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HIT Policy CommitteeHIT Policy Committee

PCAST Report WorkgroupPCAST Report WorkgroupFriday, January 14, 2011

2:00pm ET

Paul Egerman, Chair

William Stead, Vice Chair

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CalltoOrder CalltoOrder

1. Call to Order/Roll Call

± Judy Sparrow, Office of the National Coordinator for Health Information

Technology

2. Overview of the Agenda

± Paul Egerman, Chair

± Bill Stead, Vice Chair

3. Discussion: PCAST Report

± Bill Press, Vice Chair, PCAST

4. Use Case Examples & Comparison

± Paul Egerman & Bill Stead

5. Public Comment

6. Adjourn

Agenda

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Workgroup Members

Members:

Dixie Baker SAIC

Hunt Blair Vermont HIE

Tim Elwell Misys Open Source

Carl A. Gunter University of Illinois

John Halamka Beth Israel Deaconess Medical Center, HMS

Leslie Harris Center for Democracy & Technology

Stan Huff Intermountain

Robert Kahn [invited]

Gary Marchionini University of North Carolina

Stephen Ondra Office of Science & Technology Policy

Jonathan Perlin Hospital Corporation of America Richard Platt Harvard Medical School

WesRishel Gartner

Marc Rothstein

Steve Stack American Medical Association

Eileen Twiggs Planned Parenthood

Chair: Paul Egerman, Chair

Co-Chair: William Stead, Vice Chair, Vanderbilt University

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Workgroup Charge

The PCAST Report Workgroup is charged to :

Assist ONC synthesize and analyze the public comments and

input to the PCAST report;

Discuss the implications of the report and it¶s specific

recommendations to ONC on current ONC strategies;

Assess the feasibility and impact of the PCAST report on ONC

programs;

Elaborate on how these recommendations could be integrated

into the ONC strategic framework.

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Meeting Dates

January 7, 4:30 to 5:30 pm/ET

Jan 14, 2 to 4 pm/ET

Jan 27, 11 to 2 pm/ET

Feb 10, 12 to 2 pm/ET

Feb 15 ± 16 ± 17, one of these dates (or perhaps 1.5 days) for an in-person

meeting in Washington -TBD

Mar 3, 1 to 4 pm/ET

Mar 17, 10 to 1 pm/ET

Meeting Dates

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Use Case to Illustrate Stage 1 MU Patient Summary

Use Case #1:

Patient presents to the emergency department

complaining of severe chest pains that were suffered

while patient was working on a home improvementproject. In this use case, using Stage 1 of MU, the ED

clinician retrieves a CCD patient summary, which

contains important information that is needed to treat

the patient. An active medications list is necessary,

along with a problem list. Indeed, the sample datashows an existing cardiac problem that could be

relevant.

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Sample Patient Summary - Text Form

Problems

1. AV Nodal Reentry

Tachycardia (Active)

2. Glaucoma (Active)

3. Vegan (Active)

4. Lyme Disease

(Resolved)

5. Corneal Abrasion

(Resolved)

Medications

1. Centrum Silver 1

PO qd

2. Vitamin D3 1600

units PO qDay

3. Xalatan 1 drop

each eye qhs

Vital Signs

BP: 115/70

Pulse: 50

Respiratory Rate: 14

Height: 73 inches

Weight: 170 pounds

Body MassIndex: 22.4

Immunizations

Hepatitis A vaccine:

#1 Sep 03, 2004

Hepatitis A vaccine:

#2 Mar 01, 2005

Tetanus vaccine:

Jun 20, 2008

Pneumovax:

Sep 03, 2009

Influenza:

Oct 19, 2010

Allergies

1. Penicillin (Rash)

Labs

Cholesterol: 135

Triglyceride: 59

HDL: 40

Procedures

1. RFID Chip Implant

in right triceps

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Patient Summary in XML

<?xml version="1.0" encoding="UTF-8"?>

<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">

<realmCode code="US"/>

<typeId root="2.16.840.1.113883.1.3" extension="POCD_ HD000040"/>

<templateId root="2.16.840.1.113883.10.20.1"/>

<templateId root="2.16.840.1.113883.3.88.11.32.1"/>

<templateId root="2.16.840.1.113883.10.20.3"/>

<templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>

<id root="809680b0-1e0d-11e0-ac64-0800200c9a66"/>

<code code="34133-9" codeSystem="2.16.840.1.113883.6.1" displayName="Summarization of episode note"/>

<title>Continuity of Care Document</title>

<effectiveTime value="20110111000000-0500"/>

<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>

<languageCode code="en-US"/>

<recordTarget>

<patientRole>

<id extension="996-756-495" root="2.16.840.1.113883.19.5"/>

<addr >

<streetAddressLine>5739 Hazel Street</streetAddressLine>

<city>Williamsport</city>

<state>PA</state>

<postalCode>17701</postalCode>

<country>USA</country>

</addr >

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Use Case to Compare Stage 1 of MU with PCAST

Report

Use Case #2:

Patient presents to the ED after suffering a minor laceration that

occurred during a home improvement project in a bathroom.

Only simple first aid is needed. Because of the circumstances of

the injury, the ED nurse would like to check the status of the

patient's tetanus immunization.

MU Stage 1 Transaction: Entire patient summary document is

requested. As the sample data set shows, the patient summary

would contain the immunization status, but it would also contain

other information that is not needed.

PCAST Approach: The nurse could request the Tetanus

immunization status only.

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CCD ± Summary of Patient¶s Immunization Record (code)



<component>

<section>

<templateId root="2.16.840.1.113883.10.20.1.6"/>



<code code="11369-6" codeSystem="2.16.840.1.113883.6.1"/>

«

<entry typeCode="DRIV">

<substanceAdministration classCode="SBADM" moodCode="EVN">

<templateId root="2.16.840.1.113883.10.20.1.24"/>



<id nullFlavor="NI"/>

<statusCode code="completed"/>

<effectiveTime xsi:type="IVL_ TS">

<center value="20040903"/>

</effectiveTime>

<consumable>

<manufacturedProduct>

<templateId root="2.16.840.1.113883.10.20.1.53"/>



<manufacturedMaterial>

<code code="52" codeSystem="2.16.840.1.113883.6.59" displayName="hepatitis A vaccine, adult dosage">

<originalText>Hepatitis A vaccine #1</originalText>

</code>

</manufacturedMaterial>

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CCD ± Summary of Patient¶s Immunization Record

(HTML)

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Illustration of Metadata Tagging - PCAST Approach

XML based Structure

<Privacy>«</Privacy>

<Attributes>«</Attributes>

<Provenance> «</Provenance>

<Data>Encrypted Immunization Data</Data>

For Example:

Privacy :<ED> Yes </>

<Referring Physicians> Yes; </>

<Exceptions

>Dr. JamesResearch </>,

Attributes : Patient Identification , Date = June 20, 2008, Vocabulary identification

(e.g. SnomedCT 96412003),

Site Provenance : Manufacturer of immunization and batch number

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Use Case from PCAST Report

Use Case #3:

When Patient changes provider, new physician wishesto examine multiple Mammograms that were taken at

multiple sites over a long period of time.

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Use Case #3 from PCAST Report (cont.)

Structure is still

<Privacy>>< Attributes><Provenance<Data>

A DEAS is used to locate additional data

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Initiator

Provider

n

Hospital x

VA/DoD

«

DEAS

n

DEAS x

DEAS

n

Query

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Definition of Metadata

Metadata: Data about data

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