Document Number: HITSP 06 N 95 Date: June 14, 2006 Discussion Document Standards Harmonization Technical Committees Update Report to the Healthcare Information Technology Standards Panel Washington DC June 14 2006 This briefing is being provided to HITSP. This material is intended to facilitate discussions during the HITSP meeting. All information contained in this briefing and the related documents is draft.
Table of Contents � Introduction � HITSP Technical Committees Overview � Standards Selection Process Overview � Building Block Overview � Standards Selection - By Technical Committee � HITSP Comments � Next Steps Healthcare Information Technology Standards Panel Healthcare Information Technology Standards Panel 1
HITSP Technical Committees Overview � Floyd P. Eisenberg, MD MPH, • Biosurveillance Transmit essential ambulatory care and emergency department visit, utilization, and SIEMENS Medical Solutions Health lab result data from electronically enabled Services - Presenter � Peter L. Elkin MD FACP, Mayo Clinic health care delivery and public health systems in standardized and anonymized College of Medicine � Shaun Grannis, MD, The Regenstrief format to authorized Public Health Agencies with less than one day lag time. Institute, Indiana University School of Medicine • 65 members � Charles Parisot, EHR Vendor • Consumer Allow consumers to establish and manage Empowerment permissions access rights and informed Association � Elaine A. Blechman PhD, Professor, consent for authorized and secure exchange, viewing, and querying of their linked patient Univ. of Colorado-Boulder registration summaries and medication histories between designated caregivers and • 67 members other health professionals. � Jamie Ferguson, Kaiser- • Electronic Allow ordering clinicians to electronically Health Record access laboratory results, and allow non- Permanente - Presenter � John Madden, MD, PhD, SNOMED ordering authorized clinicians to electronically access historical and other Intl � Steve Wagner, Department of • 85 members laboratory results for clinical care. Veterans Affairs Healthcare Information Technology Standards Panel Healthcare Information Technology Standards Panel 2
Introduction � The Healthcare Information Technology Standards Panel (HITSP) Technical Committees have begun the selection of named standards to be used in constructing the Interoperability Specifications. � The selected standards represent a continuation and refinement of the Gap Analysis delivered to HITSP and the Office of the National Coordinator (ONC) on May 30, 2006. � In this phase of its work, each Technical Committee is focusing on evaluating and selecting the specific standards to meet the requirements of its assigned Use Case. � In a future phase, the Technical Committees will provide input to the construction, testing and evaluation of Interoperability Specifications to meet the respective Use Case requirements. Healthcare Information Technology Standards Panel Healthcare Information Technology Standards Panel 3
Standards Selection Process Overview Specifically, the Technical Committee has: � Simplified the set of actions to those requiring interoperable information interchange � Focused on the information interchange actions that directly support the Community breakthroughs � Evaluated the remaining standards using the prototype Tier 2 Readiness Criteria � Produced a preliminary list of selected (named) standards expected to be used in the forthcoming Interoperability Specifications. Healthcare Information Technology Standards Panel Healthcare Information Technology Standards Panel 4
Building Blocks Overview In the analysis of their respective Use Cases, the Technical Committees have found it useful to group related actions into constructs called “Building Blocks.” Building Blocks are sets of interoperability requirements delineating abstract systems, actors, transactions and content. Grouping actions into Building Blocks also can be used to identify the supporting interoperability standards. Building Blocks have facilitated reuse within a Use Case as well as simplified the task of coordination across the Technical Committees. Building Blocks can be either Use Case specific or common across two or all three Use Cases. The Building Blocks represent the current set of analytic constructs. Healthcare Information Technology Standards Panel Healthcare Information Technology Standards Panel 5
