Technical Committee & Tiger Team Orientationsujansky.com/docs/lab/HITSP_TechCommittee_Process.pdf · 2009-10-06 · HITSP: Enabling interoperability across the health care enterprise

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Technical Committee & Tiger Team Orientation August 25, 2009

Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS Vice President, Informatics, HIMSS

HITSP Standards Implementation Technical Manager

1HITSP: Enabling interoperability across the health care enterprise

The Panel’s Purpose

To harmonize and integrate diverse standards that will meet clinical and business needs for sharing information among organizations and systems.

Harmonized standards promote interoperability, enhance healthcare quality and contain costs

Establish HITSP Interoperability Specifications and promote their acceptance;

Support the deployment and implementation of HITSP Interoperability Specifications across the health care enterprise;

Facilitate the efforts of standards developing organizations to maintain, revise or develop new standards as required to support the HITSP Interoperability Specifications.


HITSP members agreed that a standard is a well-defined approach that supports a business process and . . .

– has been agreed upon by a group of experts;

– has been publicly vetted;

– provides rules, guidelines, or characteristics;

– helps to ensure that materials, products, processes and services are fit for their intended purpose;

– is available in an accessible format;

– is subject to an ongoing review and revision process.

Standards Harmonization is required when a proliferation of standards prevents progress rather than enabling it.

HIT Standardization


www.hitsp.org

HITSP Standards Harmonization

1. Identify a pool of standards for a general focus area

2. Identify gaps and overlaps for specific context

3. Make recommendations for resolution of gaps and overlaps

4. Develop Interoperability Specifications for using the selected standard(s) for a specific context

5. Test the instruction for using the standard

Open

Inclusive

Collaborative

Use Case/Request

driven


Standards Readiness Criteria Tier I

The candidate standards required to support each Use Case/Request are organized within an agreed upon standards taxonomy

The candidate standards are examined using ‘HITSP approved’Harmonization Readiness Criteria


Standards Readiness Criteria Tier II

Suitability The standard is named at a proper level of specificity and meets technical and business criteria of use case

Compatibility The standard shares common context, information exchange structures, content or data elements, security and processes with other HITSP harmonized standards or adopted frameworks as appropriate

Preferred Standards Characteristic Approved standards, widely used, readily available, technology neutral, supporting uniformity, demonstrating flexibility and international usage are preferred

Standards Development Organization and Process Meet selected criteria including balance, transparency, developer due process, stewardship and others

Total Costs and Ease of Implementation Deferred to future work


Standards Harmonization GoalsTo achieve interoperability, harmonization must be achieved in 5 areas:

Context/Information Model – establishing a common reference information model to support clinical, public health, financial, and administrative healthcare functions

Terminology/Content Definition – establishing common reference terminology models and data content specifications that are integrated with the information model

Privacy and Security – establishing a common security framework

Methodology – establishing a common methodology/process that all standards organizations and code set maintainers will follow to achieve standards harmonization

Information Exchange – establishing a common information interchange format and standards-based application roles and interactions in a comprehensive dynamic model


HHS Secretary Kathleen Sebelius

Project Management TeamExecutive in Charge, F. Schrotter, ANSI

Program Manager, L. Jones GSIDeputy PM, J. Corley, ATI

Project Manager, A. Peterson, Booz Allen

Project Management TeamExecutive in Charge, F. Schrotter, ANSI

Program Manager, L. Jones GSIDeputy PM, J. Corley, ATI

Project Manager, A. Peterson, Booz Allen

Standards Implementation

Technical Manager Joyce Sensmeier,

RN, HIMSS

Standards Implementation

Technical ManagerJoyce Sensmeier,

RN, HIMSS

Process Definition Technical Manager

Michelle Deane, ANSI

Process Definition Technical Manager

Michelle Deane, ANSI

HHS ONCHIT1PO, Carol Bean, PhD

HHS ONCHIT1PO, Carol Bean, PhD

John Halamka, MD HITSP Chair

Panel, Committees, and Tiger Teams

Team HHS ONC National HIT Coordinator, David

Blumenthal, MD

HHS ONC National HIT Coordinator, David

Blumenthal, MD


Patients

Consumers

Employers

General Practitioners

Review Boards

Practice Guidelines

Residential Care Providers

Specialists

Payers

Suppliers

Hospitals

Outpatient Healthcare Providers

Government Agencies

HITSP and Its Stakeholders - Harmonizing and Integrating Standards To Meet Clinical and Business Needs

HITSP - volunteer-driven, consensus-based organization funded by the Department of Health and Human Services.


