Transcript Document

Healthcare Information Technology
Standards Panel (HITSP) Overview
HIMSS Advocacy & Public Policy Steering Committee
Joyce Sensmeier MS, RN, BC, CPHIMS, FHIMSS
HIMSS Vice President Informatics
August 25, 2006
The purpose of this presentation is to orient the
Committee by providing. . .
 Information about the formation of HITSP
 An overview of the HITSP Harmonization Process
 Schedule and next steps
1
In 2005, HHS awarded contracts to seed a public-private
effort to build a national health information network
2
A public-private “Community” was then established to serve
as the focal point for America’s health information concerns
and drive opportunities for increasing interoperability
The Certification
Commission for
Health
Information
Technology
(CCHIT)
Healthcare
Information
Technology
Standards Panel
(HITSP)
HITSP includes 206 different member
organizations and is administered by
a Board of Directors
17 SDOs (8%)
161 Non-SDOs (79%)
18 Govt. bodies (8%)
10 Consumer groups (5%)
American
Health
Information
Community
The Health
Information
Security and
Privacy
Collaboration
(HISPC)
National Health
Information
Network (NHIN)
Architecture
Projects
The Community is a federally-chartered
commission and will provide input and
recommendations to HHS on how to make health
records digital and interoperable, and assure that
the privacy and security of those records are
protected, in a smooth, market-led way.
3
The Community formed workgroups to focus on four
breakthrough areas
HITSP Focus
 Biosurveillance -- Transmit essential ambulatory care and emergency department
visit, utilization, and lab result data from electronically enabled health care delivery and
public health systems in standardized and anonymized format to authorized public
health agencies with less than one day lag time.
 Consumer Empowerment -- Deploy to targeted populations a pre-populated,
consumer-directed and secure electronic registration summary. Deploy a widely
available pre-populated medication history linked to the registration summary.
 Electronic Health Record Exchange -- Deploy standardized, widely available, secure
solutions for accessing laboratory results and interpretations in a patient-centric
manner for clinical care by authorized parties.
 Chronic Care – Ensure that widespread use of secure messaging, as appropriate, is
fostered as a means of communication between clinicians and patients about care
delivery
4
The HITSP team was charged with completing eleven different
tasks, with current efforts focused on the harmonization
process
Eleven Tasks are included in this contract:
The Community
HHS Secretary
Mike Leavitt, Chair
1. Comprehensive Work Plan
HHS ONCHIT1
PO, Dr. John Loonsk
HITSP
Dr. John Halamka, Chair
Member populated
Technical Committees
Project Management Team
Executive in Charge, F. Schrotter, ANSI
Program Manager, L. Jones GSI
Deputy PM, J Corley, ATI
Project Manager, C Fantaskey, Booz Allen
Harmonization
Process Definition
Technical
Manager
Michelle Deane,
ANSI
Harmonization
Process Delivery
Technical
Manager
Joyce Sensmeier,
HIMSS
2. Conduct a Project Start Up Meeting
3. Deliver Recommended Use-Cases
4. Participate in related meetings and
activities, including the AHIC Meetings
5. Develop a Gap Analysis
6. Standards Selection, Evaluations and
Testing
7. Define a Harmonization Approach
8. Develop Interoperability Specifications
9. Develop and Evaluate a Business Plan for
the self-sustaining processes
10. Submit Monthly Reports – ongoing efforts
11. Assist with communications – ongoing
efforts
5
The HITSP process is an open, inclusive, and
collaborative process
The Community selects breakthrough areas to be worked across ONC
contracts
The HITSP then charters Technical Committees to address each break
through
– Identify a pool of standards for a general breakthrough area
– Identify gaps and overlaps for a specific context,
– Make recommendations to the HITSP for resolution of gaps and
overlaps
– Develop instructions for using the selected standard for a specific
context
– Test the interoperability specifications for using the standard
A call for participation is announced to all HITSP members
6
HITSP Technical Committees Overview
•Biosurveillance Transmit essential ambulatory care and

emergency department visit, utilization, and
lab result data from electronically enabled
health care delivery and public health systems 
in standardized and anonymized format to
authorized Public Health Agencies with less

