© 2014 White Paper: HIT Standards for HIM Practices Proposed Methodology

© 2014

White Paper: HIT Standards for HIM Practices

Proposed Methodology

Outline

1. IHE White Paper Project Overview2. Proposed Methodology

HIM and IHE Universes AmalgamationHealth Information Systems should support

HIM practices

HIM practices should inform IHE Profile Specifiers

Health Information Systems built based on the IHE Profiles should support HIM practices

Systems: Document Sharing/Exchange

HIE

System 2System 1


HIE

System 2System 1

HIM HIM

HIM

The White Paper Objectives

1. Explain/model the relationship between HIM practices (clinical-HIM workflow, HIM activities checklist) and capabilities of HIS products to support these practices

2. Conduct a gap analysis between HIM practices and existing IHE and other HIT standards for HIS aimed to support HIM practices

3. Create the roadmap for the development of new IHE profiles to support HIM practices

4. Inform IHE development process by defining Profile Specifier checklist aligned with the HIM practices checklist

Efforts To Date

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2014

AHIMA IG White Paper, 2014AHIMA HIM Principles Taskforce

Report (to be developed)

IG Principle

HIM Principles

Information Governance Principles*:

1.Accountability 2.Transparency3.Integrity4.Protection 5.Compliance 6.Availability7.Retention8.Disposition

*American Record Management Association (ARMA). Generally Accepted Record Management Principles. Information Governance Maturity Model. 2013

Needed Efforts

Needed Efforts- White Paper Scope

White PaperUse Cases

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2014



IG Principle

HIM Principles





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2014



IG Principle

HIM Principles




Use Case 1


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2014



IG Principle

HIM Principles




Use Case 2

Use Case 1

Use Case 1: Standards for Record’s State(s)Medical records states from ARMA Model:

6. Availability7. Retention8. Disposition

Activities1. Select one of these record states based on priorities (e.g.,

record lifecycle model, stakeholder value, other)2. Develop HIM action checklist(s) by state(s)3. Conduct IHE and other HIT standards gap analysis for the

selected record state4. Develop a roadmap for IHE standards development by

record state

Use Case 2: Standards for State Attribute(s)Medical records states and states’ attributes from ARMA

Model: 6. Availability7. Retention8. Disposition

Activities1. Select an attribute(s) for a record’s state (e.g., protection, integrity)

based on priorities (e.g., record lifecycle model, stakeholder value, other)

2. Model the attribute in the record lifecycle and information exchanges between systems

3. Conduct IHE and other HIT standards gap analysis for the selected attribute(s)

4. Develop a roadmap for IHE standards development by attribute (s)

1. Accountability 2. Transparency3. Integrity4. Protection5. Compliance

Health Information Systems (HIS)

The White Paper will apply to a variety of HIS:• Electronic Health Record Systems (EHRs)• Laboratory Information Management Systems

(LIMS)• Pharmacy• Public Health• Research• Personal Electronic Health Record Systems

(PEHRs)

Record Building/Sharing Environment*Clinical Encounter Record/Documents Flow

Patient Registration

Chief Complaint Orders Test

ResultsDiagnosis &

Care Plan

IHE XDW,SWF,

Cardiology and other Profiles

CCD

Prescriptions

HIM PRACTICE

S*

HIM

HIM

HIM

HIM

CCD CCD CCD

*HL7 EHR Lifecycle Model Release 1, Draft Standard for Trial Use. 27 January 2008

Billing System EHR System Laboratory System Pharmacy System


HIE

System 2System 1

HIM HIM

HIM

Record Content Populated by Various Systems

IHE Data Access Framework White Paper URL: http://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_White_Paper_DAF_Rev1.1_2014-10-24.pdf

MEDICAL

RECORD

http://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_White_Paper_DAF_Rev1.1_2014-10-24.pdf

Our Methodology

MethodologyTasks Deliverable

1. Document HIM best practices in electronic environment by selected Information Governance principle:

(a) Integrity; (b) Protection; (c) Availability

Literature ReviewHIM Practice Check list

2. Define Use Cases for selected HIM best practices by principle HIM Use Case List

3. Conduct gap analysis of IHE interoperability standards (integration profiles) to assess their capabilities to support HIM practice by harmonization of the HIM and IHE use cases

