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

– If vendors do choose or have the ability to consume HeD artifacts this may not be a con and may actually make it easier to consume the HeD work

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– Long-term goal is to ensure that there is a single,

consistent model for patient information in a CDS exchange

– Important to move towards that goal as much as possible, while still enabling bridges to that approach using current technology

– Should provide a solution that allows flexibility, but still enables interoperability.

Solution Options Considered During HL7 CDS WG call (5/21) & Standards SWG Call (5/22)

• Option 1: Base implementation guidance on Functional Interaction Type– Guidance would be provided on individual functional interaction types the standard

selected would vary for each type– Feedback:

• Would only be able to develop guidance on a few functional interaction types• Too dependent on functional interaction types• Would be difficult for implementers to build solutions for any scenarios or functional interaction

types not included in the guidance

• Option 2: Provide mapping of HeD UC2 requirements to vMR, C-CDA and QRDA – High-level guidance would be included on how to translate mappings into

implementation profiles along with a few example implementation profiles based on functional interaction types

– Feedback: • Guidance would not be specific enough to be “implementation ready”• Allows for too much flexibility

Long-term Industry Need

Foundational Model

HeD UC2 Data Requirements

vMR

Future Standards?

QRDA

C-CDA

Solution Option Presented during 5/23 All Hands Call

Community Feedback from 5/23 All Hands Call: • Outside of HeD UC2 scope• Not feasible within HeD UC2 timeline

In order to support multiple payload standards while still promoting interoperability, a solution that leverages a foundational model (ex. FHIM) was proposed to the community:

HeD UC2 Final Proposed SolutionBased on feedback from all proposed solutions last week, the HeD Leadership Team is proposing the following solution:

• 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.– Solution will be to update the vMR model to align with the semantics of C-CDA and QRDA to the

extent possible and reasonable– vMR is a streamlined data model for CDS. This model is at a similar level of granularity to models

such as Green CDA

• Pursue both SOAP and REST for the updated DSS IG for September 2013– Based on pilots, a choice may be made between SOAP and REST

• We will utilize the Functional Interaction Types to guide the IG development– Use as building blocks of data that are coordinated to meet functional interaction types– Have a section in the IG having profiles that people vote on for different interaction types if we feel

confident. If we don’t feel confident, then they will strictly be examples– Leverage pilots from UC1 for functional interaction types. Can start with Immunization Forecasting

and Quality Measure Evaluation. See what feedback we get and if any other interaction types would be useful

Long-term Industry Need

HeD UC2 Scope Potential future or parallel work

Updated vMR

Model

HeD UC2 Data

Requirements

QRDA Semantics

C-CDA Semantics

HeD UC2 Final Proposed Solution

The revised solution approach still aligns with the long-term industry need, but has been limited to a more manageable and Use Case-appropriate scope:

Foundational Model

(e.g. FHIM)Future

Standards?

QRDAC-CDA

Harmonized vMR/QDM

Model

New Decision Support

Service (DSS) IG

DSS Profile for CDS Request with SOAP

DSS Profile for CDS Response with SOAP

DSS Profile for CDS Request with REST

DSS Profile for CDS Response with REST

vMR Container Profile for Response

vMR Container Profile for Request

vMR guidance for request payload

vMR guidance for response payload

Examples based on functional interaction type

Updated DSS Standard

Add in section detailing how DSS is intended to

work with REST for general use

Modify DSS to accommodate REST, as

necessary

Updated vMR DAM

Extend vMR with additional context as

specified in UC2

Extend vMR to be able to relay actions as specifed

in UC2

Modify vMR to align with QRDA & C-CDA semantics

Updated vMR XML IG

No changes?

Updated HeD UC1 IG

No changes?

IG and Standards Development Activities to support HeD UC2 Solution

Key Milestone Dates for September Ballot

Administrative Deadlines:• HL7 Notification of Intent to Ballot: July 7• HL7 Initial Content Deadline: July 14

– Need to determine whether a full draft of the IG can be ready and submitted through E2E review by July 14.

– Need to have discussion on possible options for completing IG and conducting E2E review

Content Deadlines:• HeD End-to-End Review Period: July 1-July 11• HeD Consensus Review Period: July 18-July 24• HL7 Final Content Deadline: August 4• HL7 Examples Deadline: August 19

With this timeline, we have less than 5 weeks to complete our IG in preparation for the review process, and 10 weeks total before ballot materials are due, including ballot materials for related ballots (e.g. update to vMR standard).

9

HeD UC2 Critical Harmonization Activities & Timeline Considerations:New Decision Support Service (DSS) IG

Task Owner & Resources

Duration Target Start Date

Target End Date

Dependencies

Update IG template to reflect necessary sections

Write Overview of Modular Transport Solution in IG

Develop DSS Profile for Request with SOAP

Develop DSS Profile for Response with SOAP

Develop DSS Profile for Request with REST Bryn DSS Update with REST guidance (see next slide)

Develop DSS Profile for Response with REST Bryn DSS Update with REST guidance (see next slide)

Group UC2 Data Elements by Request vs. Response and by Container vs. Payload

Develop vMR Container Profile for Request UC2 Data Element GroupingvMR Updates

Develop vMR Container Profile for Response UC2 Data Element GroupingvMR Updates

Develop vMR Request Payload Profile for specific functional profile interaction types

vMR Updates

Develop vMR Response Payload Profile for specific functional profile interaction types

vMR Updates

Map UC2 Payload Request & Response Data Elements to vMR model UC2 Data Element Grouping

HeD UC2 Critical Harmonization Activities & Timeline Considerations:Decision Support Service Standard Updates

Task Owner & Resources

Duration Target Start Date

Target End Date

Dependencies

Update DSS Standard with REST guidance, including modifications to the standard itself (as necessary) and guidance on use of REST for general use cases (not HeD UC2-specific)

Bryn

HeD UC2 Critical Harmonization Activities & Timeline Considerations:vMR Domain Analysis Model Updates

Task Owner & Resources

Duration Target Start Date

Target End Date

Dependencies

Map UC2 Payload Request & Response Data Elements to vMR model UC2 Data Element Grouping

Map vMR DAM to semantics , terminologies and templates used by QRDA, C-CDA

Extend vMR to include additional context as specified in UC2 for request

Extend vMR capability to support communication of “actions” in response

Update vMR with any required changes to semantics, terminologies and/or templates based on harmonization effort

vMR DAM mapping to QRDA, C-CDA

HeD UC2 Critical Harmonization Activities & Timeline Considerations:New Decision Support Service (DSS) IG

Task Owner & Resources

Duration Target Start Date

Target End Date

Dependencies

Introduction

Introduction: Purpose

Introduction: Approach

Introduction: Intended Audience

Introduction: Intended Audience – Requisite Knowledge

Introduction: Organization of this Guide

Introduction: Organization of this Guide – Conformance Verbs (Key Words)

Introduction: Organization of this Guide – Cardinality

Introduction: Organization of this Guide – Definition of Actors

Implementation Approach

Implementation Approach: Pre Conditions

Implementation Approach: Constraints

Suggested Enhancements

Appendices: Definition of Acronyms and Key Terms

Appendices: Conformance Statement List

Appendices: Templates List

Appendices: Specifications References