than one day lag time.
•63 members
•Consumer
Empowerment
•61 members
•Electronic
Health Record
•77 members
Floyd P. Eisenberg, MD MPH,
SIEMENS Medical Solutions Health
Services
Peter L. Elkin MD FACP, Mayo
Clinic College of Medicine
Shaun Grannis, MD, The
Regenstrief Institute, Indiana
University School of Medicine
Allow consumers to establish and manage
permissions access rights and informed
consent for authorized and secure exchange,
viewing, and querying of their linked patient
registration summaries and medication
histories between designated caregivers and
other health professionals.
 Elaine A. Blechman PhD,
Professor, Univ. of ColoradoBoulder
 Charles Parisot, EHR Vendor
Association
Allow ordering clinicians to electronically
access laboratory results, and allow nonordering authorized clinicians to electronically
access historical and other laboratory results
for clinical care.
 Jamie Ferguson, KaiserPermanente
 John Madden, MD, PhD,
SNOMED Intl
 Steve Wagner, Department of
Veterans Affairs
7
Tier 1 Readiness Criteria
The standards required to support each major Use Case event were organized within an
agreed upon standards taxonomy.
The standards selected for inclusion in the pool were examined using ‘HITSP approved’
Tier 1 & Tier 2 Harmonization Readiness Criteria.
8
Tier 2 Readiness Criteria
•Suitability
- the standard is named at a proper level of specificity and
meets technical and business criteria of use case
•Compatibility
- the standard shares common context, information
exchange structures, content or data elements, security and
processes with other HITSP harmonized standards or
adopted frameworks as appropriate
•Preferred Standards Characteristics
- approved standards, widely used, readily available,
technology neutral, supporting uniformity, demonstrating
flexibility and international usage are preferred
•Standards Development Organization and Process
- meet selected criteria including balance, transparency,
developer due process, stewardship and others.
•Total Costs and Ease of Implementation
9
Current Work
 Technical Committees assigned to harmonize
standards that support the Community’s breakthroughs
– Biosurveillance
– Consumer Empowerment
– Electronic Health Record exchange
Status of work products
Use Cases documented 
Gap and Overlap Analysis completed 
Standards Selection completed 
Interoperability Specifications – In Progress –
due Sept 29th
10
The purpose of this presentation is to orient the
Committee by providing. . .
 Information about the formation of HITSP
 An overview of the HITSP Harmonization Process
 Schedule and next steps
11
The actual harmonization process is a series of steps taken
by industry stakeholders within the context of HITSP
Harmonization Process Steps
Receive
Request
I
Harmonization
Request
II
III
IV
Requirements
Analysis
Identification
of Candidate
Standards
Gaps,
Duplications
and
Overlaps
Resolution
V
VI
Standards
Selection
Construction
of
Interoperability
Specification
VII
Inspection
Test
VIII
Interoperability
Specification
Release
and
Dissemination
IX
Program Management
Begin
Support
12
HITSP Framework
Basis for Interoperability Specification Development
HITSP receives Use Cases and Harmonization Requests from external
sources, such as AHIC and ONC.
The Use Case or Request defines scenarios, business actors, and
business and functional/interoperability requirements.
HITSP decomposes the Use Case requirements into scenario(s) and
then into transactions providing context: technical actors, actions and
content. It may create or reuse a transaction or a grouping of
transactions (transaction package) based on commonality at this level.
Transactions are logical groupings of actions that are decomposed into
components, which are groupings of base standards that work
together, such as message and terminology.
13
HITSP Framework
Basis for Interoperability Specification Development
Each HITSP construct, i.e., transaction package, transaction or
component, may constrain the construct or standard below it.
Constraints follow a strict hierarchy and are only imposed by the next
higher construct.
Transaction packages, transactions and components all are potential
candidates for reuse if a new set of requirements and context are
successful fulfilled by the existing construct.
While reuse is a HITSP goal, it is established in the context of a use
case and its functional/interoperability requirements. The first objective
for September is meeting Use Case functional/interoperability
requirements.
HITSP constructs are version controlled and, if reused, will be uniquely
identified.
14
Policy Makers and Industry
HITSP Framework
Defines and Narrows Context
Use Case/Modification Request
Interoperability Specification
Transaction Package
1…n transactions or composite
standards
Transaction
1… n components or composite standards
Package
(Composite)
Standard
Transaction
(Composite)
Standard
Component
1... n base standards or composite standard
Component
(Composite)
Standard
s
ard s
nd tion
Sta niza
ga
Or
Base
Standard
#1
Base
Standard
#2
Base
Standard
#3
Base
Standard
#4
Base
Standard
#5
Base
Standard
#6
Base
Standard
#7
Base
Standard
#8
Potential for Reuse in Other Context
HITSP
Base
Standard
#9
15
HITSP Framework Definitions and Rules
Level
Definition
Use Case or
Harmonization
Request

