EHR Interoperability WG

The HL7 Electronic Health Record (EHR) Interoperability Work Group is an activity of the HL7 EHR Work Group.

Please subscribe to the HL7 EHR Interoperability listserver for meeting announcements, agendas and updates regarding current work.

NOTE: DRAFT documents may be incomplete and are posted for Team review and discourse. Please take care to note their draft (tentative) status if referencing or sharing with others.

HL7 EHR/PHR Standards

System Functionality Standards

• HL7 Electronic Health Record System Functional Model (EHR-S FM) Release 2, April 2014 (also published as ISO 10781)
• EHR-S FM Functional Profiles, revised 14 Jan 2019
• EHR-S FM Known National Initiatives, revised 16 May 2018
• US Department of Veterans Administration - VISTA Legacy EHR System Functions - Mapping to EHR-S FM Release 1.1
• HL7 Personal Health Record System Functional Model (PHR-S FM) Release 1, May 2014 (also published as ISO 16527)

Record Interoperability Standards

• ISO 21089 - Trusted End-to-End Information - Overview Presentation to S&I Data Provenance (DPROV) Community, Gary Dickinson, published 20 Nov 2014
• EHR Interoperability Model, Draft Standard for Trial Use, published Mar 2007
• EHR Lifecycle Model DSTU, published Feb 2008
• Implementation Guide for CDA Release 2: Reference Profile for EHR Interoperability DSTU, published Feb 2008

HL7 "Reducing Clinician Burden" (RCB) Project

Project team meets via teleconference on the 1st and 3rd Mondays each month - at 3PM ET (US). To join the teleconference: https://global.gotomeeting.com/meeting/join/798931918

• DRAFT Reducing Clinician Burden Project Overview, dated 18 Mar 2019
• DRAFT Reducing Clinician Burden Analysis Worksheet, DRAFT IN PROGRESS - COMMENTS ARE WELCOME!!, dated 18 Mar 2019

"See What We Mean"

• "See What We Mean" Video Clips, developed by Medstar Health - National Center for Human Factors in Healthcare - EHR Safety and Usability Team

HL7 RCB Project - Reducing Burden - Success Stories

• DRAFT Reducing Clinician Burden - Success Story Template, updated 28 Jan 2019
• Duke Heart Business Unit – Procedure Reporting, James Tcheng MD, posted 4 Feb 2019

US Office of National Coordinator for Health Information Technology (ONC) "Reducing Burden" Proposal and Draft for Comment

• ONC DRAFT "Strategy on Reducing Burden Relating to the Use of Health IT and EHRs", including Findings, Strategies and Recommendations, published 28 Nov 2018, comment period closed 28 Jan 2019
• HL7 Comments on ONC Draft Strategy, compiled by HL7 Policy Advisory Committee, submitted 28 Jan 2019
• CentriHealth (UnitedHealth Group) Comments on ONC Draft Strategy, submitted 28 Jan 2019

HL7 RCB Project - Focus Team Drafts

• DRAFT Team Report - Clinical Documentation: Quality and Usability - Lisa Masson MD, Lead, updated 7 Jan 2019
• DRAFT Team Outline - Clinical decision support, medical logic, artificial intelligence + Alerts, reminders, notifications, inbox management + Information overload - Jim McClay MD, Lead, updated 17 Jan 2019
• DRAFT Team Report - Clinical Workflow (Usability Focus) - David Schlossman MD, Lead, updated 21 Jan 2019
• DRAFT Root Cause Analysis - Clinical Workflow - David Schlossman MD, Lead, updated 18 Mar 2019
• DRAFT Team Report - Lock-In, Data Liquidity and Switching Costs - Michael Brody DPM, Lead, updated 15 Dec 2018
• DRAFT Team Report - Data Quality - Reed Gelzer MD, Lead, updated 4 Mar 2019

