October 2, 2008 | 2:00 – 3:30 pm (Eastern)

1enabling healthcare interoperability

Webinar Series

Sponsored by the HITSP Education, Communications and Outreach Committee

October 2, 2008 | 2:00 – 3:30 pm (Eastern)

Presenters HITSP Population Perspective Technical Committee

Floyd Eisenberg, MD, MPH, Senior Key Expert, Siemens Healthcare

and co-chair of the Population Perspective TC

Lori Fourquet, e-HealthSign, LLC

Quality

Slide 2HITSP – enabling healthcare interoperability

Learning Objectives

During this 90-minute webinar, participants will explore the population

perspective of health information sharing for quality, gaining

a basic knowledge of:

— quality measure specification data element types and value sets

— defining and selecting a sub-population of patients (measure

denominator)

— defining and identifying expected interventions (measure numerator)

— terminology issues in identifying inclusion and exclusion criteria

a webinar series on U.S. healthcare interoperability

(continued)


Learning Objectives (continued)

— expectations for information transfer from EHRs to quality reporting

organizations

— HITSP specifications for quality information sharing

— the relationship of the quality use case and interoperability specification

to other efforts for public health and for data repurposing

a webinar series on U.S. healthcare interoperability


Quality

— Quality Measure Specification

— Clinical Data for Analysis

Inclusion Criteria

Exclusion Criteria

— Quality Reporting

— Security and privacy requirements for Quality

HITSP Interoperability Specification for Quality (HITSP IS 06)

Units of Exchange

— Health Information Summary Documents

— Health Information Messages

Conformance Subsets

Questions and Answers

Agendaa webinar series on U.S. healthcare interoperability


Introduction: Steve’s Story . . . part six

Patient is a 26-year-old male coping with the long-term effects

of a brain tumor that was removed during his childhood

Patient is assisting with home care for his grandfather, a

recent widower and diabetic who has become despondent

and non-compliant with self-care requirements

— The family is becoming concerned about the quality of care

Steve’s grandfather is receiving

— A search for new providers and a successful diabetes program is

being conducted by the family

— Fact-based information is needed, more than practice locations,

hours of operation, frequency of procedures and anecdotes

based on reputation, e.g.,

Critical care information such as comparative outcomes of

care for diabetic patients and those with depression

General preventive care success factors


HITSP is a volunteer-driven, consensus-based organization that is funded

through a contract from the Department of Health and Human Services.

The Panel brings together public and private-sector experts from across

the healthcare community to harmonize and recommend the technical

standards that are necessary to assure the interoperability of electronic

health records.

Overview


The HITSP Standards Harmonization Framework

— Identify a pool of standards for an AHIC (American Health Information

Community) Use Case

— Identify gaps and overlaps in the standards for this specific Use Case

— Make recommendations for resolution of gaps and overlaps

— Select standards using HITSP-approved Readiness Criteria

— Develop Interoperability Specifications (IS) that use the selected

standard(s) for the specific context

— Test the IS

Deliverables and Mode of Operation


Each HITSP Interoperability Specification defines a set of “constructs” that:

— specify how to integrate and constrain selected standards to meet the

business needs of a Use Case; and

— define a Roadmap to use emerging standards and to harmonize

overlapping standards when resolved.

In essence, a HITSP IS represents a suite of documents that integrate and

constrain existing standards to satisfy a Use Case



HITSP construct types, in decreasing breadth of scope, include:

— Interoperability SpecificationsIntegration of all constructs used to meet the business needs of a Use Case

— Transaction PackagesLogical grouping of transactions

— TransactionsLogical grouping of actions that use components and/or composite standards to realize the actions

— ComponentsLogical grouping of base standards that work together, such as

messaging and terminology



IS Status = State in the acceptance process

— Released

Panel approved for submission to HHS

— Accepted

Secretary of HHS has accepted for a period of testing

— Recognized

Secretary of HHS has recognized the IS for immediate implementation

Revisions and updates may mean that multiple versions of some

Interoperability Specifications exist with differing status levels



Current Interoperability Specifications (IS)

IS 01 Electronic Health Record (EHR) Laboratory Results Reporting

IS 02 Biosurveillance

IS 03 Consumer Empowerment and Access to Clinical Information via Networks

IS 04 Emergency Responder Electronic Health Record (ER-EHR)

IS 05 Consumer Empowerment and Access to Clinical Information via Media

IS 06 Quality

IS 07 Medication Management


IS 06 Quality

This Interoperability Specification defines specific standards that capture the

integration of data to support quality measurement feedback and reporting into

electronic health records (EHRs), use of quality measures to support clinical decision

making, and public reporting of healthcare quality through the exchange of data

between healthcare organizations and providers and public health via an electronic

network.

