S&I Framework Update HIT Standards Committee

June 10, 2013

Doug Fridsma, MD, PhD, FACP, FACMIChief Science Officer & Director, Office of Science & Technology

S&I Framework Operating Metrics

Timing Outputs

Participation & Process

Framework Launch Date Jan 7, 2011

First Initiative Launch Date Jan 31, 2011

Elapsed Time since Initiative Launch (as-of today) 28 months

# Consensus Approved Use Cases 18

# Pilots Committed 33

# Pilot Vendors 42

Total Ballots 11

# Total HL7 Ballot Comments Received 2,953

# HL7 Ballot Comments Resolved 2,882

# Wiki Registrants 2358

# Committed Members 719

# Committed Organizations 548

# Working Sessions Held 1,596

S&I Face to Face meetings 3

Standards Organizations engaged 35

S&I Monthly Newsletter Editions 17

SDS Newsletter Subscribers 1,908

As of 6/13/2013 2

S&I Initiative Portfolio Snapshot

Transitions of Care

Query Health

Pre-Discovery Use Case Harmonization RI, Test & Pilot Evaluation

Lab Results Interface

Data Segmentation for Privacy

esMD

Longitudinal Coordination of Care

Public Health Reporting

Laboratory Orders Interface

Direct Project(S&I Archetype)

Health eDecisions

Blue Button Plus

Companion Guide & PSS completed for September ballot

IG & Second Errata Published; 2014 CEHRT In Progress

Pilots nearing completion, QRDA III Published, HQMF in Comment Reconciliation

Community-Led; RI Framework and CDA guide published; Testing & Pilots in progress; community will be meeting on a monthly basis

eDoC UC in Progress; AoR Level 2 UC achieved consensus; IG consensus closed for UC 1, UC 2, AoR L1, and Prov. Dirs. Guidance IG’s

LOI IG ballot ended on 1/7/13 and reconciliation completed 6/7/13; Lab pilot efforts include LOI and eDOS; LOI IG to be submitted for June reballot along with initial ballot for eDOS IG

Two WGs complete (Payer & Clinical Content); Two WGs (Push & Pull) in progress, at various stages of IG development

In production

Structure Data Capture

S&I Initiative Portfolio Snapshot

3PDMP Project Standard – NCPDP was selected and consented March 14, 2013

Use Case consensus complete; Standards Analysis ongoing; Forms SWG discussing CDE and Form Structure; Standards SWG kickoff July 3

Use Case 1: Knowledge Artifact Sharing Model, Schema and IG was approved by HL7, UC 1 now in Pilots – 3 of 4 pilots complete. Use Case 2: CDS Guidance Service achieved consensus. Pursuing solution that will align vMR with C-CDA and QRDA

Pilots in Evaluation, 2 IGs adopted by HL7, RESTful IG still in SDO adoption process

Community-Led; 1st UC Complete; PAS SWG Complete; Created 'Care Plan' Glossary for HITPC & HL7; Use Case 2: Care Plan Exchange in progress; C-CDA updates for Aug/Sept HL7 Ballot in progress

S&I Framework Pilots

• S&I Pilots website indicates geographically where all pilots are located

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S&I Initiatives Update

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Initiative (chronological)

Transitions of Care

Laboratory Results Interface

Query Health

Data Segmentation for Privacy

Public Health Reporting (Community-Led)

Longitudinal Coordination of Care

Lab Orders Interface

Health eDecisions

Blue Button + (formally ABBI)

Structured Data Capture

Status Key:ActiveMaintenance

Transitions of Care

Current Status:• The Companion Guide Project Scope Statement was approved for a

September Informative Ballot within HL7 Structured Documents WGo Currently working on ensuring all the necessary materials are ready for

submission in July• Coordinating ongoing S&I-related C-CDA Project Scope Statements and

other potential C-CDA updates

Next Steps: • Monitoring the Structured Documents WG and list serv for ToC/MU2/C-CDA

