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Technical Committee & Tiger Team Orientation August 25, 2009
Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS Vice President, Informatics, HIMSS
HITSP Standards Implementation Technical Manager
1HITSP: Enabling interoperability across the health care enterprise
The Panel’s Purpose
To harmonize and integrate diverse standards that will meet clinical and business needs for sharing information among organizations and systems.
Harmonized standards promote interoperability, enhance healthcare quality and contain costs
Establish HITSP Interoperability Specifications and promote their acceptance;
Support the deployment and implementation of HITSP Interoperability Specifications across the health care enterprise;
Facilitate the efforts of standards developing organizations to maintain, revise or develop new standards as required to support the HITSP Interoperability Specifications.
2HITSP: Enabling interoperability across the health care enterprise
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
3HITSP: Enabling interoperability across the health care enterprise
www.hitsp.org
HITSP Standards Harmonization
1. Identify a pool of standards for a general focus area
2. Identify gaps and overlaps for specific context
3. Make recommendations for resolution of gaps and overlaps
4. Develop Interoperability Specifications for using the selected standard(s) for a specific context
5. Test the instruction for using the standard
Open
Inclusive
Collaborative
Use Case/Request
driven
4HITSP: Enabling interoperability across the health care enterprise
Standards Readiness Criteria Tier I
The candidate standards required to support each Use Case/Request are organized within an agreed upon standards taxonomy
The candidate standards are examined using ‘HITSP approved’Harmonization Readiness Criteria
5HITSP: Enabling interoperability across the health care enterprise
Standards Readiness Criteria Tier II
Suitability The standard is named at a proper level of specificity and meets technical and business criteria of use case
Compatibility The standard shares common context, information exchange structures, content or data elements, security and processes with other HITSP harmonized standards or adopted frameworks as appropriate
Preferred Standards Characteristic Approved standards, widely used, readily available, technology neutral, supporting uniformity, demonstrating flexibility and international usage are preferred
Standards Development Organization and Process Meet selected criteria including balance, transparency, developer due process, stewardship and others
Total Costs and Ease of Implementation Deferred to future work
6HITSP: Enabling interoperability across the health care enterprise
Standards Harmonization GoalsTo achieve interoperability, harmonization must be achieved in 5 areas:
Context/Information Model – establishing a common reference information model to support clinical, public health, financial, and administrative healthcare functions
Terminology/Content Definition – establishing common reference terminology models and data content specifications that are integrated with the information model
Privacy and Security – establishing a common security framework
Methodology – establishing a common methodology/process that all standards organizations and code set maintainers will follow to achieve standards harmonization
Information Exchange – establishing a common information interchange format and standards-based application roles and interactions in a comprehensive dynamic model
7HITSP: Enabling interoperability across the health care enterprise
HHS Secretary Kathleen Sebelius
Project Management TeamExecutive in Charge, F. Schrotter, ANSI
Program Manager, L. Jones GSIDeputy PM, J. Corley, ATI
Project Manager, A. Peterson, Booz Allen
Project Management TeamExecutive in Charge, F. Schrotter, ANSI
Program Manager, L. Jones GSIDeputy PM, J. Corley, ATI
Project Manager, A. Peterson, Booz Allen
Standards Implementation
Technical Manager Joyce Sensmeier,
RN, HIMSS
Standards Implementation
Technical ManagerJoyce Sensmeier,
RN, HIMSS
Process Definition Technical Manager
Michelle Deane, ANSI
Process Definition Technical Manager
Michelle Deane, ANSI
HHS ONCHIT1PO, Carol Bean, PhD
HHS ONCHIT1PO, Carol Bean, PhD
John Halamka, MD HITSP Chair
Panel, Committees, and Tiger Teams
Team HHS ONC National HIT Coordinator, David
Blumenthal, MD
HHS ONC National HIT Coordinator, David
Blumenthal, MD
8HITSP: Enabling interoperability across the health care enterprise
Patients
Consumers
Employers
General Practitioners
Review Boards
Practice Guidelines
Residential Care Providers
Specialists
Payers
Suppliers
Hospitals
Outpatient Healthcare Providers
Government Agencies
HITSP and Its Stakeholders - Harmonizing and Integrating Standards To Meet Clinical and Business Needs
HITSP - volunteer-driven, consensus-based organization funded by the Department of Health and Human Services.