Interoperability
Specification




Transaction
Package

Example
Rules
Defines business/functional
requirements
Sets Context
 ONC Harmonized
EHR Use Case
Models business/ functional/
interoperability requirements
Identifies technical/system
requirements to meet use-case
Identifies how to use one or more
HITSP constructs to meet use-case
requirements
 HITSP EHR
Interoperability
Specification

Defines how two or more
transactions are used to support a
stand-alone information interchange
within a defined context between
two or more systems
 Record Locator
Service
 Entity
Identification
Service








Transaction

Logical grouping of actions,
including necessary content and
context, that must all succeed or fail
as a group.
 Query lab result
 Send lab result




Based on UML diagram to identify
technical actors and actions
Sets context
Testable functional requirements
Ids transactions or transaction packages
Thin context and interoperability
requirements
Testable
Based on analysis of like technical actors,
context and content harmonized across
transactions
May be fulfilled by one or more
transactions or composite standard
Expresses constraints on the transactions
or composite standard
Fulfills all actions between two or more
systems needed to meet one or more
interoperability requirements
Testable
May be fulfilled by components or
composite standard
Expresses constraints on components or
composite standard
16
HITSP Framework Definitions and Rules (cont.)
Level
Definition
Example
Rules
Component

An atomic construct used to
support an information
interchange or to meet an
infrastructure requirement (e.g.,
security, logging/audit)
 Lab result
message
 Lab result context

A standard capable of fulfilling a
discrete function within a single
category produced and
maintained by a single standards
organization.
 Messaging
standard
 Security standard
 Code set.
Per HITSP definition the term “standard” refers,
but is not limited to,:
Base Standard
Composite
Standard


Grouping of coordinated base
standards, often from multiple
standards organizations,
maintained by a single
organization. In HITSP, it can
serve as a component,
transaction or transaction
package functional requirements..
 Integration
profiles
 Implementation
guides
 Health transaction
services

