Presenters: Co-Chairs of the EHR-Centric IS Tiger Team Michael Nusbaum, BASc, MHSA, FHIMSS

1enabling healthcare interoperability

2009 Webinar Series

Sponsored by the HITSP Education, Communications and Outreach Committee

Presenters: Co-Chairs of the EHR-Centric IS Tiger TeamMichael Nusbaum, BASc, MHSA, FHIMSSManick Rajendran, BS, MBACorey Spears

EHR Centric Interoperability Specification

Webinar #9 October 8, 2009 | 2:00 – 3:30 pm (Eastern)

Slide 2HITSP – enabling healthcare interoperability 2009 Webinar Series

Overview

Re-organization and re-purposing of all of HITSP’s 13 original Interoperability Specifications (IS) into an EHR-centric view

— Aligned with the Health Information Technology (HIT) provisions of the American Recovery and Reinvestment Act of 2009 (ARRA).

Simplified framework for HITSP’s ongoing activities, making future work products easier to understand and simpler to implement.


Learning Objectives

During this 90-minute webinar, participants will:

— Learn why this IS is important to EHR vendors and organizations

— Understand how the HITSP EHR-Centric IS can support ARRA requirements

— Learn how the EHR-Centric IS utilized the concepts of “capabilities” and “service collaborations” to simplify the specifications and facilitate ease of implementation

— Discover how HITSP efforts going forward will further leverage Capabilities and Service Collaborations as re-usable components

— Learn how to find and navigate the IS107 EHR Centric document


Agenda

What is HITSP?

What HITSP produces

What is ARRA?

What was the EHR-Centric IS Tiger Team asked to produce?

Introduction of new “building blocks”— Capabilities— Service Collaborations— A new HITSP approach— Navigating the IS107 Document

Conclusion

Questions and Answers


To serve as a cooperative partnership between the public and

private sectors for the purpose of achieving a widely accepted

and useful set of standards specifically to enable and support

widespread interoperability among healthcare software applications,

as they will interact in a local, regional, and national health

information network for the United States.

Mission


Overview

HITSP is a volunteer-driven, consensus-based organization

that is funded through a contract from the Department of

Health and Human Services

— Created in 2005

HITSP develops Interoperability Specifications (IS) – documents

that harmonize and recommend the technical standards that are

necessary to assure the interoperability of electronic health records

— Production to date: 14 IS and 60 related constructs


Patients

Consumers

Employers

General

Practitioners

Outpatient

Providers

Government

Agencies

Hospitals

HITSP Stakeholders

Review Boards

Practice

Guidelines

Residential

Care Providers

Standards

Developers

Specialists

Payers

Suppliers

Current Participation in HITSP:

800+ organizations 1,000+ individuals

Over 25,000 volunteer hours


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


What is ARRA? Also known as the “economic stimulus package”

Signed into law by President Obama on February 17, 2009

What is HITECH?

A portion of ARRA referred to as the Health Information Technology

for Economic and Clinical Health (HITECH) Act

— TITLE XIII—Health Information Technology

— TITLE IV—Medicare and Medicaid

Health Information Technology

Contains numerous provisions related to

Health Information Technology (HIT) and

privacy with aggressive timelines for completion


To Address ARRA Requirements, Tiger Teams Were Created with Specific Focus Areas

A new EHR Centric Interoperability Specification

to meet ARRA requirements

Security, Privacy & Infrastructure

Quality Measures

Data Architecture (Element,

Template, and Value Set)

Exchange Architecture and

Harmonization Framework

Clinical Research

Tiger Team

membership

232 technical experts


Released Accepted Recognized

Federal projects must use HITSP recognized standardsPer Executive Order 13410

Panel approved for submission to HHS

Secretary of HHS has accepted for a period

of testing

Secretary of HHS has recognized the IS for

immediate implementation

Status: Interoperability Specifications


IS 01Electronic Health Record (EHR) Laboratory Results Reporting

IS 02 Biosurveillance

IS 03 Consumer Empowerment

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

IS 05Consumer Empowerment and Access to Clinical Information via Media

IS 06 Quality

IS 07 Medication Management

HITSP Interoperability Specifications (IS)

Accepted

Recognized


IS 08 Personalized Healthcare

IS 09 Consultations and Transfers of Care

IS 10 Immunizations and Response Management

IS 11 Public Health Case Reporting

IS 12 Patient – Provider Secure Messaging

IS 77 Remote Monitoring

IS 107 EHR Centric

HITSP Interoperability Specifications (IS)

Released /Panel

Approved

Accepted


Utilizing the 13 recognized/accepted (as of 13Feb09) HITSP Interoperability Specifications . . .

