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August 25, 2006
Healthcare Information Technology Standards Panel (HITSP) Overview
HIMSS Advocacy & Public Policy Steering Committee
Contract HHSP23320054103EC
1
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
2Evaluation of Standards Harmonization Process for HIT
In 2005, HHS awarded contracts to seed a public-private effort to build a national health information network
3Evaluation of Standards Harmonization Process for HIT
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
American Health
Information Community
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.
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.
HITSP includes 206 different member organizations and is administered by
a Board of Directors17 SDOs (8%)
161 Non-SDOs (79%) 18 Govt. bodies (8%)
10 Consumer groups (5%)
HITSP includes 206 different member organizations and is administered by
a Board of Directors17 SDOs (8%)
161 Non-SDOs (79%) 18 Govt. bodies (8%)
10 Consumer groups (5%)
4Evaluation of Standards Harmonization Process for HIT
The Community formed workgroups to focus on four breakthrough areas
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
HITSP Focus
5Evaluation of Standards Harmonization Process for HIT
The HITSP team was charged with completing eleven different tasks, with current efforts focused on the harmonization process
The CommunityHHS Secretary
Mike Leavitt, Chair
Project Management TeamExecutive in Charge, F. Schrotter, ANSI
Program Manager, L. Jones GSIDeputy PM, J Corley, ATI
Project Manager, C Fantaskey, Booz Allen
Project Management TeamExecutive in Charge, F. Schrotter, ANSI
Program Manager, L. Jones GSIDeputy PM, J Corley, ATI
Project Manager, C Fantaskey, Booz Allen
Harmonization Process Delivery
Technical Manager
Joyce Sensmeier, HIMSS
Harmonization Process Delivery
Technical Manager
Joyce Sensmeier, HIMSS
Harmonization Process Definition
Technical Manager
Michelle Deane, ANSI
Harmonization Process Definition
Technical Manager
Michelle Deane, ANSI
HITSPDr. John Halamka, Chair
Member populated Technical Committees
Eleven Tasks are included in this contract:
1. Comprehensive Work Plan
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
6Evaluation of Standards Harmonization Process for HIT
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
7Evaluation of Standards Harmonization Process for HIT
HITSP Technical Committees Overview
Jamie Ferguson, Kaiser-Permanente
John Madden, MD, PhD, SNOMED Intl
Steve Wagner, Department of Veterans Affairs
Allow ordering clinicians to electronically access laboratory results, and allow non-ordering authorized clinicians to electronically access historical and other laboratory results for clinical care.
Electronic Health Record
77 members
Elaine A. Blechman PhD, Professor, Univ. of Colorado-Boulder
Charles Parisot, EHR Vendor Association
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.
Consumer Empowerment
61 members
Floyd P. Eisenberg, MD MPH, SIEMENS Medical Solutions Health Services Peter L. Elkin MD FACP, Mayo Clinic College of MedicineShaun Grannis, MD, The Regenstrief Institute, Indiana University School of Medicine
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.
Biosurveillance
63 members
8Evaluation of Standards Harmonization Process for HIT
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 approvedTier 1 & Tier 2 Harmonization Readiness Criteria.
9Evaluation of Standards Harmonization Process for HIT
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 (Deferred to future work)
10Evaluation of Standards Harmonization Process for HIT
Technical Committees assigned to harmonize standards that support the Community s breakthroughs
BiosurveillanceConsumer EmpowermentElectronic Health Record exchange
Status of work productsUse Cases documented Gap and Overlap Analysis completed Standards Selection completed Interoperability Specifications In Progress
due Sept 29th
11
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
12Evaluation of Standards Harmonization Process for HIT
Harmonization Process Steps
The actual harmonization process is a series of steps taken by industry stakeholders within the context of HITSP
13Evaluation of Standards Harmonization Process for HIT
HITSP FrameworkBasis 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.
14Evaluation of Standards Harmonization Process for HIT
HITSP FrameworkBasis 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.
15Evaluation of Standards Harmonization Process for HIT
Use Case/Modification Request
Interoperability Specification
Transaction1 n components or composite standards
Component1... n base standards or composite standard
Base Standard
#1
Base Standard
#2
Base Standard
#3
Transaction Package1 n transactions or composite
standards
Package (Composite)
Standard
Component (Composite)
Standard
Transaction(Composite)
Standard
Pot
entia
l for
Reu
se in
Oth
er C
onte
xt
Defines and N
arrows C
ontext
Policy Makers and Industry
Base Standard
#4
HITSP
Base Standard
#6
Base Standard
#7
Base Standard
#8
Base Standard
#9
Base Standard
#5
Standards
Organizations
HITSP Framework
16Evaluation of Standards Harmonization Process for HIT
Fulfills all actions between two or more systems needed to meet one or more interoperability requirementsTestableMay be fulfilled by components or composite standardExpresses constraints on components or composite standard
Query lab resultSend lab result
Logical grouping of actions, including necessary content and context, that must all succeed or fail as a group.