HL7 RCB Project - Reference Sources

• Fortune and Kaiser Health News - Death by a Thousand Clicks: Where Electronic Health Records Went Wrong, Erika Fry and Fred Schulte, published 18 Mar 2019
• HIStalk - To Douse the Flames of Physician Burnout, Target the Four Biggest Time-Wasters in the EHR, David Butler MD, published 13 Mar 2019
• Healthcare IT News - Epic CEO Judy Faulkner on Apple, docs who actually like their EHRs..., Mike Miliard, published 13 Feb 2019
• Thrive Global - Here’s Why Physician Burnout is Officially “A Public Health Crisis”, Jane Burnett, 31 Jan 2019
• US Office of the National Coordinator for Health Information Technology (ONC) - DRAFT FOR COMMENT - Strategy on Reducing Burden Relating to the Use of Health IT and EHRs, published 28 Nov 2018, comments due 28 Jan 2019
• Health Data Management, AMA president calls for end to electronic health record abuse, Greg Slabodkin, published 14 Nov 2018
• The New Yorker/Annals of Medicine - Why Doctors Hate Their Computers, Atul Gawande, published 12 Nov 2018
• US Centers for Medicare/Medicaid Services - Clinician Letter - Reducing Documentation Burden and Coding Reform, Seema Verma, published 8 Nov 2018
• Health Data Management - Study links stress from EHR use to physician burnout, Greg Slabodkin, 6 Nov 2018
• Thoughts on addressing the clinician burden issue, Alpo Värri, Tampere University of Technology (Tampere, Finland), CEN TC251 WG II, published 16 Oct 2018
• Reducing Clinician Burden - Baltimore Presentation, David J Freedman DPM FACFAS FASPS CPC CPMA, published 4 Oct 2018
• Health Affairs - Patient-Centered, Value-Based Health Care Is Incompatible With The Current Climate Of Excessive Regulation, John O'Shea, published 3 Oct 2018
• National Academy of Medicine - Implementing Optimal Team-Based Care to Reduce Clinician Burnout, Cynthia D. Smith, Celynne Balatbat, Susan Corbridge, Anna Legreid Dopp, Jessica Fried, Ron Harter, Seth Landefeld, Christina Y. Martin, Frank Opelka, Lew Sandy, Luke Sato, Christine Sinsky, published 17 Sep 2018
• American College of Surgeons - EHRs add to surgeons’ administrative burdens - The ACS responds, Vinita Ollapally JD, published 1 Sep 2018
• Association of American Medical Colleges, AAMCNews - Electronic health records: What will it take to make them work? Peter Jaret, published 21 Aug 2018
• HIMSS Analytics Research Findings - Frequent Interruptions Distract Clinicians from Patient Care, Contribute to Stress and Burnout, published 22 May 2018
• Annals of Internal Medicine - Physician Burnout in the Electronic Health Record Era: Are We Ignoring the Real Cause? N Lance Downing MD, David W Bates MD MSc, Christopher A Longhurst MD MS, published 8 May 2018
• EHR Intelligence - Physicians urge CMS to Adjust the 2018 MIPS Reporting Period from One Year to 90 days for Reduced Administrative Burden, Kate Monica, published 23 Apr 2018
• Health Data Management - Seven Challenges Physicians Face Accessing Patient Data, Joseph Goedert, published 18 Apr 2018
• Predictors of physicians’ stress related to information systems: A nine-year follow-up survey study. BMC Health Services Research, Tarja Heponiemi, Hannele Hyppönen, Sari Kujala, Anna-Mari Aalto, Tuulikki Vehko, Jukka Vänskä, Marko Elovainio, published 13 Apr 2018
• EHR Intelligence - NQF Advises CMS Align Quality Measures, Cut Administrative Burden, Kate Monica, published 3 Apr 2018
• Journal of General Internal Medicine - Keystrokes, Mouse Clicks, and Gazing at the Computer: How Physician Interaction with the EHR Affects Patient Participation, Richard L. Street Jr, Lin Liu, Neil J. Farber, Yunan Chen, Alan Calvitti, Nadir Weibel, Mark T. Gabuzda, Kristin Bell, Barbara Gray, Steven Rick, Shazia Ashfaq, Zia Agha, published April 2018
• Physician Practice - Reducing Clinician Burnout in Five EHR-Related Areas, Gabriel Perna, published 9 Mar 2018
• Healthcare Informatics - Clinicians to CMS, ONC: “Right the Ship” to Simplify Reporting, Ease Regulatory Burdens, Heather Landi, published 13 Feb 2018
• Journal of General Internal Medicine - Electronic Health Records: a “Quadruple Win,” a “Quadruple Failure,” or Simply Time for a Reboot?, Michael Hochman, published 5 Feb 2018
• American Academy of Family Physicians - AAFP (letter to CMS/ONC regarding) Recommendations to Reduce Clinician Burden from Health Information Technology, John Meigs MD, published 2 Feb 2018
• American College of Surgeons - Regulatory Burden Reduction, Lauren Foe MPH, published 1 Feb 2018
• EHR Intelligence - EHR Use, Administrative Burden Accelerating Physician Burnout, Kate Monica, published 16 Jan 2018
• Applied Clinical Informatics - Consensus Statement: Feature and Function Recommendations to Optimize Clinician Usability of Direct Interoperability to Enhance Patient Care, Steven R Lane, Holly Miller, Elizabeth Ames, Lawrence Garber, David C Kibbe, Joseph H Schneider, Christoph U Lehmann, published 21 Jan 2018
• Stanford Medicine/The Harris Poll - How Doctors Feel About Electronic Health Records, Results of a national physician poll, 2018
• Dark Daily - EHR Systems Continue to Cause Burnout, Physician Dissatisfaction, and Decreased Face-to-Face Patient Care, published 22 Dec 2017
• EHR Intelligence - American Association of Physician Assistants - AAPA EHR Toolkit Offers Best Practices for EHR Design, Usability , Kate Monica, published 8 Dec 2017