— Version: 1.0 Recognized — Version 1.0.1 Panel Review

IS 06VIA AN

ELECTRONIC NETWORK

IS 06VIA AN

ELECTRONIC NETWORK

Healthcare Provider Quality Reporting Organizations


Hospital-based quality measures

— Automate data capture and reporting of Hospital Quality Alliance (HQA)

measures through EHRs in support of provider workflows

— Communicate HQA measure data to external agencies

Clinician-level data

— Automate data capture and reporting of Ambulatory Quality Alliance (AQA)

measures through EHRs in support of provider workflows

— Communicate AQA quality measure data to external entities for

aggregation and reporting

IS 06 QualityOverall Objectives


Feedback to Clinicians

— enable real-time or near-real-time feedback regarding specific quality indicators which are relevant for a particular patient

— enable provision of tailored performance information to clinicians on quality measures for specific patient groups

(continued)

IS 06 Quality

Overall Objectives (continued)


Public Reporting

— Aggregate data across multiple sources (claims data, medication data, laboratory data, etc.)

— Support quality measurement, promote accountability among providers, and aid consumers in making informed choices

— Communicate quality measurement data quickly and clearly in a manner that makes it useful to a wide variety of decision makers (patients, healthcare providers, payers, health plans, and regulators who are involved with this process)

IS 06 Quality

Overall Objectives (continued)


Ancillary Entities

Clinicians

Consumers

Government Healthcare Agencies

Healthcare Delivery Organizations

Health Information Exchange

Health Information Management

Personnel

Health Information Technology

System Developers

Healthcare Payers

Healthcare Purchasers

Health Researchers

Processing Entities

Public Health Agencies

Quality Organizations

IS 06 QualityStakeholders


Quality Measure Specification

— Structured and codified

— Denominator and Numerator Inclusions – Value Sets

— Denominator and Numerator Exclusions – Value Sets

Data Capture / Aggregation

Data Reporting to External Agencies

IS 06 QualityRequirements


Integrating the Healthcare Enterprise (IHE) Quality, Research & Public Health Domain, Performance Measurement Value Set White Paper, August 2008

IS 06 QualityRequirements (continued)


Hospital-based care

Clinician / Ambulatory-based care

IS 06 QualityPerspectives


Healthcare Information Technology Expert Panel (HITEP)— Convened by the National Quality Forum (NQF)

— Identified 84 Institute of Medicine (IOM) High Priority Measures

Common data types

Reduce logic to common data types

Analyze frequency

— 88 Data Elements (9 additional subtypes added by HITEP)

Facility / clinician demographics

Patient demographics

Clinical data

IS 06 QualityData Elements / Types


— Base Facility Data Elements Identifier

Name

Location

— Patient Data Elements Pseudonymized Data Linker

Encounter Date/Time

History

Birth

Gender

Visit Data

Location

Discharge

Death

— Clinical Data Elements

Problem Data

Diagnosis Data

Allergy / Adverse Reaction

Vital Signs

Procedures and Diagnostic Tests

Medication Data

Study Findings/Test Results – Laboratory

Study Findings/Test Results – Radiology and Other Studies

Other (e.g. clinician-clinician communications, provider-patient communications, care classification-”comfort measure only,” clinical trial)

IS 06 Quality

Data Elements / Types / Examples


Processing Entity / HIE

Other Communities

Hospital

Clinician/Ambulatory

Provider

Document-Based

Transmission

Message-Based

Transmission

Quality Measurement

Organization

IS 06 QualityMain Business Actors

Measurement Consumer


Quality Report

MDO

MDO NQF

MDO

EHR

Quality Measure

Patient Data

measure endorsement, maintenance, syndication, and live broadcast

Quality Measure imported

EHR creates patient data summary internally, uses imported measure to calculate quality scores and export quality report