Industry & Government Stakeholder Participation in HITSP

HITSP stakeholders are Subject Matter Experts that represent broad Healthcare stakeholders and the IT community

Panel Members – Board of Directors – Technical Committee Stakeholders

Year Number of Stakeholder Hours

Number of Stakeholders

2007 12,000 387

2008 19,000 520

2009 – to date 20,216 809


HITSP Organization, Responsibility Sharing, and Interfacing

Coo

rdin

atio

n C

omm

ittee

sBoar

d

Tech

nica

lMan

agem

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Proj

ect M

anag

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t

Prog

ram

Man

agem

ent

ON

C

AH

IC

CC

HIT

SD

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Indu

stry

/ G

over

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t

Tech

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Tactical

Strategic

Participating Stakeholders Staff External Stakeholder

NHIN and CCHIT Joint Working Group


In 2007 Three Technical Committees were formed to focus on the initial set of AHIC breakthrough areas

Care DeliveryConsumer

Empowerment Population Health

Technical Committees

• EHR – Lab Reporting

• Emergency Responder

– EHR

• Medication Management

• Consumer Empowerment

• Consumer Access to

Clinical Information

• Biosurveillance

• Quality

http://publicaa.ansi.org/sites/apdl/Documents/Standards Activities/Healthcare Informatics Technology Standards Panel/Technical Committees/AHIC Harmonized Use Cases/Harmonized EHR - Lab Use Case Version 1.0.pdf

http://publicaa.ansi.org/sites/apdl/Documents/Standards Activities/Healthcare Informatics Technology Standards Panel/Technical Committees/Emergency Responder-Electronic Health Record Use Case/2006 12 20 - Emergency EHR Detailed Use Case - Final.pdf

http://publicaa.ansi.org/sites/apdl/Documents/Standards Activities/Healthcare Informatics Technology Standards Panel/Technical Committees/AHIC Harmonized Use Cases/2007 06 18 Medication Management Detailed Use Case - vFinal.pdf

http://publicaa.ansi.org/sites/apdl/Documents/Standards Activities/Healthcare Informatics Technology Standards Panel/Technical Committees/AHIC Harmonized Use Cases/Harmonized Consumer Empowerment - Registration and Medication Use Case Version 1.0.pdf

http://publicaa.ansi.org/sites/apdl/Documents/Standards Activities/Healthcare Informatics Technology Standards Panel/Technical Committees/AHIC Harmonized Use Cases/2007 06 18 CACI Detailed Use Case vFinal.pdf

http://publicaa.ansi.org/sites/apdl/Documents/Standards Activities/Healthcare Informatics Technology Standards Panel/Technical Committees/AHIC Harmonized Use Cases/2007 06 18 CACI Detailed Use Case vFinal.pdf

http://publicaa.ansi.org/sites/apdl/Documents/Standards Activities/Healthcare Informatics Technology Standards Panel/Technical Committees/AHIC Harmonized Use Cases/Harmonized Biosurveillance - Visit Utilization Lab Use Case Version 1.0.pdf

http://publicaa.ansi.org/sites/apdl/Documents/Standards Activities/Healthcare Informatics Technology Standards Panel/Technical Committees/AHIC Harmonized Use Cases/2007 06 18 Quality Detailed Use Case - vFinal.pdf


2008 Technical Committee New Work & Resource Restructuring Plan


Provider Perspective and Domain Technical Committees Collaborate on Standards Harmonization