• HITECH Answers - CMS Finalizes Policies that Reduce Provider Burden and Lower Drug Prices, published 2 Nov 2017
• Finnish physicians’ stress related to information systems keeps increasing: A longitudinal three wave survey study, Tarja Heponiemi, Hannele Hyppönen, Tuulikki Vehko, Sari Kujala, Anna-Mari Aalto, Jukka Vänskä, Marko Elovainio, published 17 Oct 2017
• Annals of Family Medicine - Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations, Brian G. Arndt, MD, John W. Beasley, MD, Michelle D. Watkinson, MPH, Jonathan L. Temte, MD, PhD, Wen-Jan Tuan, MS, MPH, Christine A. Sinsky, MD, Valerie J. Gilchrist, MD, published Sep 2017
• National Academy of Medicine - Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care, Lotte N. Dyrbye, Tait D. Shanafelt, Christine A. Sinsky, Pamela F. Cipriano, Jay Bhatt, Alexander Ommaya, Colin P. West, and David Meyers, published 5 Jul 2017
• American College of Physicians - Putting Patients First by Reducing Administrative Tasks in Health Care, Shari M. Erickson MPH, Brooke Rockwern MPH, Michelle Koltov MPH, Robert M. McLean MD, published 2 May 2017
• Deloitte Survey of US Physicians - Findings on health information technology and electronic health records, published 3 Oct 2016
• EHR Intelligence - Tips for Reversing Physician Burnout Caused by EHR Use, Sheri Stoltenberg, published 16 Oct 2016
• FierceHealthcare - Intermountain's Marc Probst - We're not close to solving interoperability, Dan Bowman, published 28 Sep 2016
• EHR Burden Weighs Heavily on Physicians, Leads to Burnout, Diana Phillips, published 6 Sep 2016
• EHR Intelligence - EHR Use Continues to Contribute to Physician Burnout, Kyle Murphy PhD, published 20 Jun 2016
• Five Usability Barriers Preventing Health IT From Supporting Clinician Needs, David M. Schlossman, MD, PhD, FACP, MS (Informatics), CPHIMS and Nancy Staggers, PhD, RN, FAAN, published 16 Jun 2016
• Health Affairs - Make The Clinician Burnout Epidemic A National Priority; Andrew Shin, Tejal Gandhi, Shoshana Herzig; published 21 Apr 2016
• Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine, Lisa Rosenbaum, M.D.; published 22 Oct 2015
• Electronic Health Record Vendor Adherence to Usability Certification Requirements and Testing Standards, Raj M Ratwani PhD, Natalie C Benda BS, A Zachary Hettinger MD MS, published 8 Sep 2015
• Alliance for Nursing Informatics/Computers Informatics Nursing - Nursing centric technology and usability: A call to action, Nancy Staggers PhD RN FAAN, Beth L Elias PhD MS, Jane R Hunt MS BSN RN, Ellen Makar MS RN-BC CCM CPHIMS CENP, Gregory L Alexander PhD RN FAAN, published Aug 2015
• Journal for Electronic Health Data and Methods - Improving Clinical Workflow in Ambulatory Care: Implemented Recommendations in an Innovation Prototype for the Veteran’s Health Administration, Emily S Patterson PhD, Svetlana Z Lowry PhD, Mala Ramaiah MD, Michael C Gibbons MD, David Brick, MD, Robert Calco, Greg Matton JD, Anne Miller PhD, Ellen Makar MSN RN-BC CPHIMS CCM, and Jorge A Ferrer MD MBA LSA, published 9 Jul 2015
• Journal of the American Medical Informatics Association - Electronic health record usability: analysis of the user-centered design processes of eleven electronic health record vendors, Raj M Ratwani, Rollin J Fairbanks, A Zachary Hettinger, Natalie C Benda, published 6 Jun 2015
• American Medical Informatics Association - Report of the AMIA EHR-2020 Task Force on the status and future direction of EHRs; Thomas H Payne, Sarah Corley, Theresa A Cullen, Tejal K Gandhi, Linda Harrington, Gilad J Kuperman, John E Mattison, David P McCallie, Clement J McDonald, Paul C Tang; published 26 May 2015
• Journal of the American Board of Family Medicine - Physician Information Needs and Electronic Health Records (EHRs): Time to Reengineer the Clinic Note, Richelle J. Koopman MD MS, Linsey M. Barker Steege PhD, Joi L. Moore PhD, Martina A. Clarke MS, Shannon M. Canfield MPH, Min S. Kim PhD and Jeffery L. Belden MD, published May 2015
• Annals of Internal Medicine, American College of Physicians - Clinical Documentation in the 21st Century, Thomson Kuhn, MA; Peter Basch, MD; Michael Barr, MD, MBA; Thomas Yackel, MD, MPH, MS, published 17 Feb 2015
• Indianapolis Business Journal - The tragedy of electronic medical records, JK Wall, 23 Oct 2014
• American Medical Association - Improving Care: Priorities to Improve Electronic Health Record Usability, published 2014
• RAND Report - Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy, Mark W. Friedberg, Peggy G. Chen, Kristin R. Van Busum, Frances Aunon, Chau Pham, John Caloyeras, Soeren Mattke, Emma Pitchforth, Denise D. Quigley, Robert H. Brook, F. Jay Crosson, Michael Tutty, published 2013
• Population Health Management - The Complexity of Disease Combinations in the Medicare Population, James Sorace, Hui–Hsing Wong, Chris Worrall, Jeffrey Kelman, Shahin Saneinejad, and Thomas MaCurdy, published 11 Aug 2011
• Journal of the American Medical Informatics Association - Health information technology: fallacies and sober realities, Ben-Tzion Karsh, Matthew B Weinger Patricia A Abbott, and Robert L Wears, published 30 Apr 2010
• CMS/ONC Reducing Clinician Burden Conference - Comments Submitted by CentriHealth, Gary Dickinson, dated 22 Feb 2018

