The Health eDecisions Initiative

Launch

June 6th, 2012

Agenda

• Opening Remarks - Jacob Reider, MD, Acting Chief Medical Officer, ONC

• The Standards & Interoperability Framework - Doug Fridsma, MD, PhDDirector, Office of Standards and Technology, ONC

• Initiative Introduction - Initiative Coordinator, Tonya Hongsermeier, MD, Principal Informatician for Clinical Informatics Research and Development, Partners Healthcare System

• Co-Coordinator, Bryn Rhodes, Software Architect – Veracity Solutions• Co-Coordinator, Aziz Boxwala, Principal Consultant – Meliorix, Inc.

• History of Health eDecisions• Problem: Inability to share/import CDS interventions• Accomplishments of CDS intervention sharing research to date• Health eDecisions Initiative

• Next Steps/Call for Participation• Questions • Resources

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Office of Standards and Technology(OST)

Promote compliance with validated information exchange standards, services and policies to assure interoperability between validated systems

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• Call for Participation: The overall success of the S&I Framework is dependent upon volunteer experts from the healthcare industry and we welcome any interested party to get involved in S&I Framework Initiatives, participate in discussions and provide comments and feedback by joining the Wiki: http://wiki.siframework.org

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• Specific health interoperability initiatives guide the design and development of a fully integrated and connected health information system

• An S&I Initiative focuses on a single challenge with a set of value-creating goals and outcomes, and the development of content, technical specifications and reusable tools and services

S&I Framework Overview

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ONC Programs & Grantees

Community S&I Framework

FACAs

SDOs

• State HIE Program & CoPs• SHARP Program• REC Program & CoPs• Beacon Program

• Technology Vendors• System Integrators• Government Agencies• Industry Associations• Other Experts

• HL7• IHE• CDISC• NCPDP• ASC X12• ASTM• WEDI

• HIT Standards Committee• HIT Policy Committee• Tiger Team

• ISO/TC 215• IHTSDO• NLM• NQF• Regenstrief• Other health IT

standards related organizations

S&I Framework Coordination

S&I Framework LifecycleOur Mission• Promote a sustainable ecosystem that drives increasing interoperability and standards adoption• Create a collaborative, coordinated, incremental standards process that is led by the industry in

solving real world problems• Leverage “government as a platform” – provide tools, coordination, and harmonization that will

support interested parties as they develop solutions to interoperability and standards adoption.

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Tools and ServicesTools and Services

Use Case Development

and Functional Requirements

Use Case Development

and Functional Requirements

Standards DevelopmentSupport

Standards DevelopmentSupport

Certificationand TestingCertificationand Testing

Harmonization ofCore Concepts

Harmonization ofCore Concepts

Implementation Specifications

Implementation Specifications

Pilot Demonstration Projects

Pilot Demonstration Projects

Reference Implementation

Reference Implementation

Architecture Refinement and ManagementArchitecture Refinement and Management

S&I Framework Phases

Phase Planned Activities Pre-Discovery Development of Initiative Synopsis

Development of Initiative Charter Definition of Goals & Initiative Outcomes

Discovery Creation/Validation of Use Cases, User Stories & Functional Requirements Identification of interoperability gaps, barriers, obstacles and costs Review of Vocabulary

Implementation Creation of aligned specification Documentation of relevant specifications and reference implementations such as

guides, design documents, etc. Validation of Vocabulary Development of testing tools and reference implementation tools

Pilot Validation of aligned specifications, testing tools, and reference implementation tools Revision of documentation and tools

Evaluation Measurement of initiative success against goals and outcomes Identification of best practices and lessons learned from pilots for wider scale

deployment Identification of hard and soft policy tools that could be considered for wider scale

deployments

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• Barriers exist to the adoption and implementation of Clinical Decision Support– despite research demonstrating effectiveness in improving quality and

safety• Lack of widely accepted, implementable standards

– for importing and/or sharing proven CDS interventions (reminders, order sets, documentation templates)

• ONC and AHRQ have invested– in multiple research projects such as GLIDES, CDSC, ACDS and eRecs

to advance CDS implementation, sharing and adoption• At the April 2012 Face 2 Face Meeting,

