Health Information Technology Standards Panel

1. Health Information Technology Standards Panel HITSP Technical Committee and Approval of its Interoperability Specifications Charles Parisot, GE Healthcare August 2006

2. The Certification Commission for Health Information Technology (CCHIT) Health Information Technology Standards Panel (HITSP) American Health Information Community The Health Information Security and Privacy Collaboration (HISPC) National Health Information Network (NHIN) Architecture Projects The Community is the hub that drives opportunities for increasing nation wide health information interoperability • CCHIT focuses on developing a mechanism for certification of health care IT products • HITSP brings together all relevant stakeholders to identify appropriate IT standards • HISPC addresses variations in business policy and state law that affect privacy and security • NHIN is focused on interoperability pilots

3. HITSP was formed to prototype a process used to harmonize industry-wide HIT standards . . . • HITSP formed under the sponsorship of the American National Standards Institute (ANSI), coordinator of the U.S. voluntary standardization system • Brings together a wide range of stakeholders into a formal “panel” to identify, select, and harmonize standards for communicating data throughout the healthcare spectrum • Formation of the Panel was endorsed by a number of industry groups and has the oversight and backing ONCHIT • John D. Halamka, MD, MS, CIO of the Harvard School of Medicine chairs the Panel • A total of 200 organizations participate in HITSP representing consumer, SDO, non-SDOs, and government interests • Non SDO make up 67% of the panel and include clinicians, providers, safety net providers, vendors, purchasers, payers, public health professionals, and researchers

4. . . . The process is repeatable and fully integrated with CCHIT and AHIC • For each AHIC Use Case, HITSP Technical Committees identify candidate standards which are harmonized into a final list of standards • They also identify overlaps and highlight gaps. Gaps are forwarded to Standards Development Organizations for their guidance as to emerging candidate standards or new standards requirements. • The final standards chosen by the Technical Committees are discussed and ratified by the HITSP panel. • These standards are available for public comment and feedback. • Technical Committees work with SDOs and other groups to produce detailed specifications, an unambiguous “cookbook”, for the implementation of chosen standards. HITSP provides a convening and facilitation function for this activity. • HITSP work products are delivered to AHIC for their endorsement. • CCHIT will include functional criteria for interoperability based on HITSP specifications in its certification work

5. The HITSP process results in creation of an Interoperability Specification used to promote nationwide interoperable health information exchange ReceiveRequest Harmonization Process Steps I Harmonization Request II RequirementsAnalysis III Identificationof CandidateStandards IV Gaps,Duplicationsand Overlaps Resolution V Standards Selection VI ConstructionofInteroperabilitySpecification VII InspectionTest VIIIInteroperabilitySpecificationReleaseandDissemination IX Program Management BeginSupport

6. The three HITSP Technical Committees are working toward a September deadline to publish Interoperability Specifications

7. Progress to date has positioned each committee to provide NCVHS with relevant insights into NHIN requirements • In June of 2006, HITSP reduced 570 candidate standards to 90 appropriate standards for secure exchange of medication, lab, allergy and demographic data • By September 29, 2006, HITSP will deliver unambiguous interoperability specifications which will enable vendors, hospitals and government to create software components for clinical data exchange • Beyond 2006, HITSP will develop harmonized standards and unambiguous implementation guides which provide precise instructions for data sharing for all future requests for harmonization • Also, it will standardize the interoperability specifications for technology products, while permitting differentiation and competitive advantage in the marketplace. HITSP hopes to empower patients and care providers with Electronic Health Records (EHR) that facilitate easy access to critical health data that is accurate, private and secure. • HITSP is a key component of the Health and Human Services vision to create an interoperable healthcare system, and we look forward to our work products empowering patients, providers and government stakeholders in 2006 and beyond

8. The actual harmonization process is a series of steps taken by industry stakeholders within the context of a standards panel -- HITSP Fed. Medications RXNorm ASTM CORE HL7 NCPDP IHE SNOMED LOINC DICOM X12 ReceiveRequest Harmonization Process Steps I Harmonization Request II RequirementsAnalysis III Identificationof CandidateStandards IV Gaps,Duplicationsand Overlaps Resolution V Standards Selection VI ConstructionofInteroperabilitySpecification VII InspectionTest VIIIInteroperabilitySpecificationReleaseandDissemination IXProgram Management BeginSupport March-August 2006