Key Strategies for Standards Selection Simplification � Initial analysis of the Use Cases included an extensive number of events and action. – Many of the events and actions did not require interoperable information interchange between systems. – Deferred such actions as necessary pre- or post-conditions that represent system functional requirements but not system level interoperability. – Addressed only the remaining actions requiring information interchange. Focus � Within this set of information interchange functions, the Technical Committee focused on those essential in support of the “breakthrough.” – Focused on context (information model), the content to be exchanged and the information interchange method itself. – This deferred work on infrastructure, security, workflow and policy issues. Healthcare Information Technology Standards Panel Healthcare Information Technology Standards Panel 6
Key Strategies for Standards Selection Evaluation � The Technical Committee then evaluated all of the remaining standards using the Tier 2 Readiness Criteria. � These criteria are prototypes and as such, are under evaluation. They are designed to document the evaluation process and to show, but not calculate, justification for selecting a standard. � The criteria include ONC preference for use of standards named by the Consolidated Health Informatics (CHI) and other federal initiatives. Selection � Based on the Tier 2 evaluations, named standards were selected. � It is important to understand that the standards selected here are within the context of the specific Use Case requirements and do not necessarily reflect selection in other contexts. � During the actual construction of Interoperability Specifications, the Technical Committee may need to refine this listing based on detailed analysis. Healthcare Information Technology Standards Panel Healthcare Information Technology Standards Panel 7
Biosurveillance Use Case Standards Selection Overview Simplification further performed at the Technical Committee Feasibility to accomplish within the time frame • Relevance • Use in community • Meet requirements for use case Number of standards by category (1) Context Information Model 17 (2) Information Exchange 46 (3) Terminology 28 (4) Security and Privacy 11 (5) Identifier (Individual and organization) 5 (6) Functionality and Process (workflow) 0 (7) Other 0 107 Total does not equal the 92 total standards since some standards meet more than one category, e.g. DICOM meets 5 categories Healthcare Information Technology Standards Panel Healthcare Information Technology Standards Panel 8
Biosurveillance Use Case Standards Selection Overview- Cont. Number of standards by organization 14 IETF 11 OASIS 10 HL7 6 ASTM, ASC X12 5 DICOM 4 ISO, CMS 3 W3C, NIST 2 FDA, ANSI/ADA 1 16 organizations (VA, Sabacare, Regenstrief, NLM, NCI, ITU, IEEE, ICH, FDA/NCPDP, CDISC, CDC Biosense, CDC & States, CDC, Snomed, California Health Foundation, AMA) Healthcare Information Technology Standards Panel Healthcare Information Technology Standards Panel 9
Biosurveillance- Building Blocks Overview Building Blocks (Integration Profiles <IP>) • Components of use cases that are reusable • Overlaps among the HITSP TCs potentially other efforts (e.g., IHE) • Common vocabulary – hierarchies of standardization and functional requirements are identified in the building blocks as they relate to use cases Healthcare Information Technology Standards Panel Healthcare Information Technology Standards Panel 10
Surveillance Document-based Data Submission Patient Encounter (Lab, EMR) Anonymize and Pseudonymize Existing Work Data (IP19) (Including managing free text) Recipient inverse capability Current Effort Verify Patient Consent, Authorizations, Derivative of Current Advance Directives (IP15) IHE BPPC (for reportable conditions, New Work Manage Provider Credentials for policy override for PH Disclosure) Machine only (IP26) Retrieve Form for Data Capture (IP39) IHE-RFD Evaluate ORM Maintain Consistent Time (Optional) Shared Document Resource across enterprises (IP54) IHE-XDS (IP22) IHE-CT (Document Source) Encounter Report Document (IP52) Digitally Sign Documents IHE-Medical Summary Verify authenticity of (Machine signature only) transmission contents (IP46) (IP4) IHE-DSG Laboratory Report Document (IP53) Shared Document Resource Collect and Communicate Audit Trail IHE-Lab Report Doc Provide Node Authentication & (IP54) IHE-XDS (Document Consumers: secured communication channel Radiology Report Document Public Health Systems/ (IP2, IP25) IHE-ATNA (IP49) Case Workers) Add authorization vocabulary for log IHE-Lab Report Doc XDS-Stored Query Healthcare Information Technology Standards Panel Healthcare Information Technology Standards Panel 11
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