Companion Guide PSS activities and general C-CDA activities

Transitions of Care (ToC)

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Maintenance

IC: John Feikema

LRI

Current Status:• LRI Pilots were completed and Validation Suite Tool was released for 2014

CEHRT• HL7 OO WG has addressed the outstanding open issues not covered in the

first errata for the LRI IG and included those in the recently published second erratao Any additional issues will be included in a possible third erratao Normative version of IG will occur in 2014

Next Steps: • HL7 OO WG to determine if a third errata will be necessary

Laboratory Results Interface (LRI)

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Maintenance

IC: John Feikema

Query Health

Current Status:• High-level pilots feedback was received in

previous weeks and additional technical feedback on HQMF/QRDA will be received in a follow-up meeting with the pilot implementation team (awaiting completion of HQMF implementation at MDPHnet)o AppNET is in the planning stageo Allscripts and HealthShare Montana

indicated interest, but there has not been any movement on either in several months

• HQMF task force continues to work on outstanding issues. A timeline was established for reaching a “publishable” version of the standard no later than 6/29

• Discussing and brainstorming next steps with various stakeholders for future Query work including Query Basics and Targeted Query

Query Health (QH)

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Active

IC: John FeikemaNext Steps: • Meeting upcoming between Doug

Fridsma and Joyce Sensmeier the week of 6/17 to discuss IHE involvement and engagement for QH

• Gather and summarize detailed technical & standards based pilot feedback from all sites

• Monitor HQMF HL7 activity• Outline timeline, scope, and approach

for Query Basics and Targeted Query work streams

Data Segmentation for Privacy

Current Status:• The initiative has transitioned into a community-led effort with the Pilots and SDO

balloting as main focus. • The pilots will continue their efforts and meet as needed to discuss with the community. • The Direct and Exchange IGs have been adopted by HL7 and are being refined for

September ballot. The RESTful IG is still in development and is in consideration for a joint IHE/HL7 balloting process.

Next Steps:• Will host multi-pilot interoperability demo on next DS4P All Hands Call (June 26)• Data Segmentation for Privacy (DS4P) Joint Project Work (HL7-CBCC/Security)

Workgroup• HL7 workgroup for refining the DS4P IGs meets on Tuesdays at 4pm EST

Data Segmentation for Privacy

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Maintenance

IC: Jeanne Burton (formerly Johnathan Coleman)ONC Sponsors: Joy Pritts & Melissa Spring (formerly Scott Weinstein)

Public Health Reporting

Current Status:• Completed Public Health Reporting Reference Implementation Framework:

o Reference document on interoperability standards for the following public health program (domains): Adverse Events; Cancer; Communicable Disease Case Reporting; Early Hearing Detection and Intervention (EHDI); Healthcare Associated Infections (HAI); Immunization; and Vital Records

• Completed PHRI CDA Guide: Specifies CDA structure for public health report for communicable diseases and adverse events

• Testing and Pilots Demonstration Attestation in progress

Next Steps:• Continue planning for PHRI Phase 2 which includes cross-participation in SDC

initiative• Exploring collaboration with San Diego and North Carolina Beacon communities for

Testing/Pilots

Public Health Reporting (PHR)

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Active

IC: Walter Suarez (Community-led)

Longitudinal Coordination of Care

Current Status:• Developing the Interoperable Care Plan Exchange Use Case • Revising the C-CDA to support Transitions of Care and Care Plan Exchange for the HL7

Fall Ballot cycle• Aligning Care Plan exchange efforts with various HL7 WGs (Patient Care WG, SOA

Care Coordination Services) • Coordinating Care Plan standard development activities with other SDO and Federal

Care Plan activities (HL7 Patient Care WG, IHE Patient Care Coordination Technical Committee, AHIMA LTPAC HIT Collaborative, CMS esMD)

Next Steps:• Identify and manage Pilots for the transitions of care and care plan implementation

guides • Participate in the LTPAC HIT Summit (mid-June)• Develop and submit recommendations to HL7 WGs for Care Plan exchange