Quality report detail exported

IS 06 QualityImplementation Option #1: EHR does the work

Acronym LegendMDO – Measure Development OrganizationNQF – National Quality Forum


Quality Report

MDO

MDO NQF

MDOmeasure endorsement, maintenance, syndication, and live broadcast

Quality Measure imported QIO

Quality MeasureEHR

Quality data assembled internally

Data transmit Clinical Data

importedQIO uses imported Quality measures and clinical details to calculate quality scores and export Quality report

Quality report detail exportedPatient Data

IS 06 QualityImplementation Option #2:Quality Improvement Organization (QIO) / HIE

Acronym LegendHIE – Health Information ExchangeMDO – Measure Development OrganizationNQF – National Quality Forum

Mes

sage

Doc

umen

t


IS06 QualityTraditional HL7 Messaging


IS06 QualityDocument Sharing


IS06 QualityAssembly of Patient-Level Quality Data


Query for Existing Data (NEW)

TP 21

Patient Level Quality Data Message (NEW)

C 34

Patient Level Quality Data Document (NEW)

C 38

Patient Demographics Query (NEW)

T 23

IS 06 Quality New Constructs for IS06

Supports dynamic queries for clinical data to gather patient-level quality data elements

Support the process of sending patient-level quality data to an aggregator for analysis and aggregation of quality measures

Provide a list of patients and their demographics


Collect & Communicate Security Audit Trail

T 15

Secured Communication Channel

T 17

Access Control

TP 20

Nonrepudiation of Origin

C 26

Consistent Time

T 16

IS 06 QualityPrivacy and Security

Ensure the authenticity, integrity, and confidentiality of transactions, and the mutual trust between communicating parties

Provides a mechanism to ensure that all the entity systems communicating within the network have synchronized system clocks

Record audit event in repository

Ensure that an entity is the person or application that claims the identity provided

Describes the mechanisms to define and identify security relevant events and the data to be collected and communicated as determined by policy, regulation or risk analysis. It also provides the mechanism to determine the record format to support analytical reports that are needed.


Manage Consent Directives

TP 30

Entity Identity Assertion

C 19

IS 06 QualityPrivacy and Security

Ensure that an entity is the person or application that claims the identity provided

Deals with the capture and communication of patient consent directives and non-patient originated authorizations for disclosure of health information

Pseudonymize

T 24

Anonymize

C 25

Provides specific instruction for anonymizing data that is ready for repurposing.

Anonymization: According to the International Organization for Standardization (ISO), is the process that removes the association between the identifying data set and the data subject.

Defined to support pseudonymization of protected health information.

Pseudonymization : The process of supplying an alternative identifier that permits a patient to be referred to by a key that suppresses his/her actual identification information


Notification of Document Availability

T 29

Manage Sharing of Documents

T 13

Retrieve Form for Data Capture

TP 50

Patient ID Cross-Referencing

TP 22

IS 06 QualityInfrastructure

Deals with identifying and cross-referencing different patient attributes for the same patient.

Facilitates the registration, distribution and access of patient electronic health records across health enterprises

Notifies its recipient that a document is available and provides the information needed to retrieve the document

Supports public health authority reportable conditions monitoring and management.Enables capture of supplemental data variables not typically maintained in an electronic health record or laboratory information system

Document Reliable Interchange (NEW)

T 31

Supports a point-to-point interchange of metadata and documents

Transfer of Documents on Media (NEW)

T 33

Supports media interchange of metadata and documents


Measurement Criteria Message

TBD

Measurement Criteria Document

TBD

IS 06 QualityFuture Direction

New Constructs Required

Current Activities:Collaborative for Performance Measure Integration with EHR SystemsNational Committee for Quality Assurance (NCQA)American Medical Association (AMA)Electronic Health Records Association (EHRA, formerly EHRVA)

http://www.ama-assn.org/ama/pub/category/18352.html


Quality Measurement Message

TBDQuality Measurement Document

TBD


Current Activities:Quality Reporting Document Architecture (QRDA)September 2008 Ballot – HL7, Vancouver, BC

IS 06 Quality

Future Direction (continued)


Derived Information

TBD

Validation, Data Quality Checking

TBD


Case Review Document

TBD

Case Review Message

TBD

IS 06 Quality

Future Direction (continued)

Feedback mechanism to the provider to assure patients represented in the quality report are valid; review step

Quality check of the output for a quality reportDescribe how to derive information from existing data element, e.g., duration of medication from frequency and # dispensed.