9. HITSP Transaction Package Consumer/Patient Id X-ref Base Std NDCRxNorm SPL Consumer Empowerment Registration and Medication HistoryDocuments Overview AHIC-ONC CE Consolidated Use Case Consumer Empowerment Registration & Meds History - Interoperability Specification Transaction Package Manage Sharing of Docs Transaction Patient Demographics Query IHEXDS IHEPIXPDQ CAQH Core Federal Medication Terminologies Component Registration & Med History Doc Content IHE XPHR Map CCR Reg/Med to Reg/Med Doc. Map X12 Reg.to Reg/Med Doc Map NCPDP Med.to Reg/Med Doc Other Base Standards Base Std HL7CDA r2 Base Std LOINC Base Std X12 270/271, Base Std ISO 15000ebRS 2.1/3.0 Base Std HL7 V2.5 ASTM CCR2369 Base Std NCPDP 8.1 Base Std ASTM/HL7 CCD

10. HITSP AHIC-ONC EHR Consolidated Use Case Transaction Package Consumer/Patient Id X-ref Component Lab Terminology EHR Sharing Lab Results Documents Overview EHR – Laboratory Results Reports - Interoperability Specification Transaction Package View Lab From Web Transaction Package Manage Sharing of Docs Transaction Package Send Lab Result Msg to Ordering Clinician Transaction Patient Demographics Query IHEXDS IHEPIXPDQ Transaction Notif of Doc Availability IHE NAV Component Lab Report Message Component Lab Report Document IHE XDS-LAB Base Std LOINC Base Std HL7V2.5 Base Std HL7CDA r2 Base Std HL7 V3 Lab Base Std ISO 15000ebRS 2.1/3.0 Base Std HL7 V2.5 Other Base Standards

11. HITSP AHIC-ONC BIO Consolidated Use Case Transaction Package Consumer/Patient Id X-ref Component Lab Report Document Component Lab Terminology Component Radiology Msg Component Utilization Msg Component Encounter Msg Component Anonymize Biosurveillance Ambulatory, Emergent Encounter, Utilization, Lab data to Public Health BIO – Ambulatory, Emergent Encounter, Utilisation, Lab - Interoperability Specification Transaction Package Manage Sharing of Docs Transaction Package Send Lab Result Msg to Ordering Clinician Transaction Patient Demographics Query Transaction Pseudonimize IHEXDS IHEPIXPDQ Transaction Notif of Doc Availability IHE NAV IHE XDS-LAB Component Lab Report Message Base Std LOINC Base Std HL7V2.5 Base Std HL7V2.5 Base Std HL7CDA r2 Base Std ISO 15000ebRS 2.1/3.0 Base Std HL7 V2.5 Other Base Standards

12. The actual harmonization process is a series of steps taken by industry stakeholders within the context of a standards panel -- HITSP Harmonization Process Steps ReceiveRequest I Harmonization Request II RequirementsAnalysis III Identificationof CandidateStandards IV Gaps,Duplicationsand Overlaps Resolution V Standards Selection VI ConstructionofInteroperabilitySpecification VII InspectionTest VIIIInteroperabilitySpecificationReleaseandDissemination IXProgram Management BeginSupport You are here

13. Key Deliverable Key Meeting The testing process will occur over a two-weeks period with updates scheduled throughout

14. The Inspection Test is just one in a series of tests that will be performed to validate the utility of the specification • The HITSP harmonization process results in an interoperability specification that will be widely disseminated • A series of tests is required to validate the quality and usability of the specification • The first test in the series of test is the Inspection Test • The objective of the Inspection Test is to ensure that the IS meets the requirements of the Use Case and can be used to implement the requirements

15. Interoperability Specifications will be inspected to meet the following objectives

16. The inspection testing process steps . . . • Identify and engage key volunteer test resources – assign testers to IS documents • Develop the tools and procedures for gathering and responding to test findings • Instruct testers about the general process and schedule • Distribute Interoperability Specifications to the assigned testers – conduct a test kick-off conference call ~ Aug 21 • Post IS at HITSP.org and send message to list serve to invite informal review- Aug 18 • Collect interim test results on conference call ~ Aug 25 • Collect final results and conduct conference call ~ August 31 • Analyze test results and disposition them through the formal Change Control Board • Provide approved change requests to the IS writers • Implement IS changes • Validate IS changes