Transaction
Thin context and interoperability requirementsTestableBased on analysis of like technical actors, context and content harmonized across transactionsMay be fulfilled by one or more transactions or composite standardExpresses constraints on the transactions or composite standard
Record Locator ServiceEntity Identification Service
Defines how two or more transactions are used to support a stand-alone information interchange within a defined context between two or more systems
Transaction Package
Based on UML diagram to identify technical actors and actionsSets contextTestable functional requirementsIds transactions or transaction packages
HITSP EHR Interoperability Specification
Models business/ functional/ interoperability requirementsIdentifies technical/system requirements to meet use-case Identifies how to use one or more HITSP constructs to meet use-case requirements
Interoperability Specification
ONC Harmonized EHR Use Case
Defines business/functional requirementsSets Context
Use Case or Harmonization Request
RulesExampleDefinitionLevel
HITSP Framework Definitions and Rules
17Evaluation of Standards Harmonization Process for HIT
HITSP Framework Definitions and Rules (cont.)
Per Definition aboveIntegration profilesImplementation guides Health transaction services
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..
Composite Standard
Per HITSP definition the term standard refers, but is not limited to,:
Specifications
Implementation Guides
Code Sets
Terminologies
Integration Profiles
Messaging standardSecurity standardCode set.
A standard capable of fulfilling a discrete function within a single category produced and maintained by a single standards organization.
Base Standard
Typically will use one primary standard and may have other secondary standardsExpresses constraints on base or composite standards
Lab result messageLab result context
An atomic construct used to support an information interchange or to meet an infrastructure requirement (e.g., security, logging/audit)
Component
RulesExampleDefinitionLevel
18Evaluation of Standards Harmonization Process for HIT
Current HITSP Document InventoryHITSP
document number
Construct Name Type TC
02 Interoperability Specification BIO IS BIO03 Interoperability Specification CE IS CE01 Interoperability Specification EHR. IS EHR
13 Manage Sharing of Docs TP BIO, CE, EHR14 Send Lab Result Message to Ordering Clinician and Providers of Care TP BIO, EHR
18 View lab results from a web application TP EHR
24 Pseudonymize Tx BIO25 Anonymize Tx BIO
22 Patient ID Cross Referencing (IHE PIX) Tx BIO, CE, EHR23 Patient Demographics Query (IHE PDQ) Tx BIO, CE, EHR29 Notification of lab report availability Tx BIO, EHR19 Patient Registration Information Update Tx CE
41 Radiology Results Message C BIO
47 Resource Utilization Message C BIO39 Encounter Message - HL7 ADT C BIO, CE
45 Acknowledgements C BIO, CE, EHR36 Lab Report Message - HL7 2.5 (as constrained by ELINCS, etc.) C BIO, EHR37 Lab Report Document Structure C BIO, EHR32 Registration and Med History Document(s) Content C CE33 Map x12 Registration to Reg/Med Document C CE34 Map NCPDP 8.1 to Reg/Med Doc C CE35 EHR Lab Terminology C EHR44 Secure Web Connection C EHR
19Evaluation of Standards Harmonization Process for HIT
The Harmonization Process Inspection Testing
Harmonization Process Steps
We are here
20Evaluation of Standards Harmonization Process for HIT
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 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
21Evaluation of Standards Harmonization Process for HIT
The purpose of the inspection test is to ensure the Interoperability Specifications meet the following objectives
Check the specification to determine the existence of the following:
Ambiguities/ lack of specificityInconsistenciesGaps and overlapsTestabilityCompletenessInternal consistencyAbility to implement
Is Technically Valid
Validate that the IS when implemented will meet the specific requirements as defined in the use case
Meets Use Case Requirements
Validate the references to other documents and data sources are valid and that data in tables is accurate.
Contains Accurate References and Data
Ensure the integrity of document pieces that all the cascading documents are presentValidate grammar, spelling, and consistency of terminologyValidate that it follows the style guide for text and graphics
Conforms to Style and Editorial Guidelines
(Note that this will primarily be the responsibility of the HITSP project team and not the testers)
22Evaluation of Standards Harmonization Process for HIT
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
23
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
24Evaluation of Standards Harmonization Process for HIT
25Evaluation of Standards Harmonization Process for HIT
26Evaluation of Standards Harmonization Process for HIT
Lab
Emergency
Surgical
Pharmacy
Copyright © 2002 College of American Pathologists
Building a National Health Information Network
27Evaluation of Standards Harmonization Process for HIT
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