– stakeholders gathered from across the vendor, academic, and healthcare communities to discuss how to advance the shareability of CDS interventions and build on the research and existing standards to date

Health eDecisions - a brief history

Goal Scenarios for sharing CDS interventions

• At the April 2012 Face 2 Face Meeting two use cases were identified

1. Vendor or user downloads importable CDS interventions from an external source into their local EHR for deployment

2. An EHR is able to send patient data to a CDS service, receive CDS interventions recommendations back, and insert those interventions into the desired relevant workflow

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• Content suppliers and EHR/PHR vendors all have proprietary formats and methods for exchanging, implementing, life-cycle managing, and executing CDS interventions

• Each content supplier-EHR/PHR vendor integration for CDS exchange is unique

• No widely accepted/adopted standards for exchange or services insertion

• Even within a vendor, clients cannot always exchange content with each other

• Healthcare systems with successful implementation of CDS are unable to share their proven interventions with others in an importable format, even if they wished to

Current state of CDS sharing

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Relevant Standards and Outstanding Work Identified at the April 2012 Face to Face Meeting (starting point)Components Candidate Standard Outstanding work

1. Data Model for CDS intervention authoring Lingua franca for pt. data

Data, instance, conditions

Virtual Medical Record (vMR)

CDSC Patient Information Model (PIM)

Ensure that vMR contains all required data elements for CDS.

2. Knowledge Representation Lingua franca for CDS logic (Rules, interventions, actions) Standard transport format that references standard value sets

CDSC L3

CREF

CDSC L3 and CREF

ArdenML

Specify expressions within L3 using CREF for computable knowledge representation.

3. CDS Services Insertion Automated consumption

HL7 CDS Standards, including list of required services to support CDS as a service.

Specify additional service interfaces.

4. Patient Data Output by EHR/PHR/Workflow System to CDS Services Supplier

Consolidated CDA (MU 2)

For more details and information on the meeting above please see the Health eDecisions Reference Wiki Face 2 Face Meeting Minutes: http://wiki.siframework.org/Health+eDecisions+Reference+Materials

Sharing CDS interventions is nowthe Health eDecisions Initiative• With these scenarios and relevant standards in mind,

broader stakeholder involvement and contribution is needed

• The ONC has enlisted the help of the S&I Framework to create a forum for this work

• CDS has now become the Health eDecisions Initiative– The Health eDecisions Initiative will take advantage of the

collaborative tools, processes and community members within the S&I Framework to further our objectives

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• Initiative Coordinator:• Tonya Hongsermeier, MD, Principal Informatician for Clinical

Informatics Research and Development - Partners Healthcare System

• Co-Coordinators:• Bryn Rhodes, Software Architect –Veracity Solutions• Aziz Boxwala, Principal Consultant – Meliorix, Inc.

• ONC Sponsors:• Jacob Reider, MD, Acting Chief Medical Officer - ONC• Alicia A. Morton, DNP, RN-BC, CDS Lead - ONC

• Support Team– Jamie Parker and Jennifer Brush – Project Management– Heather Stevens and Emily Mitchell – Use Case Support– Apurva Dharia – S&I Administrative Support

Health eDecisions Initiative Team

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Health eDecisions Project Charter

Challenge

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‘‘The term ‘clinical decision support intervention’ align[s] with, and clearly allow[s] for, the variety of decision support mechanisms available that help improve clinical performance and outcomes. A CDS intervention is not simply an alert, notification, or explicit care suggestion. Rather, it should be more broadly interpreted as the user facing representation of evidence-based clinical guidance. Our goal in clarifying the nomenclature is to focus more on the representation of the guidance (the CDS intervention) that the EHR technology should offer to the user rather than prescribe the form of either the logical representation of the clinical guidance or how the intervention interacts with the user.” 45 C.F.R. §170.314(a)(8) (2012)

• Effective Clinical Decision Support requires availability of computable biomedical knowledge, person-specific data, and a reasoning or inference mechanism that combines these elements to generate and present helpful information to clinicians, patients or caregivers in the right way – and the right time.