Constructs(single purpose

or reusable)

Type 1: Base or Composite Standards

Re-Use

Applying an existing

construct to more than one IS

Re-Purpose

Updating a construct to

meet the needs of a

new Use Case

Can extend or constrain when reusing or re-purposing

— Specifications contain a common superset

— Superset can be extended as new requirements are encountered

— Superset can be constrained with use-specific constraints

Units of Information Exchange HITSP IS Constructs - Re-Use and Re-Purpose


Effective interoperability

— Quality Measurement is based on existing EHR available data

— Reporting is processed in a standard, machine readable format

— Current activities that increase data entry for quality measurement are reduced

— Implementation is flexible for local architecture

— Data are secure and private

— Near real-time feedback is available for clinicians

— Information is available for consumers to make healthcare choices

IS 06 QualityStrengths


Steve’s story . . . the future

Patients can make informed decisions about the ongoing care

of themselves and their family members

— consumers have access to quality and safety reports

about individual providers and care facilities

Data is collected automatically during routine care and reused

for performance measurement

Outcome data is available for determining best care protocols,

enables standards-based and evidence-based care

Reports are standard and comparable enabling true

benchmarking and continuous improvement

— Transparency is the rule

Decision support is part of the workflow, with useful safety alerts


Healthcare in an interoperable world . . .

The Future is Now HIT data exchange is becoming transparent so that the quality of

care delivered by providers and hospitals can be known no

matter where the patient is located

Consumers are empowered to

— get the right information at the right time

— find appropriate, quality and safe care for themselves and

their families

— assume that repeatable information will be safe and secure

while also being accessible by those who need it – before,

during and after a visit to a care provider

Care providers are empowered to

— provide safe, effective and evidence-based care with

information integrated within a clinical care workflow


Use or specify HITSP Interoperability Specifications in your HIT efforts

and in your Requests for Proposals (RFPs)

Ask for CCHIT certification

Leverage Health Information Exchanges to promote HITSP specifications

to make connections easier in the future

Ask . . . Is there a HITSP standard we could be using?

Get involved in HITSP . . . Help shape the standards

How YOU can become involved


Webinar 1 Standardizing How We Share Information in Healthcare: An Introduction to HITSP

Thursday, June 5, 2008 — 2:00-3:30 pm EDT

Webinar 6 Quality

Thursday, August 7, 2008 — 2:00-3:30 pm EDT

Webinar 2 HITSP Foundational Components


Webinar 7 Security, Privacy and Infrastructure

Thursday, August 21, 2008 — 2:00-3:30 pm EDT

Webinar 3 Consumer Access to Clinical Information


Webinar 8 EHR and Emergency Response

Thursday, September 4, 2008 — 2:00-3:30 pm EDT

Webinar 4 Biosurveillance

Thursday, July 10, 2008 — 2:00-3:30 pm EDT

Webinar 9 Medication Management

Thursday, September 18, 2008 — 2:00-3:30 pm EDT

Webinar 5 Electronic Health Record (EHR) and Lab Reporting

Thursday, July 24, 2008 — 2:00-3:30 pm EDTReplays available for all Webinars

www.HITSP.org/webinars

How YOU can become involved

Learn more about specific HITSP activities in these webinars available for replay:


Webinar Series IIComing soon

Stay Tuned – same timeThursdays — 2:00-3:30 pm EDT

Send your Webinar ideas to [email protected]


Jessica Kant, HIMSS Theresa Wisdom, [email protected] [email protected]

Re: HITSP Technical Committees

Michelle Deane, ANSI [email protected]

Re: HITSP, its Board and Coordinating Committees

Join HITSP in developing a safe and

secure health information network for

the United States.

Visit www.hitsp.org or contact . . .


A Successful Collaboration

Interweaving many different standards to address business needs

A successful collaboration between HITSP and several HITSP

member organizations developing base standards and

implementation guides/profiles


Sponsor Strategic Partners

www.HITSP.org

45enabling healthcare interoperability

Webinar Series

Sponsored by the HITSP Education, Communications and Outreach Committee

Quality

Questions and Answers