Typically will use one “primary” standard
and may have other “secondary” standards
Expresses constraints on base or
composite standards
–
Specifications
–
Implementation Guides
–
Code Sets
–
Terminologies
–
Integration Profiles
Per Definition above
17
Current HITSP Document Inventory
HITSP
Construct Name
document
number
02 Interoperability Specification BIO
03 Interoperability Specification CE
01 Interoperability Specification EHR.
Type
TC
IS
IS
IS
BIO
CE
EHR
13 Manage Sharing of Docs
14 Send Lab Result Message to Ordering Clinician and Providers of Care
TP
TP
BIO, CE, EHR
BIO, EHR
18 View lab results from a web application
TP
EHR
24 Pseudonymize
25 Anonymize
Tx
Tx
BIO
BIO
22
23
29
19
Tx
Tx
Tx
Tx
BIO, CE, EHR
BIO, CE, EHR
BIO, EHR
CE
41 Radiology Results Message
C
BIO
47 Resource Utilization Message
39 Encounter Message - HL7 ADT
C
C
BIO
BIO, CE
45
36
37
32
33
34
35
44
C
C
C
C
C
C
C
C
BIO, CE, EHR
BIO, EHR
BIO, EHR
CE
CE
CE
EHR
EHR
Patient ID Cross Referencing (IHE PIX)
Patient Demographics Query (IHE PDQ)
Notification of lab report availability
Patient Registration Information Update
Acknowledgements
Lab Report Message - HL7 2.5 (as constrained by ELINCS, etc.)
Lab Report Document Structure
Registration and Med History Document(s) Content
Map x12 Registration to Reg/Med Document
Map NCPDP 8.1 to Reg/Med Doc
EHR Lab Terminology
Secure Web Connection
18
The Harmonization Process – Inspection Testing
Harmonization Process Steps
Receive
Request
I
Harmonization
Request
II
III
IV
Requirements
Analysis
Identification
of Candidate
Standards
Gaps,
Duplications
and
Overlaps
Resolution
V
VI
Standards
Selection
Construction
of
Interoperability
Specification
VII
Inspection
Test
VIII
Interoperability
Specification
Release
and
Dissemination
IX
Program Management
We are here
Begin
Support
19
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
Title
Inspection Test
Due to HHS
Sept 29, 06
Stakeholders
HITSP, EHRVA,
IHE, Gov’t,
others
Plan for interoperability Sept 29, 06
testing
HITSP, NIST,
NLM, others
Third party testing
2007
HITSP, NIST,
CCHIT
Orchestration and
implementation test
2007
HITSP, IHE, FHA,
EHRVA, NHIN
 The first test in the series of tests 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
20
The purpose of the inspection test is to ensure the
Interoperability Specifications meet the following objectives
Conforms to Style and Editorial Ensure the integrity of document pieces – that all the cascading
Guidelines
documents are present
Validate grammar, spelling, and consistency of terminology
(Note that this will primarily be the
Validate that it follows the style guide for text and graphics
responsibility of the HITSP project
team and not the testers)
Contains Accurate References Validate the references to other documents and data sources are
and Data
valid and that data in tables is accurate.
Meets Use Case
Requirements
Validate that the IS when implemented will meet the specific
requirements as defined in the use case
Is Technically Valid
 Check the specification to determine the existence of the
following:
• Ambiguities/ lack of specificity
• Inconsistencies
• Gaps and overlaps
• Testability
• Completeness
• Internal consistency
• Ability to implement
21
There are 8 major steps to complete the Interoperability
Specification (IS) inspection test process
1. Identify and engage key volunteer test resources
2. Develop the tools and procedures for gathering and responding to test findings
3. Assign testers to IS documents
4. Distribute Interoperability Specifications to the assigned testers
5. Conduct the test and hold test monitoring sessions– including a test kickoff, mid-point
test monitoring session, IS specific walkthrough sessions, and final test debrief
6. Consolidate and document test results
7. Writers analyze and disposition test defects, updating IS documents as appropriate
8. Wrap up testing and prepare for posting to HITSP.org for public comment
22
The purpose of this presentation is to orient the
Committee by providing. . .
 Information about the formation of HITSP
 An overview of the HITSP Harmonization Process
 The schedule and next steps
23
Meeting Schedule
Activity
Description of Activity
Responsible
Dates
Meetings
TC Face to Face I
TC’s meet to draft Interoperability
Specifications
Four Points Sheraton - Baltimore
TCs and
Performance
Team
TC Leadership: July 17
TC: July 18 - 20
TC Face to Face II
TC’s meet to finalize Interoperability
Specifications
Chicago Hilton Garden Inn
TCs and
Performance
Team
TC Leadership: August 14
TC: August 15 – 17
Project team only August 18
TC Face to Face III
TC’s meet to update Interoperability
Specifications post Test and
Comment
Crystal City Marriott at Reagan
National Airport
TCs and
Performance
Team
TC: September 6-8
Board Meeting
Board meets to review HITSP
progress
Design Team Lead September 8
Panel Meeting
Panel meets to approve
Interoperability Specifications
Design Team Lead September 20
24
Other Deliverables
Activity
Description of Activity
Responsible
Dates
TCs & Performance
Team
July 5 – August 17 COB
August 18 – Project team
Panel Review I: Comment and/or Interoperability Specification is
Inspection Test of IS
reviewed and inspection tested by
the HITSP Panel and public
Design Team Lead
Posts, Performance
Team manages
comments
August 18 - 30
Update I: Address Comments
from Review / Inspection Test
Technical Committees update
Interoperability Specifications
TCs & Performance
Team
August 31 – September 12
Panel Review II: Review and
comment of IS updates
Posted to www.HITSP.org and
review and comment thru the 19th –
comment review period closes the
20th
Design Team Lead
Posts, Performance
Team manages
comments
September 13 – 19
Panel Approval: Approval IS
HITSP Panel Approves IS
Panel
September 20
Update II: TCs Finalize
Interoperability Specifications
TC’s finalize IS for delivery to ONC
TCs & Performance
Team
September 20 – 25 COB
Finalize Interoperability
Specifications
TCs update based on panel
comments
Project Management September 26 – 28 COB
Team
Deliver Interoperability
Specifications
SOW Ref # 9
Project Management Friday, September 29, 2006
Team
Draft Interoperability
Specifications
Technical Committees meet to
finalize the draft IS for inspection
testing
25
Building a Nationwide Health Information Network
Lab
Pharmacy
Emergency
Surgical
Copyright © 2002 College of American Pathologists
26
Contact Information
Joyce Sensmeier MS, RN, BC, CPHIMS, FHIMSS
Vice President, Informatics
Healthcare Information and Management Systems Society (HIMSS)
230 East Ohio, Suite 500
Chicago, IL 60611
312-915-9281
[email protected]
27