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Active

Longitudinal Coordination of Care (LCC)

IC: Evelyn GallegoONC Sponsor: John Feikema

Laboratory Orders Interface

Current Status:• LOI IG completed DSTU ballot comment reconciliation for all 400 comments and will

be pursuing out-of-cycle ballot on June 19th o Note – eDOS IG and LOI IG will be balloted at the same time in June

• LOI Vocabulary WG finalizing Ask at Order (AOE) document to include in eDOS IG• Pilots progress – LOI Tool for testing is almost complete and will be referenced by

upcoming pilots

Next Steps• Prepare LOI IG to be submitted for second ballot by June 19th along with the initial

ballot for eDOS IG

Laboratory Orders Interface (LOI)Active

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IC: John Feikema

Health eDecisions

Current Status:• Currently we support 3 work streams

• Work stream 1: HL7 ballot for UC 1• Updating the IG based on the work of Pilots

• Work stream 2: Pilot • NewMentor and Allscripts completed the NQF 68 Million Hearts Rule• CDC and Allscripts – completed the San Diego Pertussis rule • Wolters Kluwer and VA – completed the Urinary Tract Documentation template• Zynx Health and DesignClinicals are in the final wrap up stage of the Heart Failure order set

• Work stream 3: Use Case 2• Submitted Project Scope Statement to HL7 for September meeting• Finalized Harmonization activities:

• We will 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.

• Pursue both SOAP and REST for the updated DSS IG for September 2013Next Steps:• Continue to prepare UC 2 IG for HL7 ballot in September• Work to finalize the IG for UC 1• Finish the last remaining pilot for UC1 and incorporate feedback from pilots into UC1 IG

Health eDecisions

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Active

IC: Ken KawamotoONC Sponsors: Alicia Morton & Jacob Reider

Blue Button Plus Initiative

Current Status:• The BlueButton Website (http://bluebuttonplus.org) launched in March and includes Push

Implementation Guidance, Privacy & Security Guidance, and Clinical Content Guidance. • Draft Pull Guidance is available on the Pull API Documentation site (http://blue-

button.github.io/blue-button-plus-pull/). • Blue Button+ successfully demonstrated sending patient health information via Direct to

multiple providers and provider partners during HIMSS 2013. • Energized by this success, workgroups are now focused on data holder adoption (for

vendors, providers and payers).

Next Steps:• Document high-level tasks and work plan for standing up a Pull Reference Implementation;

share with community. • Prepare for new Presidential Fellows and Initiative Coordinator transition in mid-June.• Announce All Hands Meeting in late June to communicate the plan for moving forward with

the BlueButton+ initiative.

Blue Button Plus Initiative

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Active

IC: Pierce Graham-Jones

Structured Data Capture

Current Status: • Evaluation of identified Candidate Standards against

HITSC criteria is close to completeo May need to include additional standards that were

recently identified by WG members• Technical work streams kickoffs :

o Forms SWG kickoff was kicked off in June 5 - Led by AHRQ, NLM

Working on define Common Data Element (CDE) Structure guidance

Working on define Form/Template including form structure, layout, and attributes

o Standards SWG kickoff planned for July 11 - Led by S&I Support team

Focus - EHR Interaction with form/template guidance

Focus - Auto-population of form/template guidance

Structured Data Capture (SDC)

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Active

IC: Evelyn GallegoONC Sponsor: Farrah Darbouze

Next Steps:

• Continue Forms SWG activities & Launch Standards SWG (Technical Work stream)

• Finalize Standards Evaluation and continue with Technical feasibility of each Standard by mapping against identified Use Case requirements for further evaluation

• Update SDC Project Plan based on NLM/AHRQ updates to Forms SWG planning artifacts.

• Launch Pilot Engagement activities (June 13, 2013)

Questions/Discussion

ONC website:www.healthit.gov/

S&I Framework Wiki:http://wiki.siframework.org/

Questions/Discussion

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