9HITSP: Enabling interoperability across the health care enterprise
Industry & Government Stakeholder Participation in HITSP
HITSP stakeholders are Subject Matter Experts that represent broad Healthcare stakeholders and the IT community
Panel Members – Board of Directors – Technical Committee Stakeholders
Year Number of Stakeholder Hours
Number of Stakeholders
2007 12,000 387
2008 19,000 520
2009 – to date 20,216 809
10HITSP: Enabling interoperability across the health care enterprise
HITSP Organization, Responsibility Sharing, and Interfacing
Coo
rdin
atio
n C
omm
ittee
sBoar
d
Tech
nica
lMan
agem
ent
Proj
ect M
anag
emen
t
Prog
ram
Man
agem
ent
ON
C
AH
IC
CC
HIT
SD
Os
Pane
l
Indu
stry
/ G
over
nmen
t
Tech
nica
l Com
mitt
ees
Tactical
Strategic
Participating Stakeholders Staff External Stakeholder
NHIN and CCHIT Joint Working Group
11HITSP: Enabling interoperability across the health care enterprise
In 2007 Three Technical Committees were formed to focus on the initial set of AHIC breakthrough areas
Care DeliveryConsumer
Empowerment Population Health
Technical Committees
• EHR – Lab Reporting
• Emergency Responder
– EHR
• Medication Management
• Consumer Empowerment
• Consumer Access to
Clinical Information
• Biosurveillance
• Quality
12HITSP: Enabling interoperability across the health care enterprise
2008 Technical Committee New Work & Resource Restructuring Plan
13HITSP: Enabling interoperability across the health care enterprise
Provider Perspective and Domain Technical Committees Collaborate on Standards Harmonization
Provider Perspective
Population Perspective
Consumer Perspective
Care Management and Health Records Domain Committee
Security, Privacy and Infrastructure Domain Committee
Administrative and Financial Domain Committee
14HITSP: Enabling interoperability across the health care enterprise 14
HITSP Priorities and Use Case Roadmap
15HITSP: Enabling interoperability across the health care enterprise
Extensions/Gaps/Use Cases 2009
General Lab Orders
Order Sets
Long Term Care – Assessment
Provider Consumer Population
Admin/Finance
Care Management/ Health Records
Scheduling
Prior-Authorization in Support of
Treatment, Payment, & Operations
Common Device Connectivity
Medical Home: Co- morbidity and
Registries
Medication Gaps
Clinical Note Details
Newborn Screening
Maternal & Child Health
Consumer Adverse Event Reporting
Quality Measures
Clinical Research
Consumer Preferences
Common Data Transport
SPI
16HITSP: Enabling interoperability across the health care enterprise
Provider PerspectiveIS 01 - Electronic Health Record (EHR) Laboratory Results Reporting
IS 04 - Emergency Responder Electronic Health Record (ER-EHR)
IS 08 - Personalized Healthcare
IS 09 - Consultations and Transfers of Care
Population PerspectiveIS 02 - Biosurveillance
IS 06 - Quality
IS 10 - Immunizations and Response Management
IS 11 - Public Health Case Reporting
Consumer Perspective• IS 03 ‐
Consumer Empowerment• IS 05 ‐
Consumer Empowerment and Access to Clinical Information via Media• IS 07 ‐
Medication Management• IS 12 ‐
Patient –
Provider Secure Messaging• IS 77 ‐
Remote Monitoring
17HITSP: Enabling interoperability across the health care enterprise
President Barack Obama announces an audacious plan: Computerize all health records within five years.
