PCAST Report Workgroup 01-14-11

HIT Policy CommitteeHIT Policy CommitteePCAST Report WorkgroupPCAST Report Workgroup

Friday, January 14, 2011

2:00pm ET

Paul Egerman, Chair

William Stead, Vice Chair

Call to OrderCall to Order

1. Call to Order/Roll Call– Judy Sparrow, Office of the National Coordinator for Health Information

Technology

2. Overview of the Agenda – Paul Egerman, Chair

– Bill Stead, Vice Chair

3. Discussion: PCAST Report– Bill Press, Vice Chair, PCAST

4. Use Case Examples & Comparison– Paul Egerman & Bill Stead

5. Public Comment

6. Adjourn

Agenda

Workgroup Members

Members:• Dixie Baker SAIC• Hunt Blair Vermont HIE• Tim Elwell Misys Open Source• Carl A. Gunter University of Illinois• John Halamka Beth Israel Deaconess Medical Center, HMS• Leslie Harris Center for Democracy & Technology• Stan Huff Intermountain• Robert Kahn [invited]• Gary Marchionini University of North Carolina• Stephen Ondra Office of Science & Technology Policy• Jonathan Perlin Hospital Corporation of America• Richard Platt Harvard Medical School• Wes Rishel Gartner• Marc Rothstein• Steve Stack American Medical Association• Eileen Twiggs Planned Parenthood

Chair: Paul Egerman, Chair

Co-Chair: William Stead, Vice Chair, Vanderbilt University

Workgroup Charge

The PCAST Report Workgroup is charged to :

• Assist ONC synthesize and analyze the public comments and input to the PCAST report;

• Discuss the implications of the report and it’s specific recommendations to ONC on current ONC strategies;

• Assess the feasibility and impact of the PCAST report on ONC programs;

• Elaborate on how these recommendations could be integrated into the ONC strategic framework.

Meeting Dates

•January 7, 4:30 to 5:30 pm/ET

•Jan 14, 2 to 4 pm/ET

•Jan 27, 11 to 2 pm/ET

•Feb 10, 12 to 2 pm/ET

•Feb 15 – 16 – 17, one of these dates (or perhaps 1.5 days) for an in-person

meeting in Washington -TBD

•Mar 3, 1 to 4 pm/ET

•Mar 17, 10 to 1 pm/ET

Meeting Dates

Use Case to Illustrate Stage 1 MU Patient Summary

Use Case #1:

Patient presents to the emergency department complaining of severe chest pains that were suffered while patient was working on a home improvement project. In this use case, using Stage 1 of MU, the ED clinician retrieves a CCD patient summary, which contains important information that is needed to treat the patient. An active medications list is necessary, along with a problem list. Indeed, the sample data shows an existing cardiac problem that could be relevant.

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Sample Patient Summary - Text Form

Problems1. AV Nodal Reentry Tachycardia (Active)

2. Glaucoma (Active)

3. Vegan (Active)

4. Lyme Disease (Resolved)

5. Corneal Abrasion (Resolved)

Medications1. Centrum Silver 1 PO qd

2. Vitamin D3 1600 units PO qDay

3. Xalatan 1 drop each eye qhs

Vital SignsBP: 115/70Pulse: 50Respiratory Rate: 14Height: 73 inchesWeight: 170 poundsBody Mass Index: 22.4

ImmunizationsHepatitis A vaccine: #1 Sep 03, 2004

Hepatitis A vaccine: #2 Mar 01, 2005

Tetanus vaccine: Jun 20, 2008

Pneumovax: Sep 03, 2009

Influenza: Oct 19, 2010

Allergies1. Penicillin (Rash)

LabsCholesterol: 135Triglyceride: 59HDL: 40

Procedures1. RFID Chip Implant in right triceps

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Patient Summary in XML

<?xml version="1.0" encoding="UTF-8"?>

<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">

<realmCode code="US"/>

<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>

<templateId root="2.16.840.1.113883.10.20.1"/>

<templateId root="2.16.840.1.113883.3.88.11.32.1"/>

<templateId root="2.16.840.1.113883.10.20.3"/>

<templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>

<id root="809680b0-1e0d-11e0-ac64-0800200c9a66"/>

<code code="34133-9" codeSystem="2.16.840.1.113883.6.1" displayName="Summarization of episode note"/>

<title>Continuity of Care Document</title>

<effectiveTime value="20110111000000-0500"/>

<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>

<languageCode code="en-US"/>

<recordTarget>

<patientRole>

<id extension="996-756-495" root="2.16.840.1.113883.19.5"/>

<addr>

<streetAddressLine>5739 Hazel Street</streetAddressLine>

<city>Williamsport</city>

<state>PA</state>

<postalCode>17701</postalCode>

<country>USA</country>

</addr>

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Use Case to Compare Stage 1 of MU with PCAST Report

Use Case #2:

Patient presents to the ED after suffering a minor laceration that occurred during a home improvement project in a bathroom. Only simple first aid is needed. Because of the circumstances of the injury, the ED nurse would like to check the status of the patient's tetanus immunization.

MU Stage 1 Transaction: Entire patient summary document is requested. As the sample data set shows, the patient summary would contain the immunization status, but it would also contain other information that is not needed.

PCAST Approach: The nurse could request the Tetanus immunization status only.

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CCD – Summary of Patient’s Immunization Record (code)

<component>

<section><templateId root="2.16.840.1.113883.10.20.1.6"/>

<code code="11369-6" codeSystem="2.16.840.1.113883.6.1"/>

…<entry typeCode="DRIV">

<substanceAdministration classCode="SBADM" moodCode="EVN"><templateId root="2.16.840.1.113883.10.20.1.24"/>

<id nullFlavor="NI"/><statusCode code="completed"/><effectiveTime xsi:type="IVL_TS">

<center value="20040903"/></effectiveTime><consumable>

<manufacturedProduct><templateId root="2.16.840.1.113883.10.20.1.53"/><manufacturedMaterial>

<code code="52" codeSystem="2.16.840.1.113883.6.59" displayName="hepatitis A vaccine, adult dosage"><originalText>Hepatitis A vaccine #1</originalText></code></manufacturedMaterial>

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CCD – Summary of Patient’s Immunization Record (HTML)

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Illustration of Metadata Tagging - PCAST Approach

• XML based Structure

<Privacy>…</Privacy>

<Attributes>…</Attributes>

<Provenance> …</Provenance>

<Data>Encrypted Immunization Data</Data>

For Example:

Privacy :<ED> Yes </>

<Referring Physicians> Yes; </>

<Exceptions>Dr. James

Research </>,

Attributes : Patient Identification , Date = June 20, 2008, Vocabulary identification (e.g. SnomedCT 96412003),

Site Provenance : Manufacturer of immunization and batch number

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Use Case from PCAST Report

Use Case #3:

When Patient changes provider, new physician wishes to examine multiple Mammograms that were taken at multiple sites over a long period of time.

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Use Case #3 from PCAST Report (cont.)

• Structure is still <Privacy>><Attributes><Provenance<Data>

• A DEAS is used to locate additional data

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InitiatorInitiator

Provider n

Provider n

Hospital xHospital x

VA/DoDVA/DoD

…

DEAS nDEAS n

DEAS xDEAS x

DEAS nDEAS n

Query

Definition of Metadata

Metadata: Data about data

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Health & Medicine

PCAST Report Workgroup 01-14-11