• In order to recognize these benefits, CDS interventions must be made more easily shareable so that anyone can easily acquire and deploy CDS interventions.

• To this end, standards must be advanced to enable either the consumption of CDS via a web service or the import of CDS interventions into CDS systems

Health eDecisions Project Charter

Scope and Value Statements• Scope Statement:

• To define standards that facilitate the emergence of systems and services whereby CDS interventions can be shared or accessed by any healthcare stakeholder via an importable format or via a CDS web service

• Value Statement: • Health information technologies designed to improve clinical decision making are

particularly attractive for their ability to address the growing information overload clinicians face and to provide a platform for rapidly incorporating evidence based knowledge into care delivery.

• Standardized expressions of Clinical Decision Support have a number of important benefits including:

• Increased quality of care and enhanced health outcomes• Avoidance of errors and adverse events• Improved efficiency, cost benefit, and provider and patient satisfaction• Reduced latency from new clinical knowledge and evidence-based

guidelines to incorporation in clinical practice• Focusing the S&I Framework community on Clinical Decision Support through

the Health eDecisions Initiative will enable the translation of interventions into implementable components, increasing the speed and ease of adoption by the provider community

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Health eDecisions Project Charter

Outcomes

• Repositories from which interventions can be “selected” for use in an EHR – Each intervention will represent a standardized expression of the

clinical guideline that can be accessed by EHR system developers and users to simplify the process of incorporating clinical guidelines into EHRs

• Clinical Decision Support Services can interact with EHRs and/or other Health Information Technology implementations

• Alignment with other S&I Initiatives i.e. Query Health (HQMF)

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Health eDecisions Project Charter

Proposed Timeline• Phase I: Pre-Discovery (In

Progress)• Phase II: CDSIF development

(Early Summer through Fall 2012)• Use Case Development• Confirmation of Candidate

Standards• Pilots of the prototype CDSIF• SDO Prep

• Phase IIIa: SDO ballot preparation (Mid/Late Fall 2012)

• Phase IIIb: SDO balloting (Winter 2013)

• Comment review and reconciliation

• Phase IV: Conduct pilots (Winter - Spring 2013)

• Finalize pilots, final SDO recommendations (Late Spring - 2013)

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Health eDecisions Project Charter

Deliverables

• Use Case and Functional Requirements

• List of Relevant Standards

• Standards Support and Coordination Plan

• Implementation Guidance

• Pilot applications, plans and lessons learned

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• We will be meeting as a community every week on Thursdays• This will be a 90 minute meeting• Proposed Times:

• 11:00-12:30 EST• 11:30-1:00 EST• 12:00-1:30 EST• 12:30-2:00 EST

• All Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Use Case, Project Charter and General Health eDecisions information will be posted on the Health eDecisions Wiki page• http://wiki.siframework.org/Health+eDecisions+Homepage

Logistics

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Health eDecisions Wiki Home Page

20Health eDecisions Wiki Page

• Join us for our next Work Group Meeting June 14th, 2012• See the wiki page for the meeting updates

• http://wiki.siframework.org/Health+eDecisions+Homepage

• The ONC Health eDecisions Initiative is open for anyone to join

• This community will meet frequently by webinar and teleconference

• We use Wiki pages to facilitate discussion. Information on how to join the Community can be found on the Health eDecisions Sign Up Wiki:• http://wiki.siframework.org/Health+eDecisions+Sign+Up

• In order to ensure the success of our initiative and the subsequent pilot, we encourage broad and diverse participation from the community. • This is your chance to have an impact on the creation and implementation

of a pilot program in this important area of health IT development

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Next Steps…

• Please comment on the Proposed Project Charter• Review the Project Charter:

http://wiki.siframework.org/Health+eDecisions+Project+Charter• Complete the Health eDecisions Project Charter Comment Form:

• Join us for our next meeting June 14th, 2012• The time and meeting information will be available on the Health

eDecisions Wiki page: http://wiki.siframework.org/Health+eDecisions+Homepage

• Details on the Health eDecisions launch including web meeting access and call in information are posted on the wiki: • http://wiki.siframework.org/Health+eDecisions+Homepage

Next Steps cont.…

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Questions and Open Discussion

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Resources