Health Level Seven (HL7) Report Out

1. Health Level Seven (HL7) Report Out Population Science and Structured Documents Workgroup (SDWG) Riki Ohira September 22, 2011

2. Plenary Session: HL7 and the Value Proposition for CDC’s Surveillance of HAI • Presentation by Daniel Pollock, Surveillance Branch Chief for the CDC’s Division of Healthcare Quality Promotion (DHQP) was part of a Panel Session on “How HL7 has delivered value and the value HL7 has enabled through facilitating collaboration with different stakeholders” • Daniel Pollock commented that HL7 standards could be the catalyst in epidemiologic shift that is dependent on information • Primary focus (as an example) is use of HL7’s Clinical Document Architecture (CDA) for submission of Healthcare-Associated Infections (HAIs) to the CDC’s National Healthcare Safety Network (NHSN) • http://www.cdc.gov/nhsn/ • CDA enables automated submission of HAI information to the CDC’s NHSN (otherwise entered manually through web interface) and interoperability for HAI data collection and reporting

3. HL7 IG for CDA R2: NHSN HAI Reports • NHSN developed CDA IG for HAI Reporting and commits resources to tools for accessing NHSN vocabulary and validating CDA file imports • NHSN and CDA Capability includes: • Can accept CDA files for 4 HAIs and 1 “process of care” • Central line associated bloodstream infection (CLABSI) • Catheter associated urinary tract infection (CAUTI) • Surgical site infection (SSI) • Multi-drug resistant organism infection (CDI) • Central line insertion practices (CLIP) • In October 2012, plan to include CDA files for dialysis events and antimicrobial use and resistance (AUR)

4. Structured Documents Workgroup (SDWG) • Mission: This group supports the HL7 mission through development of structured document standards for healthcare. • Work products and contributions to HL7 processes: The Work Group will produce a comprehensive architecture to facilitate exchange and processing of electronic healthcare documents. The Work Group will support HL7 through education in the development, evolution, and use of structured document specifications. The specifications created by this committee will follow the accepted HL7 development processes. • Formal relationships with other HL7 Workgroups: • The Work Group will collaborate with RIM class stewards to resolve issues arising from requirements for document specifications. This will include, but not be limited to, participation in RIM harmonization and development of vocabulary domain tables. • Orders and Observations, Patient Care, and other Work Groups define the clinical content used in the specifications created by the Structured Document Work Group. The Structured Document Work Group will collaborate with these groups to establish a consistent approach to information exchange.

5. Activities within the SDWG relevant to caBIG (1) • HL7/IHE Health Story Implementation Guide Consolidation ballot reconciliation • Project description: This project will take a series of existing CDA implementation guides for various types of clinical documents and consolidate them into a single publication with the following objectives: 1. Reconciling discrepancies among the guides (HL7, IHE, HITSP) 2. Disambiguate current templates 3. Updating to meet regulatory requirements (C32, C83 where they overlap with the implementation guides listed here) 4. Adopting consistent publication format/style for conformance statements. • Adding Public Health Reporting Requirements to Health Quality Measures format (HQMF) • Project Description: This joint PHER/SD project is intended to extend and generalize the HQMF standard to include support for specifying requirements for public health reporting using structured documents, including specifications for reporting timing requirements, reporting formats (e.g. CDA documents, forms, messages), and designated report recipients. HQMF is a structured document that describes measure metadata data, data criteria, and measure logic for inclusion/exclusion in measure population, numerator, and denominator computations. This standard is expected to be used by public health authorities to express the reporting requirements of the jurisdiction in a structured, human readable and machine-interpretable format.

6. Activities within the SDWG relevant to caBIG (2) • Joint meeting with the Regulated Clinical Research Information Management (RCRIM) Workgroup • Discussion on using CDA R2 in clinical trials • Main issue was around subject data, which is too human focused and would need to be broadened to include animals, specimen, “experimental unit” • There was a recommendation that if >90% of existing CDA would work for clinical trials, then they could work to resolve the remaining 10%; RCRIM representative commented that they thought there was 95% overlap • Ultimately no decision was really made; I think they are investigating options to extend CDA R2 for use in clinical trials, but also commented that CDA may not be the answer

7. Questions?