. . . in the context of the ARRA

to produce an EHR-Centric IS . . .

that is: simplified easily understood applicable beyond limitations of initiating use cases implementable leverages existing work

EHR-Centric Tiger Team Produced the EHR-Centric Interoperability Specification (IS)


EHR-Centric IS Addresses ARRA / HITECH Priority Areas

Eight Priority Areas for HIT in ARRA

HITSP Phase 1 Tasks for ARRA

1Security + Privacy

2HIT

Infrastructure

3Certified

Health Record

4Disclosure

Audit

5Improve Quality

6IIHI*

Unusable

7Demographic

Data

8 Needs of

Vulnerable


Security and Privacy Service (Suite)

Quality Measures project

Supporting Deliverables

Harmonization framework and information/ exchange architecture

Data Element, Template, and Value Set

* Individually Identifiable Health Information (IIHI) Unusable


ARRA Title IV (Division B) – Section 401 – Medicare Incentives

HITSP Phase 1 Tasks for ARRA

Meaningful Use to Include

e-Prescribing

Exchange of Information to Improve

Quality of Care

Reporting Clinical Quality Measures

Certified EHR Defined


Security and Privacy Service (Suite)

Quality Measures project

Supporting Deliverables

Harmonization framework and information/ exchange architecture

Data Element, Template, and Value Set

EHR-Centric IS Facilitates Achievement ofARRA / HITECH Meaningful Use


New Harmonized Construction Rules Were Needed

Something every organization can use for its EHR

Takes advantage of opportunities to work smarter

Re-use and re-purpose


Putting the Pieces Together

HITSP created IS’s to harmonize standards

and make them implementable

Before HITSP, there was a “custom

puzzle” to build for every organization

to talk to another organization

HITSP used existing Interoperability

Specification (IS) constructs to create

reusable Capabilities and Service

Collaborations


Meeting Business Needs

Capabilities and Collaborations could be used to build any new

Interoperability Specification to meet a particular business need


HITSP Capabilities

Enable systems to address a business need for interoperable information exchange

Bridge between business, policy and implementation views:— Define a set of information exchanges at a level

relevant to policy and business decisions

— Support stakeholder requirements and

business processes

— Define information content and

secure infrastructure

— Specify use of HITSP constructs

sufficiently for implementation

— Include constraints and identify specific

network topologies

Created To Simplify Design and Use of

HITSP Specifications for ARRA Efforts

and Beyond


AHIC Use Case

Interoperability Specification (IS)

Identifies the framework that is a solution

for business need (use case) Defines requirements including

transactions and terminology Addresses multi-year roadmap

as needed

Constructsavailable for reuse or repurposing

Component

Transaction

Transaction Package

Technical Notes

Overview: HITSP Interoperability Specifications


HITSP Glossary

Interoperability Specifications (IS) – Integration of all constructs used to meet

business needs or the business needs specified in a Use Case

— Components (C) – Logical grouping of base standards that work together,

such as messaging and terminology

— Transactions (T) – Logical grouping of actions that use components

and/or composite standards to realize the actions

— Transaction Packages (TP) – Logical grouping of transactions

Capability (CAP) – Specifies a business service that an EHR system

addresses and specifies the contents and secure infrastructure

needed for that business service

Service Collaboration (SC) – Defines a standards-based secure

infrastructure needed for interoperable information exchanges and

includes a secure transport mechanism with topology and other

options regardless of content


Standards “Real World” examples of Base and Composite Standards

XML (base)

IHE-XDS (composite)

HL7-CCD (base)

DICOM (base)

LOINC (base)

SNOMED-CT (base)

NCPDP-Script (composite)

etc.

Base Standard

capable of fulfilling

a discrete function

Composite Standards

groupings of coordinated

base standards

Examples Basic Specifications

Implementation Guides

Code Sets and Terminologies


Exchange a prescription with an Ambulatory or Long-Term

Care Organization

What Is an Example of a Capability?

Requirement: Hospital wants to exchange a discharge prescription with an patient’s physician’s office.

