Health eDecisions (HeD) All Hands Meeting

1. Health eDecisions (HeD)All Hands Meeting June 13th, 2013

2. Meeting Etiquette • Remember: If you are not speaking, please keep your phone on mute • Do not put your phone on hold. If you need to take a call, hang up and dial in again when finished with your other call • Hold = Elevator Music = frustrated speakers and participants • This meeting is being recorded • Another reason to keep your phone on mute when not speaking • Use the “Chat” feature for questions, comments and items you would like the moderator or other participants to know. • Send comments to All Panelists so they can be addressed publically in the chat, or discussed in the meeting (as appropriate). From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute  All Panelists

3. Agenda

4. Announcements • Vocabulary and Terminologies sub work will be changing their meeting date. (there is no meeting this week) – stay tuned for meeting updates • HeD Meetings (By Day)

5. HL7 Update • We have completed a rough draft of the Implementation Guide • http://wiki.siframework.org/HeD+Pilot+Tools • The Vocabulary and Terminology IG is also complete and will be incorporated into our IG. • To view and comment on the work of the Vocab and Terminology team please see the pilots tool page: http://wiki.siframework.org/HeD+Pilot+Tools • We are now meeting on Tuesdays from 3-4 pm to discuss HL7 topics for both UC 1 and UC 2

6. HeD Pilots Update…ALMOST • We met this week • Pilots Update • CDC and AllScripts–ECA Rule --- DONE • NewMentor and AllScripts – ECA Rule DONE • Zynx and DesignClinicals - Order Set DONE • VA and Wolters Kluwer - Documentation Template DONE

7. HeD Pilots Goal • Goal • The goal of this initiative is to produce, consume and where feasible, execute 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 • Submission of explicit feedback to sub workgroups such as vMR and Vocabulary and Terminology work group to close gaps • 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. • Demonstrate intent of artifact (specifically structures and semantics) are communicated either by direct execution or by translation to native format • Ensure completeness and consumability of artifact New

8. Timeline We are Here

9. Vendor Partners

10. Use Case 2

11. SDS & Harmonization HeDAgenda • Timeline Overview • HeD UC2 vMR Mapping Template Update • Sub Work Stream and Work Products review • DSS Profile Update

12. SDS & Harmonization HeD Agenda • Timeline Overview • HeD UC2 vMR Mapping Template Update • Sub Work Stream and Work Products review • DSS Profile Update

13. HeD Use Case 2 Timeline Jun ‘13 Jul ‘13 Aug ‘13 DSS vMR Extension & Alignment HeD UC2 Guidance Community Review & Ballot Preparations

14. Key Milestone Dates for September Ballot Administrative Deadlines: • HL7 Notification of Intent to Ballot: July 7 • HL7 Initial Content Deadline: July 14 Content Deadlines: • End-to-End Review Period: • Initial DSS Update & Profile Review & Packaging : 6/25 – 7/9 • Initial vMR DAM Review & Packaging: 7/12 – 7/25 • Initial vMR XML IG Review & Packaging : 7/22 – 8/2 • Initial vMR XML HeD UC1 IG Review & Packaging: 7/22 – 8/2 • New DSS IG Review & Packaging: 7/22 – 8/2 • There will be end to end reviews of each section as they are completed at earlier dates • HL7 Final Content Deadline: August 4 • HL7 Examples Deadline: August 19 • HeD Consensus Review Period: August 19 – September 2 • Comments will be received during balloting from August 19 – August 26 • Comments will be vetted by the community August 27 – September 2 • Submit Comments to HL7 on September 3

15. SDS & Harmonization HeD Agenda • Timeline Overview • HeD UC2 vMR Mapping Template Update • Sub Work Stream and Work Products review • DSS Profile Update

16. HeD UC2 vMR Mapping Template • Dave Shields has created a tool/spreadsheet to map the UC2 data elements to vMR, aligned with CCDA and QRDA, for specific templates. • Important to drive forward and meet our deadlines while staying grounded with the requirements in UC2

