Health eDecisions RI/ Pilots Sub-Workgroup

1. Health eDecisionsRI/ Pilots Sub-Workgroup February 4th, 2013

2. Agenda • Announcements • HL7 …what we learned • Verification of Pilot Sites • Review RI/Pilot Sub-WG Timeline - Updated • Review of Materials for Pilot • Review In Scope/Out of Scope • Pre-conditions/ Post Conditions • Schedule of pilot project presentations • Questions and Answers • Review Action Items, Next Steps

3. Announcements • We will be continuing our work … • Next meeting February 11, 2013 • We will start the presentation of Project Plans • New potential partnershipsand pilots • Practice Fusion • AllScripts

4. HL7 What We Learned • We will continue the work of pilots • Our IG passed it is important we continue to pilot the IG with an eye toward – we will pilot our ballot with minor changes • Harmonization with HQMF • This will happen starting with alignment of metadata structures • Bulk of work will be done by Keith Boone • This work will be done after pilots with a goal of presenting this work at the September HL7 meeting • vMR and QDMH • There is a new HL7 group CQI (Clinical Quality Information) spearheading this effort • Claude and Aziz will represent us here • This work is going to take a bit more time and falls outside of our initiative/pilot timeline • The work in pilots will create significant and meaningful input into both of these activities

5. Pilots

6. Support Team • Support Team: • Pilots Lead: Jamie Parker: jamie.parker@esacinc.com • Pilot Support: Rebecca Angeles: rebecca.angeles@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 • Harmonization: CemMangir: cmangir@deloitte.com • SDO Support: Anna Langhans: anna.langhans@accenture.com

7. HeD Pilots Goal • Goal • The goal of this initiative is to produce and consume 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 • 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.

8. Timeline We are Here

9. Logistics • Wiki Page: • http://wiki.siframework.org/Health+eDecisions+Pilots • Process: • Register as a “committed member” and attend Pilot Sub-WG calls. • Complete Pilot Brief and submit to Pilot Sub-WG • Think of this as “what do you intend to pilot” • See Pilots wiki for the document: • http://wiki.siframework.org/Health+eDecisions+Pilots • Pilot RI/ Pilot implementation – Development, Testing. • Provide feedback to ONC and HeD All Hands Community Meeting • Select a community member to represent our work at these meetings.

10. Review: Value Statement (need to re-evaluate after Pilot Project Plans) • Discuss Value Statement: • Health information technologies designed to improve clinical decision making are particularly attractive for their ability to address the growing information overload clinicians face and to provide a platform for rapidly incorporating knowledge into care delivery.Standardized expressions of Clinical Decision Support have a number of important benefits including:Increased quality of care and enhanced health outcomes for individuals and populations • Improvement in workflow (does not always come with standardized expressions of clinical decision support – it depends on how it is presented) • Avoidance of errors and adverse events • Improved efficiency, cost benefit, and provider and patient satisfaction • May not be the end result of pilots • Reduced latency for incorporating new clinical knowledge and evidence-based guidelines into clinical practice • This is the focus for pilots? • Harmonization of Knowledge • Focusing the S&I Framework community on Clinical Decision Support through the Health eDecisions Initiative will enable the translation of interventions into implementable components, increasing the speed and ease of adoption by the provider community.

11. Success Criteria – Work in Progress will need to re-evaluate 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

12. 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)

13. 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

14. 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)

15. 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

16. Pilot Preparations Revisited… • Pilot Team • Identify the members of your organization who will be supporting this pilot. If possible include the role he/she will play in the pilot and contact information • Goal of the Pilot • Please include a write up or create a Visio diagram of what you intend to show/prove/support during the pilot process. Make this an actionable statement with specifics. Also include in this description what you hope to gain from this pilot. • What portions of the IG are you Piloting • Please use this section to document what parts of the IG your are intending to pilot. Please be as specific as possible. This should include any of the examples you intend to pilot (ECA Rules, Documentation Templates, Order Sets) • Identify the Use Case Actors Involved: • A pilot may involve the following participants from the healthcare ecosystem: (For example):Laboratories, Vendors, Standards Organizations, System Integrators, EHR Vendors, Physicians/Providers, Payors, Patients etc. • Minimum Configuration • What is your current set up? What will you be using to conduct the pilot? For example:An ambulatory Electronic Health Record (EHR) system, A transport system being used in Production environments, A security system being used in Production environments, Standards (and any types of mappings you suspect you will need, a database (which one/type), Any type of interface between 2 different systems etc.

17. Pilots Preparation cont. • Timeline • What is your proposed timeline given we want to wrap up pilots by end of April/Mid May at the latest? (see Appendix A for more detailed timeline and activities) As a high level reminder here are the overarching tasks per month – please document in more details your plans • January – Kick off and Logistics • February: Start Pilots • March: Continue with Pilots • April: Conclude Pilots • Success Criteria • What will you/your organization use to determine the success of this pilot? This needs to be quantitative and not subjective in as much as possible. (For example: Successfully implement 1 ECA Rule showing successful execution from the EHR system) • In Scope/Out of Scope • If you already know what will be in and out of scope for your pilot (beyond the IG or the UC) please document it here: (for example in scope – working with 1 vendor – out of scope customizing the ECA Rules to include a trigger event from a Documentation template) • Questions/Needs • Please include those items you wish to consider any questions you have or hope the pilot addresses. Additionally, please include those items you need in order to succeed.(we will try to accommodate as many of these needs as possible within the scope of ONC, S&I and HeD)

18. Pilot Project Schedule • We will do 4 – 10 minute project presentations each week • February 11th, 2013 • 1:10-1:20 –Julie - NewMentor • 1:20-1:30 – Dave Shields • 1:30-1:40 - • 1:40-1:50 • February 25th, 2013 • 1:10-1:20 - Zynx • 1:20-1:30 • 1:30-1:40 • 1:40-1:50 • March 4th, 2013 (HIMSS WEEK) – might be a conflict so we are canceling this meeting

19. Action Items & Next Steps • Review and Provide Feedback on the Value Statement and Success Metrics • Establish partnerships if necessary • Begin Pilot Brief for next WG meeting • If you need help with this activity please contact: • Jamie Parker (jamie.parker@esacinc.com) • Becky Angeles (rebecca.angeles@esacinc.com)

20. Meeting Reminder • Pilots Work stream meets (next meeting: February 11th, 2013) • Every Monday • 1-2:30 pm EDT (we have increased the duration of this call to 90 minutes in order to complete our work knowing we are canceling the Feb 18th and March 4th meetings) • See Wiki homepage for meeting details: http://wiki.siframework.org/Health+eDecisions+Homepage