The Practical Guide for SOA in Health Care Volume II:

1. The Practical Guide for SOA in Health Care Volume II: • EHR Immunization and Adverse Event Reporting Case Study • For presentation at HL7 Rio Workgroup Meeting, 18 May 2010 • Five Weeks to Rio, 26 March 2010 Discussion Slides • PHONE: +1 770-657-9270 Pass code 071582# WEB: http://my.dimdim.com/hssp • Details available at www.HSSP.wikispaces.com/Reference+Architecture HL7 “EHR SD RM” Stephen.Hufnagel.ctr@tma.osd.mil, Project Facilator GovProjects, EHR, PHER, HSSP co-sponsors

2. EHR SD RM Milestones 2008 2009 2010 2011 Healthcare SOA Reference Architecture (H-SOA-RA) EHR SD RM Immunization & Response Management (IRM) Prototype HSSP Practical Guide for SOA in Healthcare Volume II: IRM Case Study __________ EHR SD RM Informative DSTU EHR SD RM Normative Standard DSTU is Draft Standard for Trial Use (ANSI standards development)

3. Healthcare SOA FrameworkBased on HL7 EHR System Functional Model & Thomas Erl’s SOA Layers 2

4. ANATOMY OF AN ANCILLARY SYSTEM LABORATORY RADIOLOGY PHARMACY CARDIOLOGY OT/PT/SPEECH IDENTITY TERMINOLOGY AUTHORIZATION SCHEDULING CORE BUSINESS SERVICES SUPPLY CHAIN (ORDER/CHARGE) DOCUMENT RECORDS MANAGEMENT s DECISION SUPPORT PERFORMANCE DATA MANAGEMENT 3

5. HL7 EHR_S-Based Functional Architecture/Services Analysis Primary Care Critical/Emergency Care Laboratory Pharmacy Dental Non-Surgical Specialty Care Nursing Behavioral Health ETC. Population Health ETC Manage Business Rules Infrastructure Functions Interoperability • Infrastructure • Services • Security • Policy • Records Management • Audit • Terminology • Registry • Workflow • Business Rules • etc Terminology Unique ID, Registry, and Director Information and Records Management Security Lines of Business Record Management Manage Patient History • Core Clinical • Services • Entity Identification • Resource Location and • Updating Services • Decision Support • Orders Management • Scheduling • Image Management • Etc. Preferences, Directives, Consents, and Authorizations Summary Lists Management of Assessment Cross-Cutting Direct Care/ Support Functions Care Plans, Treatment Plans, Guidelines, and Protocols Orders and Referral Management Documentation of Care, Measurement, and Results Record Patient Specific Instructions Clinical Decision Support Clinical Workflow Tasking Support Clinical Communication Support Knowledge Access ETC

6. INTEGRATED REQUIREMENTS DESIGNS: Putting the H-SOA-RA Pieces Together Ancillary Systems PT/OT/SPEECH LABORATORY SPECIALTY CARE RESPIRATORY PHARMACY CARDIOLOGY RADIOLOGY DIETARY IDENTITY TERMINOLOGY Inter-Service TEST ONLY AUTHORIZATION INPATIENT SCHEDULING Federated Business Services SUPPLY CHAIN: (ORDERS/CHARGES) Core Business Services Inter-Agency ER DOCUMENT RECORDS MANAGEMENT ASU Federated Services, may be categorized by: -- Encounter Types -- CMS billing category -- Record type -- Care setting type -- etc. DECISION SUPPORT PERFORMANCE CLINIC Across Providers OUTPATIENT OTHER DATA MANAGEMENT ANALYTIC Agnostic Services SUPPORT Data sets are defined for each system functional-capability-service module IT PLATFORM 5

7. EHR SD RM AgendaHSSP Practitioners Guide Volume IIImmunization and Adverse Event Reporting PrototypeFrom HL7 and HITSP Artifacts Item Max Time Roll Call and Introductions 3 min Overview Agenda 2 min Requirements/ Architecture Development Cycle 7 min Candidate Core Clinical Services 15 min Candidate Cross Cutting Direct Care Support Functions/ Services 15 min Candidate Infrastructure Services 15 min Wrap Up 2 min