17. HeD UC2 vMR Mapping Template Continued… • A tab has been created labeled “HeD UC2 Data Elements” • This tab contains all UC2 Data Elements as well as the templates(tabs) contained in the spreadsheet • This tab can keep track of which data elements have been mapped to specific templates • Data elements not mapped to any specific template will be easily identifiable

18. HeD UC2 vMR Mapping Template Continued… • All columns have been defined on what information to capture • 20 templates have been initially chosen for mapping • Ken has made a suggestion to change the tabs to “Categories” instead of “Templates” • Each category will have specific templates related to that category in one tab, with the columns repeated for each template • Each category is it’s own tab in order to divide the work. • Can combine all categories and templates into one master tab • It was decided that initially, vMR data elements would be the base and would be mapped to CCDA and QRDA • HeD UC2 data elements would then be mapped for each template afterwards • Bryn Rhodes has done an initial mapping of vMR data elements to HeD UC2 clinical data elements. Bryn will complete the rest of the data elements. • Bryn will populate each template with the applicable data elements • The HeD Internal team will then being filling out the CCDA and QRDA columns • David Tao has provided a document with Guidance for this mapping

19. HeD UC2 vMR Mapping Template Bryn’s Suggestions • Categories may be at too granular a level • Elements of the vMR will tend to be duplicated quite a bit • If we have a single category for each kind of data within vMR, the overall effort could be more manageable. • Suggestion is for now, to collapse the categories to only those categories that map directly to concept types within the vMR • Demographics • Adverse Events • Encounters • Goals • Observations • Problems • Procedures • Medications (Substance Administration) • Supplies

20. HeD UC2 vMR Mapping Template Victor’s Questions on “HeD/vMR Value Restriction to Date” Column • Are all of our recommendations final? • Becky and Rob had noted that we were sometimes inconsistent regarding whether our “final answer” was placed in the “Proposed Values” column or the “Working Solution” column—did we ever fix that to achieve consistency? • Is there a way to validate that the entries in this column accurately represent the recommendations from the VST SWG?

21. SDS & Harmonization HeD Agenda • Timeline Overview • HeD UC2 vMR Mapping Template Update • Sub Work Stream and Work Products review • DSS Profile Update • Planned Meetings for the Week

22. Updated DSS Standard Updated vMR DAM Updated HeD UC1 IG Updated vMR XML IG IG and Standards Development Activities to support HeD UC2 Solution New Decision Support Service (DSS) IG DSS Profile for CDS Request with SOAP Add in section detailing how DSS is intended to work with REST for general use DSS Profile for CDS Response with SOAP DSS Profile for CDS Request with REST Modify DSS to accommodate REST, as necessary DSS Subworkstream DSS Profile for CDS Response with REST vMR Container Profiles for Response & Request Align XML IG with updated vMR DAM as necessary Extend vMR with context (for request) and actions (for response) as specified in UC2 vMR guidance for request payload HeD S/vMR guidance for response payload vMR Extensions Subworkstream Align HeD UC1 IG with updated vMR DAM as necessary Modify vMR to align with QRDA & C-CDA semantics Semantics guidance, leveraging modified vMR DAM vMR-QRDA-CCDA Alignment Subworkstream Examples based on functional interaction type HeD UC2 Guidance Subworkstream

23. HeD UC2 vMR Templates • Open Question: • How will the newly identified & defined templates feed into the final work products • DSS IG • vMR DAM • vMR XML IG • HeD UC2 IG

24. SDS & Harmonization HeD Agenda • Timeline Overview • Sub Work Stream and Work Products review • HeD UC2 vMR Mapping Template Update • DSS Profile Update