Provider Perspective

Population Perspective

Consumer Perspective

Care Management and Health Records Domain Committee

Security, Privacy and Infrastructure Domain Committee

Administrative and Financial Domain Committee

14HITSP: Enabling interoperability across the health care enterprise 14

HITSP Priorities and Use Case Roadmap


Extensions/Gaps/Use Cases 2009

General Lab Orders

Order Sets

Long Term Care – Assessment

Provider Consumer Population

Admin/Finance

Care Management/ Health Records

Scheduling

Prior-Authorization in Support of

Treatment, Payment, & Operations

Common Device Connectivity

Medical Home: Co- morbidity and

Registries

Medication Gaps

Clinical Note Details

Newborn Screening

Maternal & Child Health

Consumer Adverse Event Reporting

Quality Measures

Clinical Research

Consumer Preferences

Common Data Transport

SPI


Provider PerspectiveIS 01 - Electronic Health Record (EHR) Laboratory Results Reporting

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

IS 08 - Personalized Healthcare

IS 09 - Consultations and Transfers of Care

Population PerspectiveIS 02 - Biosurveillance

IS 06 - Quality

IS 10 - Immunizations and Response Management

IS 11 - Public Health Case Reporting

Consumer Perspective• IS 03 ‐

Consumer Empowerment• IS 05 ‐

Consumer Empowerment and Access to Clinical Information via Media• IS 07 ‐

Medication Management• IS 12 ‐

Patient –

Provider Secure Messaging• IS 77 ‐

Remote Monitoring


President Barack Obama announces an audacious plan: Computerize all health records within five years.

- January 12, 2009

2009 – Obama vows to continue the HIT Plan begun by President Bush

February 17, 2009 – the American Reinvestment and Recovery Act (ARRA) is signed into law

– HITECH Act component of ARRA provides a $19 billion program to stimulate the adoption and use of HIT, with a focus on meaningful use of certified EHR systems

http://www.daylife.com/photo/03ub1GZa3R1le?q=Barack+Obama


The VisionIn order to meet the ARRA statutory requirements, in April, 2009 HITSP focused its volunteers, staff, and leadership on supporting this effort

HITSP's “recognized” and “accepted” products to date were leveraged to create new streamlined electronically published standards guides organized around the ARRA EHR interoperability requirements instead of Use Cases

End result: much more compact, easy to implement, and flexible implementation guidance that supports meaningful use of EHRs and protection of privacy


Starting Point – ARRA Requirements and Tiger Teams


1

Perspective and Domain Technical Committees Collaborate on Interoperability Specification Development

Provider Perspective

Population Perspective

Consumer Perspective

Care Management and Health Records Domain Committee

Security, Privacy and Infrastructure Domain Committee

Administrative and Financial Domain Committee

2009 Technical Committee Structure

2009 Tiger TeamsData Architecture Quality Measures

Consumer Preferences

Clinical Research


Technical Committee & Tiger Team LeadershipPopulation Perspective TC-Floyd P. Eisenberg, MD, MPH, National Quality Forum

-Eileen Koski, M. Phil, Medco Health Solutions, Inc

-Anna Orlova, PhD, Public Health Data Standards Consortium

Quality Measures Tiger Team-Floyd P. Eisenberg, MD, MPH, National Quality Forum

-Eileen Koski, M. Phil, Medco Health Solutions, Inc

Clinical Research Tiger Team -Walter Suarez MD, Kaiser Permanente


Technical Committee & Tiger Team LeadershipConsumer Perspective TC

-Mureen Allen, MD, FACP, Active Health Management

-Charles Parisot, EHR Association

-Scott Robertson, PharmD, Kaiser Permanente

Provider Perspective TC

-Allen Hobbs, PhD, Kaiser Permanente

-Mike Lincoln, MD, Veterans Health Administration, US Dept of Veterans Affairs

-Steve Hufnagel, PhD, DoD


Technical Committee & Tiger Team LeadershipSecurity, Privacy & Infrastructure Domain TC– Glen Marshall, Grok-A-Lot, LLC

– John Moehrke, GE Healthcare

– Walter Suarez, MD, Kaiser Permanente

Administrative and Financial Domain TC– Donald Bechtel, Siemens Medical Solutions