- January 12, 2009
2009 – Obama vows to continue the HIT Plan begun by President Bush
February 17, 2009 – the American Reinvestment and Recovery Act (ARRA) is signed into law
– HITECH Act component of ARRA provides a $19 billion program to stimulate the adoption and use of HIT, with a focus on meaningful use of certified EHR systems
18HITSP: Enabling interoperability across the health care enterprise
The VisionIn order to meet the ARRA statutory requirements, in April, 2009 HITSP focused its volunteers, staff, and leadership on supporting this effort
HITSP's “recognized” and “accepted” products to date were leveraged to create new streamlined electronically published standards guides organized around the ARRA EHR interoperability requirements instead of Use Cases
End result: much more compact, easy to implement, and flexible implementation guidance that supports meaningful use of EHRs and protection of privacy
19HITSP: Enabling interoperability across the health care enterprise
Starting Point – ARRA Requirements and Tiger Teams
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Perspective and Domain Technical Committees Collaborate on Interoperability Specification Development
Provider Perspective
Population Perspective
Consumer Perspective
Care Management and Health Records Domain Committee
Security, Privacy and Infrastructure Domain Committee
Administrative and Financial Domain Committee
2009 Technical Committee Structure
2009 Tiger TeamsData Architecture Quality Measures
Consumer Preferences
Clinical Research
21HITSP: Enabling interoperability across the health care enterprise
Technical Committee & Tiger Team LeadershipPopulation Perspective TC-Floyd P. Eisenberg, MD, MPH, National Quality Forum
-Eileen Koski, M. Phil, Medco Health Solutions, Inc
-Anna Orlova, PhD, Public Health Data Standards Consortium
Quality Measures Tiger Team-Floyd P. Eisenberg, MD, MPH, National Quality Forum
-Eileen Koski, M. Phil, Medco Health Solutions, Inc
Clinical Research Tiger Team -Walter Suarez MD, Kaiser Permanente
22HITSP: Enabling interoperability across the health care enterprise
Technical Committee & Tiger Team LeadershipConsumer Perspective TC
-Mureen Allen, MD, FACP, Active Health Management
-Charles Parisot, EHR Association
-Scott Robertson, PharmD, Kaiser Permanente
Provider Perspective TC
-Allen Hobbs, PhD, Kaiser Permanente
-Mike Lincoln, MD, Veterans Health Administration, US Dept of Veterans Affairs
-Steve Hufnagel, PhD, DoD
23HITSP: Enabling interoperability across the health care enterprise
Technical Committee & Tiger Team LeadershipSecurity, Privacy & Infrastructure Domain TC– Glen Marshall, Grok-A-Lot, LLC
– John Moehrke, GE Healthcare
– Walter Suarez, MD, Kaiser Permanente
Administrative and Financial Domain TC– Donald Bechtel, Siemens Medical Solutions
– Manick Rajendran, eZe Care LLC
– Durwin Day, Health Care Service Corporation
24HITSP: Enabling interoperability across the health care enterprise
Technical Committee & Tiger Team LeadershipCare Management and Health Record Domain TC– Keith Boone, GE Healthcare
– Corey Spears, McKesson
– Greg Alexander, PhD, RN, Alliance for Nursing Informatics
Data Architecture Tiger Team- Keith Boone, GE Healthcare
- Don Bechtel, Siemens Medical Solutions
Consumer Preferences Tiger Team-Scott Robertson, Pharm D, Kaiser Permanente
- Walter Suarez, MD, Kaiser Permanente
25HITSP: Enabling interoperability across the health care enterprise
Key HITSP DefinitionsHarmonization Request defines business or functional needs, within a workflow, and sets context and conditions for the interoperability specification. Behavioral specifications of functional needs or capabilities may be structured as use cases, scenarios, Business Process Models or other forms.