8. EHR SD RM Supporting Requirements/ Architecture Development Cycle PROCESS INPUTS -Required Capabilities -Environments -Constraints EHR SD RM Capabilities - Functions, Information Model Information Exchanges Stakeholder Requirements Definition Functions – Dependencies Conformance Criteria Requirements Loop Function or Service Interface Design Specifications Requirements Analysis Design Loop Architecture Design Test Specifications Verification & Validation Loop Compliancemeans a system provides support for a given standard. Conformanceis a recognition of  formal testing, that prove that a system provides 100% support for a given standard. PROCESS OUTPUTS -System Architecture, -System & Test Specifications -Configuration Management Baselines

9. EHR SD RM Supporting Requirements/ Architecture Development Cycle Stakeholder Requirements Whatis the system supposed to do? Where will the products of the system be used? Under what conditions will the products be used? How often? How long? Who will use the products of the system? Requirements Analysis (“HOW?” using “Action Verbs”) Analyze functions and Services Decompose higher level functions to lower level functions Allocate performance requirements to the functions Architecture Design (Whichhardware/ software elements) Define the physical architecture Each part must perform at least one function Some parts may perform more than one function Requirements Loop • Ensure all requirements are covered by at least one function • Ensure all functions are justified by a valid requirement (no unnecessary duplication) Design Loop • Ensure all functions are covered by at least one hardware or software element • Ensure all elements of physical architecture are justified by a valid functional requirement (no unnecessary duplication) Verification & Validation (V&V) Loop • Each requirement must be verifiable that the solution meets requirements and validated that it meets the user’s needs and expectations. • V&V can be accomplished by: Inspection, Analysis, Demonstration, Test

10. EHR SD RM Supporting Requirements & Architectural Processes 2010 slide

11. The HL7 Services-Aware Interoperability Framework (SAIF) SAIF Contains: Enterprise Conformance and Compliance Framework (ECCF) is based on RM-ODP Behavioral Framework (BF) Interoperability Scenarios supporting the RM-ODP Computational Viewpoint Governance Framework (GF) Governance is the overarching policy structure and set of related processes by which a group exercises its authority and demonstrates accountability for accepted responsibilities within a particular jurisdiction. SAIF Principles: Applicable within each of HL7’s three Interoperability Paradigms (IPs), (i.e., messages, documents, and services). Provide support for measurable conformance and compliance. Define appropriate governance structures and processes. Provide support for directly implementable solutions. Address the growing disparity between the various solution sets emerging from HL7. Utilize existing V3/RIM artifacts and expertise to the maximum degree possible.

12. HL7 SAIF ResponsibilitiesConformance and Compliance Framework (ECCF) Policy “Why” Content “What” Behavior “How” Implementation “Where” Traceable Consistency

13. HL7 SAIF Specification Stack ViewsConformance and Compliance Framework (ECCF) Policy Content Behavior Implementation Traceable Consistency

14. HITSP WithinHL7 SAIF ECCF Specification Stack Policy Content Behavior Implementation HITSP DA HITSP CAP Harmonization Requests/ Use Case HITSP CAP HITSP Harmonization Framework HITSP IS HITSP Component HITSP Transaction, Transaction Package and Service Collaboration Traceable EHR-S FM is EHR System Functional Model EHR SD RM is EHR System Design Reference Model RIM is Reference Information Model FHIMS is Federal Health Information Model & Standards DA is Data Architecture Consistency

15. HL7, HITSP, FHIMS, NIEM and NHIN WithinHL7 SAIF ECCF Specification Stack Policy Content Behavior Implementation HL7 EHR-S FM HITSP Harmonization Framework HL7 RIM FHA FHIMS HITSP DA HITSP CAP Harmonization Requests/ Use Case HITSP Capability Tomcat, JBoss, J2SE, Eclipse, GlassFish ESB, OpenSSO NHIN Connect Services HL7 EHR SD RM HITSP IS HITSP Component NIEM Information Exchange Package NIEM IEPs, HITSP Transaction, Transaction Package and Service Collaboration Traceable EHR-S FM is EHR System Functional Model EHR SD RM is EHR System Design Reference Model NIEM IEPs is National Information Exchange Model Information Exchange Packages RIM is Reference Information Model FHIMS is Federal Health Information Model & Standards DA is Data Architecture Consistency 14