Gap Analysis Table

4. Develop recommendations and a roadmap for addressing identified gaps in IHE interoperability standards

Recommendations and Roadmap

5. Publish draft White Paper for public comments Draft White Paper

6. Publish final White paper based on the reconciliation of public comments

Final White paper

7. Develop proposal for the IHE 2015-16 development cycle Proposal for the 2015-16 IHE development cycle

8. Communication, Outreach and Marketing JAHIMA ArticleWebinar2015 Convention

In Search of Methodology

Based on the Call 12/01/14 discussion:

1.Review of IHE White Papers

• IHE Health Information Exchange White PaperURL:

http://www.ihe.net/Technical_Framework/upload/IHE_ITI_White-Paper_Enabling-doc-sharing-through-IHE-Profiles_Rev1-0_2012-01-24.pdf

• IHE Data Access Framework White Paper URL:






IHE HIE White PaperThis white paper is focused on explaining the IHE profiles used to address

interoperability aspects of document sharing and how they work together to solve common document sharing problems. This paper will describe a set of building blocks for health document sharing and each environment will use some set of those building blocks to enable the architecture desired by the community or communities participating.

IHE enables interoperable sharing of documents but assumes this sharing occurs under a document sharing governance structure agreed to by all parties involved. The governance structure addresses all policy issues necessary to enable document sharing; content format and coding; and other operational characteristics. The IHE profiles are designed to be agnostic to governance and policy, while also being designed to support and enforce those governance and policy choices. The governance may apply only within a small group, such as a hospital and small physician’s office, or may apply at a large level, like an entire nation.

IHE Profile entitled Template for XDS Affinity Domain Deployment Planning provides support for policy and deployment planning.

IHE Health Information Exchange White PaperURL: http://www.ihe.net/Technical_Framework/upload/IHE_ITI_White-Paper_Enabling-doc-sharing-through-IHE-Profiles_Rev1-0_2012-01-24.pdf


IHE HIE White Paper

IHE Data Access Framework (DAF) White Paper

The purpose of this white paper is to provide a framework of modular, substitutable and interoperable integration profiles that shows how IHE enables data access for a wide variety of use cases using queries as follows: • Queries within and across enterprises • Queries accessing individual patient data and queries

accessing population data • Support for multiple data models based on the type of data

being accessed such as clinical data and patient demographic data

• Securing the data being exchanged (both query requests and query responses)

IHE Data Access Framework White Paper URL: http://www.ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_White_Paper_DAF_Rev1.1_2014-10-24


IHE DAF White Paper



IHE DAF White Paper




HIE

System 2System 1

HIM HIM

HIM


HIE

System 2System 1

HIM HIM

HIM

IHE HIE WPIHE DAF WP



Project Scope: Document Sharing/Exchange

HIE

System 2System 1

HIM HIM

HIM




Methodology: Tasks 1 and 21.Document HIM best practices in electronic environment by selected Information

Governance principle: (a) Integrity; (b) Protection; (c) Availability (Examples: Grzybowski, 2014 p. 31 and 40)

2.Define Use Cases for selected HIM best practices by principleHIM Practice HIM Use Case

ProtectionP1. Does MPI contain the correct number of entries in the right sequence, so that it has episode of care integrity within its account number?

To be developed

P2. Global or universal authorization can be filed at the enterprise (medical record number) vs. individual episode of care

To be developed

IHE Universe – ITI XDS Profiles Family

Cross-Enterprise Document Sharing (XDS) Profiles Family enables a number of healthcare delivery organizations belonging to an XDS Affinity Domain (e.g., a community of care) to cooperate in the care of a patient by sharing clinical records in the form of documents as they proceed with their patients’ care delivery activities. This profile is based upon ebXML Registry standards and SOAP. It describes the configuration of an ebXML Registry in sufficient detail to support Cross Enterprise Document Sharing.

Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). Cross-Enterprise Document Sharing (XDS) Integration Profile .URL: http://ihe.net/uploadedFiles/Documents/ITI/IHE_ITI_TF_Vol1.pdf

IHE Universe – Information Technology Infrastructure (ITI) Technical Framework

Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). URL: http://ihe.net/uploadedFiles/Documents/ITI/IHE_ITI_TF_Vol1.pdf



HIM # P1 HIM # P2

Methodology: Tasks 2 and 3

HIM Practice HIM Use Case IHE Use Case IHE profile

ProtectionP1. Does MPI contain the correct number of entries in the right sequence, so that it has episode of care integrity within its account number?