Stakeholder is a person or organization that uses or benefits from systems that interoperate.
System (previously known as Business Actor) is an IT system application that plays a role in one or more information exchanges addressed by a HITSP Interoperability Specification or Construct.
Capability describes a business process and specifies interoperable information exchanges using HITSP constructs. A Capability supports stakeholder requirements and business processes and includes workflow, information content, infrastructure, security and privacy.
Service Collaboration is a composition of constructs into a reusable workflow
26HITSP: Enabling interoperability across the health care enterprise
HITSP Program Management
Steps in the HITSP Harmonization Process
Receive Request to Harmonize
I
Conduct Requirements Analysis
II
Identify Candidate Standards
III
Identify and Resolve Gaps, Duplications and Overlap
IV
Select Standards
V
Develop Interoperability Specification
VI
Begin Inspection Testing
VII
Release and Disseminate Interoperability Specification
VIII
Begin Support
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A new concept - HITSP CapabilityProvides the ability for two or more systems to address a business need for interoperable information exchange. The objective is to provide the bridge between the business, policy and implementation disciplines by:– Defining a set of information exchanges at a level relevant
to policy and business decisions – Supporting stakeholder requirements and business
processes by including information content, infrastructure, Security, Privacy
– Specifying the use of HITSP constructs sufficiently for implementation.
– Including constraints and operating on specific network topologies (contexts)
Capabilities have topology and other options (e.g., point-to-point, portable media, system-to-HIE, HIE-to-HIE).
28HITSP: Enabling interoperability across the health care enterprise
HITSP Capabilities – Clinical Operations
Communicate Ambulatory and Long Term Care Prescription - CAP117
Communicate Hospital Prescription - CAP118
Communicate Clinical Referral Request - CAP121
Retrieve Genomic Decision Support - CAP125Communicate Lab Results Message - CAP126
Communicate Lab Results Document - CAP127
Communicate Imaging Information - CAP128
Retrieve and Populate Form - CAP135
Communicate Encounter Information Message - CAP137
29HITSP: Enabling interoperability across the health care enterprise
HITSP Capabilities – Public Health and Emergency Response; Administrative and Financial
Communicate Benefits and Eligibility - CAP140Communicate Referral Authorization - CAP141
Communicate Quality Measure Data - CAP129Communicate Quality Measure Specification - CAP130
Update Immunization Registry - CAP131Retrieve Immunization Registry Information - CAP132Communicate Immunization Summary - CAP133Communicate Emergency Alert - CAP136Communicate Resource Utilization - CAP139
30HITSP: Enabling interoperability across the health care enterprise
HITSP Capabilities - Security, Privacy, and Infrastructure
Communicate Structured Document - CAP119Communicate Unstructured Document - CAP120Retrieve Medical Knowledge - CAP122Retrieve Existing Data - CAP123Establish Secure Web Access - CAP124Retrieve Pseudonym - CAP138Retrieve Communications Recipient - CAP142Manage Consumer Preference and Consents - CAP143
31HITSP: Enabling interoperability across the health care enterprise
Some Details on Capabilities
Capabilities are specified using HITSP Constructs.
As part of the HITSP Tiger Team effort addressing ARRA, Capabilities are meant to clearly state what types of data can and cannot be “exchanged” using HITSP constructs
Note that during the ARRA Tiger Team effort, no new standards were selected, and no new constructs were specified to build capabilities. This restriction is not imposed on new work efforts
Requirements
Capability
SystemRoles
HITSPConstructs
Orchestration of HITSPConstructs and System Roles
32HITSP: Enabling interoperability across the health care enterprise
What is an example of a capability?
Requirement: An organization wants to exchange a prescription with an ambulatory organization. The diagram on the right shows how Capability 117 was assembled to support this requirement.