– Manick Rajendran, eZe Care LLC

– Durwin Day, Health Care Service Corporation


Technical Committee & Tiger Team LeadershipCare Management and Health Record Domain TC– Keith Boone, GE Healthcare

– Corey Spears, McKesson

– Greg Alexander, PhD, RN, Alliance for Nursing Informatics

Data Architecture Tiger Team- Keith Boone, GE Healthcare

- Don Bechtel, Siemens Medical Solutions

Consumer Preferences Tiger Team-Scott Robertson, Pharm D, Kaiser Permanente

- Walter Suarez, MD, Kaiser Permanente


Key HITSP DefinitionsHarmonization Request defines business or functional needs, within a workflow, and sets context and conditions for the interoperability specification. Behavioral specifications of functional needs or capabilities may be structured as use cases, scenarios, Business Process Models or other forms.

Stakeholder is a person or organization that uses or benefits from systems that interoperate.

System (previously known as Business Actor) is an IT system application that plays a role in one or more information exchanges addressed by a HITSP Interoperability Specification or Construct.

Capability describes a business process and specifies interoperable information exchanges using HITSP constructs. A Capability supports stakeholder requirements and business processes and includes workflow, information content, infrastructure, security and privacy.

Service Collaboration is a composition of constructs into a reusable workflow


HITSP Program Management

Steps in the HITSP Harmonization Process

Receive Request to Harmonize

I

Conduct Requirements Analysis

II

Identify Candidate Standards

III

Identify and Resolve Gaps, Duplications and Overlap

IV

Select Standards

V

Develop Interoperability Specification

VI

Begin Inspection Testing

VII

Release and Disseminate Interoperability Specification

VIII

Begin Support

IX

A new concept - HITSP CapabilityProvides the ability for two or more systems to address a business need for interoperable information exchange. The objective is to provide the bridge between the business, policy and implementation disciplines by:– Defining a set of information exchanges at a level relevant

to policy and business decisions – Supporting stakeholder requirements and business

processes by including information content, infrastructure, Security, Privacy

– Specifying the use of HITSP constructs sufficiently for implementation.

– Including constraints and operating on specific network topologies (contexts)

Capabilities have topology and other options (e.g., point-to-point, portable media, system-to-HIE, HIE-to-HIE).


HITSP Capabilities – Clinical Operations

Communicate Ambulatory and Long Term Care Prescription - CAP117

Communicate Hospital Prescription - CAP118

Communicate Clinical Referral Request - CAP121

Retrieve Genomic Decision Support - CAP125Communicate Lab Results Message - CAP126

Communicate Lab Results Document - CAP127

Communicate Imaging Information - CAP128

Retrieve and Populate Form - CAP135

Communicate Encounter Information Message - CAP137


HITSP Capabilities – Public Health and Emergency Response; Administrative and Financial

Communicate Benefits and Eligibility - CAP140Communicate Referral Authorization - CAP141

Communicate Quality Measure Data - CAP129Communicate Quality Measure Specification - CAP130

Update Immunization Registry - CAP131Retrieve Immunization Registry Information - CAP132Communicate Immunization Summary - CAP133Communicate Emergency Alert - CAP136Communicate Resource Utilization - CAP139


HITSP Capabilities - Security, Privacy, and Infrastructure

Communicate Structured Document - CAP119Communicate Unstructured Document - CAP120Retrieve Medical Knowledge - CAP122Retrieve Existing Data - CAP123Establish Secure Web Access - CAP124Retrieve Pseudonym - CAP138Retrieve Communications Recipient - CAP142Manage Consumer Preference and Consents - CAP143


Some Details on Capabilities

Capabilities are specified using HITSP Constructs.

As part of the HITSP Tiger Team effort addressing ARRA, Capabilities are meant to clearly state what types of data can and cannot be “exchanged” using HITSP constructs

Note that during the ARRA Tiger Team effort, no new standards were selected, and no new constructs were specified to build capabilities. This restriction is not imposed on new work efforts

Requirements

Capability

SystemRoles

HITSPConstructs

Orchestration of HITSPConstructs and System Roles


What is an example of a capability?