To be developed To be reviewed Patient Cross Referencing for MPI

P2. Global or universal authorization can be filed at the enterprise (medical record number) vs. individual episode of care

To be developed To be reviewed Enterprise user authentication

Harmonized

Harmonized

2. Define Use Cases for selected HIM best practices by principle - Protection (Examples: Grzybowski, 2014 p. 31 and 40)

3. Conduct gap analysis of IHE profiles and harmonize use cases

Methodology: Tasks 1 and 21.Document HIM best practices in electronic environment by selected Information

Governance principle: (a) Integrity; (b) Protection; (c) Availability (Examples: Grzybowski, 2014 p. 40)


AvailabilityA1. All documents can be accounted for and the record closed as complete within a specific time period post patient discharge

To be developed

A2.Single or multiple groups of documents within the electronic medical record can be viewed by or released to the requestor

To be developed

IHE ITI XDW ProfileThe Cross-Enterprise Document Workflow (XDW) Integration Profile

enables participants in a multi-organizational environment to manage and track the tasks related to patient-centric workflows as the systems hosting workflow management applications coordinate their activities for the health professionals and patients they support. XDW builds upon the sharing of health documents provided by other IHE profiles such as XDS, adding the means to associate documents conveying clinical facts to a patient-specific workflow. XDW provides a common interoperability infrastructure upon which a wide range of specific workflow definitions may be supported. It is designed to support the complexity of health services delivery with flexibility to adapt as workflows evolve.

Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). Cross-Enterprise Document Workflow (XDW). T rial Implementation URL: http://ihe.net/uploadedFiles/Documents/ITI/IHE_ITI_Suppl_XDW.pdf

IHE ITI XDW Profile


IHE ITI XDW Profile


HIM # A1

IHE DAF White Paper


HIM # A2


HIM Practice HIM Use CaseAvailability

A1. All documents can be accounted for and the record closed as complete within a specific time period post patient discharge

To be developed To be reviewed XDW

A2.Single or multiple groups of documents within the electronic medical record can be viewed by or released to the requestor

To be developed To be reviewed IHE DAF White Paper

Methodology: Tasks 2 and 3 (continued)2. Define Use Cases for selected HIM best practices by principle –

Availability (Examples: Grzybowski, 2014 p. 31 and 40)3. Conduct gap analysis of IHE profiles and harmonize use cases

Harmonized

Harmonized

Methodology: Tasks 1 and 2 (continued1.Document HIM best practices in electronic environment by selected Information

Governance principle: (a) Integrity; (b) Protection; (c) Availability (Examples: Grzybowski, 2014 p. 31 and 40)


AvailabilityA3. A log of all requests and accounting of disclosures is kept as an audit trail and can be referenced as needed

To be developed

Methodology: Tasks 2 and 3 (continued)

Harmonized

2. Define Use Cases for selected HIM best practices by principle – Availability (Examples: Grzybowski, 2014 p. 31 and 40)

3. Conduct gap analysis of IHE profiles and harmonize use cases

HIM Practice HIM Use Case IHE Use Case IHE ProfileAvailability

A3. A log of all requests and accounting of disclosures is kept as an audit trail and can be referenced as needed

To be developed To be reviewed Audit Trail and Node Authentication (ATNA)

Harmonized



HIM # P1 HIM # P2

HIM # A3

Gap Analysis

Examples of IHE Profiles to be Reviewed

IHE Radiology DomainThe Scheduled Workflow (SWF) Integration Profile establishes the

continuity and integrity of basic departmental imaging data acquired in an environment where examinations are generally being ordered. It specifies a number of transactions that maintain the consistency of patient and ordering information as well as defining the scheduling and imaging acquisition procedure steps. This profile also makes it possible to determine whether images and other evidence objects associated with a particular performed procedure step have been stored (archived) and are available to enable subsequent workflow steps, such as reporting. It may also provide central coordination of the completion of processing and reporting steps as well as notification of appointments to the Order Placer.

Integrating the Healthcare Enterprise (IHE). Radiology Technical Framework (TF). Scheduled Workflow (SWF) Integration Profile. URL: http://ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_TF_Vol1.pdf

IHE Radiology Domain


IHE Scheduled Workflow (SWF) Profile

IHE Radiology Domain


IHE Scheduled Workflow (SWF) Profile

HIM

IHE Cardiology Domain

The Evidence Documents Profile defines ways for data recorded in the course of carrying out a procedure step, such as observations, measurements, and results (i.e., evidence documents), to be output by devices, such as acquisition systems and other workstations; to be stored and managed by archival systems; and to be retrieved and presented or used by display and reporting systems. This allows detailed non-image information, such as measurements, CAD results, procedure logs, etc. to be made available as input to the process of generating a clinical Report, either as additional evidence for the reporting physician, or in some cases for selected items in the Evidence Document to be included in the report.