— This diagram shows how Capability (CAP) 117 was assembled to support this requirement using Transaction, Transaction Package and Service Collaboration

T40T42

TP43TP46

SC114

T40T42

TP43TP46

SC114

CAP117 – Communicate Ambulatory and Long

Term Care Prescription

System Roles• Medication Order Prescriber• Medication Order Filler• Health Plan• Health Information Exchange


SC114 – Administrative Transport to Health PlanSC114 – Administrative Transport to Health Plan

TP46 – Medication Formulary and Benefits Information

TP46 – Medication Formulary and Benefits Information

TP43 – Medication OrdersTP43 – Medication Orders

Details of Capability 117

CAP117 – Communicate Ambulatory and Long Term Care Prescription

T42 – Medication Dispensing Status T42 – Medication Dispensing Status

T40 – Patient Health Plan Eligibility Verification

T40 – Patient Health Plan Eligibility Verification

PHA RMACY

Requirement: Hospital wants to exchange a discharge prescription with an patient’s physician’s office.


SC109 - Security Audit CollaborationSC109 - Security Audit Collaboration

T15 - Collect and Communicate Security Audit TrailT15 - Collect and Communicate Security Audit Trail

T16 - Consistent TimeT16 - Consistent Time

SC108 - Access Control Service CollaborationSC108 - Access Control Service Collaboration

Details of Service Collaboration 114

SC114 – Administrative Transport to Health Plan

HEALTH

PLAN

C19 - Entity Identity Assertion (Optional)C19 - Entity Identity Assertion (Optional)

T17 - Secured Communication ChannelT17 - Secured Communication Channel

TP20 - Access ControlTP20 - Access Control

TP30 - Manage Consent DirectivesTP30 - Manage Consent Directives

T85 - Administrative Transport to Health PlanT85 - Administrative Transport to Health Plan

T17 - Secured Communication ChannelT17 - Secured Communication ChannelProvider


HITSP Capabilities

CAP118 Communicate Hospital Prescription SpecificationCAP121 Communicate Clinical Referral Request SpecificationCAP125 Retrieve Genomic Decision Support SpecificationsCAP126 Communicate Lab Results Message SpecificationsCAP127 Communication of Lab Results Document SpecificationsCAP128 Communicate Imaging Information SpecificationsCAP135 Retrieve and Populate FormCAP137 Send and Receive clinical data message Specifications

Clinical Operations


CAP140 Exchange Administrative Benefits/Eligibility transactions specificationCAP141 Exchange Administrative Referral/Authorization Transactions Specifications

Administration and Finance

More HITSP Capabilities

CAP129 Communicate Quality Measure Data SpecificationsCAP130 Communicate Quality Measure Specification SpecificationsCAP131 Immunization Registry update SpecificationsCAP132 Immunization Registry Query SpecificationsCAP133 Communication of Immunization Summary SpecificationsCAP136 Emergency Alerting SpecificationsCAP139 Communicate Resource Utilization Specifications

Public Health and Emergency Response


CAP119 Communicate Structured Document SpecificationCAP120 Communicate Unstructured Document SpecificationCAP122 Retrieve medical Knowledge SpecificationsCAP123 Retrieve existing data SpecificationsCAP124 Establish Secure web access SpecificationsCAP138 Assign pseudo-identity SpecificationsCAP142 Retrieve Communications RecipientCAP143 Consumer Preferences and Consent Management

Security, Privacy, and Infrastructure

And Yes . . . there are more HITSP Capabilities


Service Collaborations (SC)

Defines a standards-based secure infrastructure needed for

interoperable information exchanges.

Includes a secure transport mechanism with topology and

other options.

Uses HITSP Constructs to specify the

secure infrastructure.

Does not specify the content of the

information exchange but may include

information to support the exchange

(e.g., authorization information)

Additional Keys to Simpler Definition

and Implementation of HITSP

Specifications


Service Collaboration – An Essential Component


HITSP Service Collaborations (SC)

SC108 – Access Control SC109 – Security Audit SC110 – Patient Identification Management SC111 – Knowledge and Vocabulary SC112 – Healthcare Document Management SC113 – Query for Existing Data SC114 – Administrative Transport to Health Plan SC115 – HL7 Messaging SC116 – Emergency Message Distribution Element


Binds content definition with secure infrastructure for a set of interoperable information exchanges

How It All Fits


Initial HITSP Approach – Use Cases


Capabilities Changed the Level at which We Work


Capabilities Allow Us to Develop New Technical Constructs As Needed


The Refined HITSP Framework

HITSP Capabilities

Component

ServiceCollaborations

ServiceCollaboration

TransactionConstructs

Transaction

Transaction Package

SDOs = Standards Development Organizations


“Meaningful Use”

From existing Interoperability

Specifications, determine subset

required for “meaningful use” as

called for in the American Recovery

and Reinvestment Act (ARRA).