CAP117 – CommunicateAmbulatory and Long Term CarePrescription
System Roles• Medication Order
Prescriber• Medication Order Filler• Health Plan• Health Information
Exchange (HIE)
I want to exchange a prescription with an Ambulatory or Long-Term Care (LTC) Organization
33HITSP: Enabling interoperability across the health care enterprise
CapabilityCapability
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
34HITSP: Enabling interoperability across the health care enterprise
HITSP Framework – Refined
Business RequirementsIdentifies interoperability
business needs
Interoperability
Specification•
Identifies what HITSP
capabilities to use to
meet Business Needs•
Defines Requirements,
Context and Constraints
for those capabilities
Base Standard#1
Base Standard#n
Base Standard#2
Base Standard#...
CompositeStandard#1
CompositeStandard#...
CompositeStandard#m
SDOs
Component
Transaction
Transaction Package
Available for Internal reuse or repurposingComponent
TransactionConstructs
Transaction
Transaction
Package
HITSP ConstructsHITSP Capabilities
Component
ServiceCollaborations
ServiceCollaboration
TransactionConstructs
Transaction
Transaction
Package
34
35HITSP: Enabling interoperability across the health care enterprise
Service Collaboration Suite SC # Service Collaboration (SC) Title # of
Service
InterfacesSCxx1 Access Control 1SCxx2 Knowledge and Vocabulary 4SCxx3 Patient Identity 8SCxx4 Query for Existing Data 2SCxx5 Security Audit 1SCxx6 Healthcare Document Management 12SCxx7 Emergency Message Distribution Element 1
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Additional Keys To Simpler Definition and Implementation Of HITSP Specifications
36HITSP: Enabling interoperability across the health care enterprise
Service Collaborations
Business Needs
Secure Infrastructure
Service Collaborations and Capabilities – Develop New Technical Constructs as Needed
Standards
HITSP Transactions,Transaction Packages,
Components
Raw material
Basic Building Blocks
Capabilities
Interoperability Spec
If New ConstructNeeded
37HITSP: Enabling interoperability across the health care enterprise
1/20HITSP Panel
HITSP 2009 TC Timeline Overview Note: Quality Measures, Consumer Preferences, Clinical Research, Common Data Transport may deviate from the timeline below, as their timelines are further established they will be included as separate line items
Panel Approval
August 24, 2009
IRT Content, Editorial and Quality Review
Full TC Meetings
Holiday
Connectathon
4 Weeks
AUG SEPT OCT NOV DEC
11/3 – 11/5 TC F2F DC Area
8/25-8/27 TC F2F, Chicago9/8
HITSP Board
12/1 HITSP Board
12/15HITSP Panel
8/24 HITSP TCL, Chicago 11/2 HITSP TCL DC Area
Comment Draft IS Dev Insp Test/ CommentComment & Resolution
R&D (Requirements and Design) Development
2009 Work Items: Wave 1
WE ARE HERE
9/11
1 week 1 w
eek
(assum
ption is
F2F
Pub.)
JAN
3 week
s
(longer du
ration
due to
holida
ys)
6 Weeks 6.5 Weeks 1 Week
Pane
l Rev
iew9/18 10/16
10/30 11/612/4
12/23 1/13 1/20
1/11-1/15 Connectathon
2009 Work Items: Wave 2
1 week Comment Draft IS Dev
4 Weeks
9/11 10/9 10/16
15 Weeks
11/131/29
R&D (Requirements and Design) Development
Testing Support, Tooling Efforts, Foundations, NHIN Support, ARRA Gaps & Feedback from ONC
Short Term Items
Ongoing Efforts
August & SeptemberGeneralize/Conform SPI SCs/Capabilities, TC Plans for Transition, Gap Resolution
for Meaningful Use, Finalize Templates
38HITSP: Enabling interoperability across the health care enterprise
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.
Learn more at www.hitsp.org or contact . . .
39HITSP: Enabling interoperability across the health care enterprise
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