Integrating the Healthcare Enterprise (IHE). Radiology Technical Framework (TF). Scheduled Workflow (SWF) Integration Profile. URL: hhttp://ihe.net/uploadedFiles/Documents/Cardiology/IHE_CARD_TF_Vol1.pdf


Integrating the Healthcare Enterprise (IHE). Radiology Technical Framework (TF). Scheduled Workflow (SWF) Integration Profile. URL: http://ihe.net/uploadedFiles/Documents/Cardiology/IHE_CARD_TF_Vol1.pdf


Integrating the Healthcare Enterprise (IHE). Radiology Technical Framework (TF). Scheduled Workflow (SWF) Integration Profile. URL: http://ihe.net/uploadedFiles/Documents/Cardiology/IHE_CARD_TF_Vol1.pdf

HIM

IHE Information Technology Infrastructure (ITI)

Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). URL: http://www.ihe.net/Technical_Frameworks/#IT

Examples of Other Standards to be Reviewed

1. AHIMA Information Governance Principles for Healthcare, September 2014

2. AHIMA First Information Governance Benchmarking White Paper, May 2014

3. Grzymbowski D. Strategies for Electronic Document and Health Record Management. 2014

4. Other1. Cohasset Associates | AHIMA 2014 Information Governance in Healthcare: Benchmarking White Paper.

URL: www.ahima.org2. AHIMA Information Governance Principles for Healthcare (IGPHC). URL: www.ahima.org

Review of HIM Business Standards

Methodology: Tasks 1 & 21. Document HIM best practices in electronic environment by selected Information

Governance principle: (a) Integrity; (b) Protection; (c) Availability2. Define Use Cases for selected HIM best practices by principle

http://www.ahima.org/

ISORecord Lifecycle Model Standard*

* ISO/TR 21089:2004 Health informatics -- Trusted end-to-end information flows

Methodology: Task 33. Conduct gap analysis of various HIT standards and harmonize use

cases

ISO/TR 21089:2004 Health informatics -- Trusted end-to-end information flows

ISO Technical Committee (TC) 215 Health Informatics

Methodology: Task 33. Conduct gap analysis of various HIT standards and harmonize use

cases

Methodology: Tasks and DeliverablesTasks Deliverable



Literature ReviewHIM Practice Check list

2. Define Use Cases for selected HIM best practices by principle HIM Use Case List


Gap Analysis Table



5. Publish draft White Paper for public comments Draft White Paper


Final White paper

7. Develop proposal for the IHE 2015-16 development cycle Proposal for the 2015-16 IHE development cycle

8. Communication, Outreach and Marketing JAHIMA ArticleWebinar2015 Convention

Project methodology and logistics set-up

Gap Analysis of IHE ProfilesRecommendations and Roadmap

Draft White Paper

Final White Paper

Proposal for HIM Standard for 2015-16 IHE cycle

Month12 1 2 3 4 5 6 7 8 9 10 11 12

HIM Practices Checklist. Use Case List

Gap Analysis Table


Draft White Paper

JAHIMA Article

HIM best practices review, HIM Use Case selection

Defined Methodology, Wiki set-up

Communication and Outreach

Final White Paper

2015-16 Proposal

2015 ConvemtionWebinar

Methodology: Timeline

AHIMA Team (Harry, Diana, Anna)Subject Matter Experts (SMEs)• Developers

–HIM SMEs (Sandra, Jonathan, Kathleen)– IHE SMEs (John, Michael)

• Reviewers–HIM SMEs (to be defined, e.g., Practice Councils)– IHE SMEs (IHE ITI Committee members)

Methodology: Roles

Methodology: RolesTasks Team



• AHIMA Team• HIM Subject Matter

Experts (SMEs)

2. Define Use Cases for selected HIM best practices by principle • AHIMA Team• HIM SMEs


• AHIMA Team• IHE SMEs


Full Team

5. Publish draft White Paper for public comments AHIMA Team


Full Team

7. Develop proposal for the IHE 2015-16 development cycle AHIMA Team

8. Communication, Outreach and Marketing (JAHIMA Article, Webinar, 2015 Convention)

AHIMA Team.HIM SMEs,IHE SMEs