Standards Analysis Summary

• vMR– Pros

• Designed for computability• Compact Wire Format• Aligned with HeD Efforts

– Cons• Limited Vendor Adoption thus far• Represents an additional required format for EHRs

Standards Analysis Summary (cont.)

• CDA (C-CDA & QRDA)– Pros

• Well specified for various use cases• Established Vendor Basis• Aligned with MU

– Cons• Difficult for computability• Expensive wire format

Standards Analysis Conclusion

• Conclusion– Not likely to be able to recommend a single format– Should provide a solution that allows flexibility in

payload formats, but still enables interoperability

Proposed IG Outline

• DSS Profile for CDS Request• DSS Profile for CDS Response• Container Profile for CDS Request• Container Profile for CDS Response • Payload Format Guidance

– Data Requirements– Interaction Types

• Modular Transport Options

DSS Profile

• DSS Profile for CDS Request• DSS Profile for CDS Response

For each, either a single, general profile or one profiled for each functional interaction type, if necessary

Container Profile

• CDSInput– vMR Container– Extended w/ additional context as specified in UC2– Extended to allow multiple payload formats

• CDSOutput– vMR Container– Extended to allow multiple payload formats

For each, either a single, general profile or one profiled for each functional interaction type, if necessary

Payload Formats

• This section would describe supported payload formats (vMR, CDA, QRDA)

• For each format, describe generally how each type of clinical concept would map into the target format– This effort would leverage the Value Sets &

Terminologies work, basically defining how to express each clinical concept in the terminology space in each format

Data Requirements

• Mapping between clinical concepts, data requirements, payload standards, and vocabulary/terminology bindings for all 225 data requirements specified in Use Case 2

• This section would describe the formal mechanism for expressing data requirements for a particular exchange

• Each exchange would be represented by a set of data requirements, where each data requirement includes:– Clinical Concept (Encounter, Problem, Procedure, etc.)– Value Set (A specific value set identifying codes)– Date Range (A date range, relative to the time of the request)– Number needed (e.g., collect X of most recent in timeframe)

Interaction Types

• A section for each functional interaction type, where each section includes:– Data Requirements, using the formal specification

described above– Mapping for each of those requirements into a

specific format for this functional interaction type.• This would involve selection of a specific C-CDA document

type, QRDA CDA template, or vMR template, as well as potentially further constraints on those specifications as appropriate

Interaction Types (cont.)

• Proposal is to select the most broadly applicable functional interaction types, along with the most appropriate payload format for each type to use as examples, for example:– Disease Management – C-CDA, History & Physical– Quality Measurement – QRDA, specific template– Immunization – vMR, specific template

Transport Format

• Recommend DSS Release 1– SOAP vs REST can be addressed as an additional

profile for DSS• This effort may be part of DSS Release 2, or may be part of

the HeD UC2 IG

CDS Request Options for Functional Interaction Types

Request Service: DSS Request ElementRequest Items Organizer/Container: vMR

Request Item Payload: vMR Clinical Statement

Request Service: DSS Request ElementRequest Items Organizer/Container: vMR

Request Item Payload: QRDA

Request Service: DSS Request ElementRequest Items Organizer/Container: vMR

Request Item Payload: CCDA

Functional Interaction Type C: CCDA

Functional Interaction Type B: QRDA

Functional Interaction Type A: vMR

13

Determine Functional

Interaction Type

Determine Data Elements for Functional

Interaction Type

Select Standard(vMR,CCDA,

QRDA)

Include Mapped Data Elements into Selected

Standard

Begin

What is selected Standard

?

Select template(s) by leveraging mapped data

elements

Update/Constrain template

CCDA,QRDA

Document as Implementation

Guide

Create vMR data profile by leveraging

mapped data elements

Select template(s) by leveraging mapped data

elements

vMR

Overview of Process to Develop Specific Functional Interaction Type Guidance