16. IS10 IRM HITSP Constructs Mapped to Standards

17. EHR SD RM AgendaHSSP Practitioners Guide Volume IIImmunization and Adverse Event Reporting PrototypeFrom HL7 and HITSP Artifacts Item Max Time Roll Call and Introductions 3 min Overview Agenda 2 min Requirements/ Architecture Development Cycle 7 min Candidate Core Clinical Services 15 min Candidate Cross Cutting Direct Care Support Functions/ Services 15 min Candidate Infrastructure Services 15 min Wrap Up 2 min Walk through EHR-S FM

18. DRAFT Table of Contents for HSSP Practitioners Guide Volume II See “HSSP Practitioners Guide Volume II May 2010 – DRAFT-A.Docx” Note that the version will change each week … A, B, C D, … till HL7 Rio Versions available at www.HSSP.wikispaces.com/Reference+Architecture Weekly Agenda/Minutes Weekly Read Ahead Slides Weekly updated “HSSP Practitioners Guide Volume II May 2010 DRAFT-A.Docx”

19. Call for Participation – HL7 in Rio • We are inviting all interested to participate in the 11th International HL7 Interoperability Conference (IHIC-2010), to be held in Rio de Janeiro, Brazil on May 2010. This time will be the first for IHIC in South America. Following the success of previous IHIC venues in Kyoto(2009), Crete (2008), New Zealand (2007), Germany (2006), Taiwan (2005), Mexico (2004), IHIC2010 aims to serve as a meeting place for more than 30 HL7 affiliates around the world as well as individuals interested in interoperability and standards, to share their HL7 implementation experience and strengthen their shared vision. The paper submissions are invited to show to the international community successful experiences using HL7 V3 and CDA R2 interoperability between informatics applications using standards. Also, results and experiences from the collaborative use of standards are most welcome, especially if they are related to HL7 standards. • Topics of interest include but are not limited to the following: • HL7 implementation experience from regional, trans-regional, or national implementation: • • HL7 v2.x and 3.0 messages • • Clinical Document Architecture (CDA) • • Imaging Diagnostics and DICOM Standard • • Use of HL7 in IHE profiles • • Terminologies, Ontologies and Coding Systems: use of local and international • standards • • Use of other standards in combination with HL7 standards: ASTM, ISO, CEN, etc. • Business Models, regional & large scale deployment: • • Electronic Healthcare Record: from strategy to implementation • • Legal and regulatory issues. • • Epidemiology, disease surveillance and control • • Geographical information systems for population health • • Disaster medicine, emergency management and public health This year, along with the successful “Show me your CDA!” track, IHIC will also incorporate the "Send me your CDA!" HL7 CDA Interoperability Showcase to display basic interoperability of applications using a HL7 V3 and HL7 CDA R2 standards. All submitted papers will be reviewed based on their technical quality and merit by the technical committee and reviewers. Papers that describe research and experimentation are encouraged. All paper submissions will be handled electronically using IEEE format, and detailed instructions on submission procedure will be available on IHIC2010 web pages (http://www.ihic2010.hl7.org.ar/). Accepted papers will be published online. For other information, please contact IHIC2010, (fportila@gmail.com) Important Dates: • Call For papers : November 2, 2009 • Deadline for submissions extended to February 15, 2010 • Evaluation and notification, March 15, 2010 • Camera-papers ready due : April 15, 2010

20. Agenda Roll Call and Introductions 3 min Overview Agenda 2 min Overview of HSSP Practitioners Guide Volume I 10 min Overview of Services Aware Interoperability Framework (SAIF) 10 min Overview of EHR System Design Reference Model (EHR SD RM) 10 min Overview of candidate HSSP Services for use in HSSP Practitioners Guide Volume II 10 min Overview of DRAFT Table of Contents for HSSP Practitioners Guide Volume II 13 min Wrap Up 2 min

21. Wrap Up Any new attendees? Agenda Time Metrics Volunteers to help prepare for next week’s meeting? Do we need one-on-one working meetings? Suggestions for Improvement Next Meeting April 2, 2010 at 12:30 Eastern Time PHONE: +1 770-657-9270 Pass code 071582# WEB: http://my.dimdim.com/hssp