25. DSS Profile Update

26. Appendix

27. HeD UC2 Finalized TechnicalSolution Based on feedback from all proposed solutions, the HeD Leadership Team is proposing the following solution: • Create implementation guidance that leverages vMR as the base model but is aligned with C-CDA and QRDA (semantics, terminologies, and templates) to the highest extent possible. • Solution will be to update the vMR model to align with the semantics of C-CDA and QRDA to the extent possible and reasonable • vMR is a streamlined data model for CDS. This model is at a similar level of granularity to models such as Green CDA • Pursue both SOAP and REST for the updated DSS IG for September 2013 • Based on pilots, a choice may be made between SOAP and REST • We will utilize the Functional Interaction Types to guide the IG development • Use as building blocks of data that are coordinated to meet functional interaction types • Have a section in the IG having profiles that people vote on for different interaction types if we feel confident. If we don’t feel confident, then they will strictly be examples • Leverage pilots from UC1 for functional interaction types. Can start with Immunization Forecasting and Quality Measure Evaluation. See what feedback we get and if any other interaction types would be useful

28. HeD UC2 Finalized Technical Solution The revised solution approach still aligns with the long-term industry need, but has been limited to a more manageable and Use Case-appropriate scope: Long-term Industry Need HeD UC2 Scope Potential future or parallel work

29. CDS Request This approach would support vMR as the payload standard with mappings to CCDA and QRDA Request Service: DSS Request Element Request Items Organizer/Container: vMR Request Item Payload: vMR Clinical Statement vMR Payload

30. CDS Response HeD Schema/vMR Response Service: DSS Response Element Response Items Organizer/Container: Harmonized vMR/HeD Schema Response Item Payload: vMR Clinical Statements

31. IG and Standards Development Activities to support HeD UC2 Solution

32. Activities by Work Product

33. HeD UC2 Critical Harmonization Activities & Timeline Considerations:New Decision Support Service (DSS) IG

34. HeD UC2 Critical Harmonization Activities & Timeline Considerations:Decision Support Service Standard Updates

35. HeD UC2 Critical Harmonization Activities & Timeline Considerations:vMR Domain Analysis Model Updates

36. HeD UC2 Critical Harmonization Activities & Timeline Considerations:New Decision Support Service (DSS) IG

37. Next Steps • Work Stream 1 – HL7: • Tuesday June 18th, 2013: http://wiki.siframework.org/Health+eDecisions+Homepage • Work Stream 2 – Pilots: • Next Pilots meeting: June 17th, 1-2:30 pm EDT see HeD home page wiki for meeting details: http://wiki.siframework.org/Health+eDecisions+Homepage • Updates on Pilot Activities, Review of Use Case • Work Stream 3 – Use Case 2: • Data Elements and Standards Sub Work Group • Next Meeting: June 19th, 2013 • Homepage wiki for meetings: http://wiki.siframework.org/Health+eDecisions+Homepage • All Hands Community Meeting • Next meeting June 20th, 2013(see the HeD Homepage wiki for meeting details: http://wiki.siframework.org/Health+eDecisions+Homepage

38. Questions?

39. Contact Information • For questions, please contact your support leads • Coordinator: • Ken Kawamoto: kensaku.kawamoto@utah.edu • Co-Coordinators: • Aziz Boxwala: aziz.boxwala@meliorix.com • Bryn Rhodes: bryn@veracitysolutions.com • ONC Leadership: • Alicia Morton: alicia.morton@hhs.gov • Project Management: • Jamie Parker: jamie.parker@esacinc.com • Use Case 2: • Dave Shevlin: d.s.shevlin@accenturefederal.com • Virginia Rhiel: virginia.riehl@verizon.net • Harmonization: • Lynette Elliot: lynette.elliott@esacinc.com • Anna Langhans: anna.langhans@accenture.com

40. Useful Links • Wiki • http://wiki.siframework.org/Health+eDecisions+Homepage • Use Case 1& 2 • http://wiki.siframework.org/Health+eDecisions+Use+Case • UC 2: Use Case 2: http://wiki.siframework.org/UC+2+-+CDS+Guidance+Service • Pilots • http://wiki.siframework.org/Health+eDecisions+Pilots • HL7 Ballot Submission: • http://wiki.siframework.org/Health+eDecisions+Reference+Materials#Ballot • UC 1 Harmonization and IG: • http://wiki.siframework.org/Health+eDecisions+Harmonization+and+Standards+%28Implementation%29 • HeD Glossary • http://wiki.siframework.org/HeD+Glossary