Requirement: An organization wants to exchange a prescription with an ambulatory organization. The diagram on the right shows how Capability 117 was assembled to support this requirement.

CAP117 – CommunicateAmbulatory and Long Term CarePrescription

System Roles• Medication Order

Prescriber• Medication Order Filler• Health Plan• Health Information

Exchange (HIE)

I want to exchange a prescription with an Ambulatory or Long-Term Care (LTC) Organization


CapabilityCapability

Any IS can be assembled using capabilities

Requirements

EHR-CentricIS

Supports

Based on

Capability

Existing HITSP Constructs

Organized by

New HITSP Interoperability Specifications

Service Collaborations


HITSP Framework – Refined

Business RequirementsIdentifies interoperability

business needs

Interoperability

Specification•

Identifies what HITSP

capabilities to use to

meet Business Needs•

Defines Requirements,

Context and Constraints

for those capabilities

Base Standard#1

Base Standard#n

Base Standard#2

Base Standard#...

CompositeStandard#1

CompositeStandard#...

CompositeStandard#m

SDOs

Component

Transaction

Transaction Package

Available for Internal reuse or repurposingComponent

TransactionConstructs

Transaction

Transaction

Package

HITSP ConstructsHITSP Capabilities

Component

ServiceCollaborations

ServiceCollaboration

TransactionConstructs

Transaction

Transaction

Package

34


Service Collaboration Suite SC # Service Collaboration (SC) Title # of

Service

InterfacesSCxx1 Access Control 1SCxx2 Knowledge and Vocabulary 4SCxx3 Patient Identity 8SCxx4 Query for Existing Data 2SCxx5 Security Audit 1SCxx6 Healthcare Document Management 12SCxx7 Emergency Message Distribution Element 1

35

Additional Keys To Simpler Definition and Implementation Of HITSP Specifications


Service Collaborations

Business Needs

Secure Infrastructure

Service Collaborations and Capabilities – Develop New Technical Constructs as Needed

Standards

HITSP Transactions,Transaction Packages,

Components

Raw material

Basic Building Blocks

Capabilities

Interoperability Spec

If New ConstructNeeded


1/20HITSP Panel

HITSP 2009 TC Timeline Overview Note: Quality Measures, Consumer Preferences, Clinical Research, Common Data Transport may deviate from the timeline below, as their timelines are further established they will be included as separate line items

Panel Approval

August 24, 2009

IRT Content, Editorial and Quality Review

Full TC Meetings

Holiday

Connectathon

4 Weeks

AUG SEPT OCT NOV DEC

11/3 – 11/5 TC F2F DC Area

8/25-8/27 TC F2F, Chicago9/8

HITSP Board

12/1 HITSP Board

12/15HITSP Panel

8/24 HITSP TCL, Chicago 11/2 HITSP TCL DC Area

Comment Draft IS Dev Insp Test/ CommentComment & Resolution

R&D (Requirements and Design) Development

2009 Work Items: Wave 1

WE ARE HERE

9/11

1 week 1 w

eek

(assum

ption is

F2F

Pub.)

JAN

3 week

s

(longer du

ration

due to

holida

ys)

6 Weeks 6.5 Weeks 1 Week

Pane

l Rev

iew9/18 10/16

10/30 11/612/4

12/23 1/13 1/20

1/11-1/15 Connectathon

2009 Work Items: Wave 2

1 week Comment Draft IS Dev

4 Weeks

9/11 10/9 10/16

15 Weeks

11/131/29

R&D (Requirements and Design) Development

Testing Support, Tooling Efforts, Foundations, NHIN Support, ARRA Gaps & Feedback from ONC

Short Term Items

Ongoing Efforts

August & SeptemberGeneralize/Conform SPI SCs/Capabilities, TC Plans for Transition, Gap Resolution

for Meaningful Use, Finalize Templates


Allyn Clemons, 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.

Learn more at www.hitsp.org or contact . . .

mailto:[email protected]



http://www.hitsp.org/


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