Document Architecture Release 2 HL7 CCD � HL7 Clinical Document Architecture Release 2 and ASTM E 2369-05 Standard Specification for Continuity of Care Record (CCR) HL7 v. 2.5 HL7 EHR Systems Functional Model Draft Standard for Trial Use (DSTU) Logical Observation Identifiers Names and Codes (LOINC)

12. 12 HITSP Recommended Standards Electronic Health Record Exchange IHE-XDS Lab � IHE Laboratory Report Document Sharing IHE-PIX � IHE Patient Identification Cross-Referencing IHE-PDQ � IHE Patient Demographics Query Health Level Seven (HL7) CDA R2 � HL7 Clinical Document Architecture Release 2 HL7 v. 2.5 Clinical Laboratory Improvement Amendments (CLIA) Logical Observation Identifiers Names and Codes (LOINC) Health Insurance Portability and Accountability Act (HIPAA) Systematized Nomenclature of Medicine � Clinical Terms (SNOMED � CT) Unified Code for Units of Measure (UCUM)

13. 13 This slide takes the same portofolio of IHE profiles and identifies in green the profiles that have already been selected by HITSP as part of its interoperability specifications that are demonstrated in this showcase. It also shows in orange the profiles that have either been placed by CCHIT on their roadmap for 2008 or 2009 testing as well as candidates that complements the first three AHIC use cases or support the next wave of AHIC use cases.This slide takes the same portofolio of IHE profiles and identifies in green the profiles that have already been selected by HITSP as part of its interoperability specifications that are demonstrated in this showcase. It also shows in orange the profiles that have either been placed by CCHIT on their roadmap for 2008 or 2009 testing as well as candidates that complements the first three AHIC use cases or support the next wave of AHIC use cases.

14. 14 Emergency Responder Use Case Under the leadership of the Office of the National Coordinator for Health Information Technology, an Emergency Responder Use Case has been developed and prioritized for the attention of the HITSP and the other ONC initiatives. The Use Case describes the role that an Emergency Responder Electronic Health Record, comprising at a minimum demographic, medication, allergy and problem list information, that can be used to support emergency and routine health care activities.

15. 15 HITSP GOALS and IHE HITSP goals with respect to testing activities Ensure 'fitness for use' of HITSP Interoperability Specifications Has relationship with IHE that developed/maintain standards/profiles used in HITSP Interoperability Specifications to help overall collaborative testing activities HITSP collaboration with IHE 8 IHE Profiles are contained in HITSP Interoperability Specs. IHE Connectathon/HIMSS Showcase provide opportunity for collaboration to meet mutual goals HIMSS07 Interoperability Showcase Demonstration To access HITSP Interoperability Specifications: www.hitsp.org

16. 16 IHE and HITSP HITSP has specified interoperability standards for three use cases - 8 IHE profiles used. EHR-Access to Lab results Historical Results: XDS + NAV + XDS-Lab + PIX + PDQ Lab to Ordering Provider: HL7 V2.5 msg with some differences with Lab-3 transaction from LSWF. Consumer Empowerment Doc Sharing: XDS + PIX + PDQ Reg/Med History: Not finalized but will be CDA/CCD. XPHR-TI version to be aligned on CCD when final is on the HITSP path. BIO Surveillance Doc Sharing track: XDS, XDS-Lab, XDS-I, XDS-MS Anonymization: PIX + PDQ (with extensions) Capture: RFD Message track, no use of IHE profiles

17. 17 HHS Health IT Strategy

18. 18 Third Nationwide Health Information Network ForumJanuary 25 � 26, 2007 The NHIN is an integral part of the National Health IT Agenda The NHIN will use the Internet to connect providers, consumers and other stakeholders It will need to connect states, regions and non geographical health exchanges RHIOs and HIEs will need to identify �their� set of services which may be cheaper to buy than build This is a developing market for service providers (Health Information Service Providers) ����..All to be accomplished in a phased approached

19. 19 Third Nationwide Health Information Network Forum~ Four NHIN Prototypes Demonstration ~ The Players Accenture Computer Sciences Corporation IBM Northrop Grumman And a Consortia of healthcare providers, technology vendors and other stakeholders supporting these four companies with prototype development The Prototypes Developed under an $18.6 million HHS grant

20. 20 Third Nationwide Health Information Network Forum~ Four NHIN Prototypes Demonstration ~  Prototype Goals Develop an architecture and a prototype network for secure information sharing among hospitals, laboratories, pharmacies, physicians and other stakeholders in the participating markets. Work to ensure information can move seamlessly between each of the four prototype networks, thus establishing a single infrastructure among all the consortia for the sharing of electronic health information. Test patient identification, information locator services, user authentication, access control, other security protections and specialized network functions. Test the feasibility of large-scale deployment. Demonstrate 3 use cases

21. 21 Future Steps Future steps with the progression of building the NHIN will be based on the 3rd Forum demonstration results, other third resources and reports such as the anticipated Gartner report. Current plans include: Validation of the 4 prototype architectures across the NHIN Release of Requests For Proposals (RFP) by HHS to develop state and regional trial implementations in March or April Awards to be announced in June or July timeframe Opportunities for all stakeholders to join or add on to existing prototype development Success will be achieved when we engage providers, involve consumers, security, government, and provide a sustainable funding model that establishes trust and provides capable business services

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