Effort began on April 7, 2009.


HITSP Capabilities Were Created from Previous Work

Full copy of this file posted with the Webinar Slides @ www.hitsp.org/webinars


Example

The Capabilities Map to ARRA Requirements


CapabilityCapability

End Result: The EHR-Centric IS was

built using these Capabilities.

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

42enabling healthcare interoperability

2009 Webinar Series

Sponsored by the HITSP Education, Communications and Outreach Committee

Document Overview and Navigation Tips



You Can Find IS107 on www. hitsp.org


Scroll to the bottom to find IS107


IS107 EHR CentricInteroperability Specification


In the EHR-Centric IS, Each Capability Is Described by:

Detailed description Design specification

— Interacting Systems

— Constraints & Assumptions

— List of constructs (including Service Collaborations)

— Specified Interfaces (mapped to construct/content)

— Interface Conditions & content optionality

— Uniform Modeling Language (UML) diagram

— Capability options (content subsets and transport options)


Each Capability is written in this format

Communicate Ambulatory and Long Term Care Prescription Specification

— 3.2.1 Overview

— 3.2.2 Design Specification

— 3.2.2.1 Interacting Systems

— 3.2.2.2 Constraints and Assumptions

— 3.2.2.3 List of Constructs

— 3.2.2.4 Specified Interfaces

— 3.2.2.5 Capability Options


Two Key Websites to Bookmark

www.hitsp.org

http://wiki.hitsp.org/docs


NEW HITSP Team Members ALWAYS welcome!www.HITSP.org

All you need is passion to get the job done

Motivation to make a difference

Drive to push the nation forward

Volunteers ARE the life blood of HITSP to get the job done

If you knew enough to attend this webinar, you know enough to jump on in!


Webinar 1 Advances in Sharing Information in Healthcare IT

Thursday, January 15, 2009 — 2:00-3:30 pm Eastern

Webinar 7 HITSP eTown Hall II with Dr. John Halamka

Thursday, August 27, 2009 — 2:00-3:30 pm Eastern

Webinar 2 Personalized Healthcare Interoperability Specification (IS 08)

Thursday, February 12, 2009 — 2:00-3:30 pm Eastern

Webinar 8 Medication Management Real World Sites

Thursday, September 10, 2009 — 2:00-3:30 pm Eastern

Webinar 3 Consultations and Transfers of Care Interoperability Specification (IS 09)

Thursday, March 12, 2009 — 2:00-3:30 pm Eastern

Webinar 9 HITSP EHR Centric Interoperability Specification

Thursday, October 8, 2009 — 2:00-3:30 pm Eastern

Webinar 4 NHIN Real World Sites

Thursday, April 16, 2009 — 2:00-3:30 pm Eastern

Webinar 10 Security, Privacy, and Infrastructure

Thursday, November 12, 2009 — 2:00-3:30 pm Eastern

Webinar 5 HITSP eTown Hall I with Dr. John Halamka

Thursday, June 18, 2009 — 2:00-3:30 pm Eastern

Webinar 11 Quality Management

Tuesday, December 8, 2009 — 2:00-3:30 pm Eastern

Webinar 6 Health Information Exchange (HIEs) in the Real World

Thursday, July 9, 2009 — 2:00-3:30 pm Eastern

NOTE:Recent schedule changes reflect HITSP’s response to new efforts in HIT based on the ARRA Stimulus bill provisions. Further changes are possible due to priority changes and availability of speakers.

The 2009 Webinar Serieswww.HITSP.org/webinars


Discussion / Questions Welcomed


View the Complete Set of HITSP Deliverableswww.HITSP.org


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

Visit www.hitsp.org or contact:


Sponsor Strategic Partners

www.HITSP.org

Documents

Presenters: Co-Chairs of the EHR-Centric IS Tiger Team Michael Nusbaum, BASc, MHSA, FHIMSS