CURRENT US Notices of Proposed Rule-Making

• US Centers for Medicare and Medicaid Services - Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans in the Federally-facilitated Exchanges and Health Care Providers, posted 4 Mar 2019, comments due 3 May 2019
• US Office of National Coordinator for Health Information Technology - 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program, posted 4 Mar 2019, comments due 3 May 2019

US Office of National Coordinator (ONC), Trusted Exchange Framework/Common Agreement (TEFCA)

• TEFCA Press Release, DRAFT Documents and Request for Comment, published 5 Jan 2018
• CentriHealth Comments on DRAFT TEFCA, Gary Dickinson, dated 20 Feb 2018
• Health Record Banking Alliance (HRBA) Comments on DRAFT TEFCA, dated 20 Feb 2018

US Office of National Coordinator (ONC), Technical Interoperability Forum, 15-16 August 2017

• Agendas, Panel Presentations, Discussions and Input

US Office of National Coordinator (ONC), Interoperability Forum, 6-8 August 2018

• Agendas, Panel Presentations, Discussions and Videos

US Office of National Coordinator (ONC), "Record to Rely On" Workshop, 29 November 2016

Leads: Mark Knee JD, Elise Sweeney Anthony JD, Mike Lipinski JD

• Truth (Authenticity) as Evidence for Trust (Assurance), slide set developed/presented by Gary Dickinson, dated 29 Nov 2016
• "Record to Rely On" Documents and Links

US Office of National Coordinator - Interoperability Standards Advisory (ISA)

• ISA 2019 Edition
• ISA 2018 Edition
• ISA 2017 Edition

HL7 FHIR Standard Release 4

• HL7 Fast Health Interoperable Resources (FHIR) R4 - Main Page, published Jan 2019

FHIR EHR-S Record Lifecycle Event Implementation Guide

• FHIR EHR-S Record Lifecycle Event Implementation Guide, based on ISO/HL7 10781:2014 Electronic Health Record System Functional Model (EHR-S FM) Release 2, Record Infrastructure Section, published as part of FHIR R4, Jan 2019

FHIR AuditEvent and Provenance Profiles

• FHIR EHR-S Record Lifecycle Event - AuditEvent Profile, published as part of FHIR R4, Jan 2019
• FHIR EHR-S Record Lifecycle Event - Provenance Profile, published as part of FHIR R4, Jan 2019

FHIR Five W's Pattern (Who, What, When, Where, Why)

• FHIR Five W's Pattern, Pursuing Alignment of Five W's and Key Meta-Data Elements across FHIR Resources, published as part of FHIR R4, Jan 2019

FHIR Implementer's Safety Check List

• FHIR Implementer's Clinical Safety Check List, published as part of FHIR R4, Jan 2019

Interoperability Assessment

• US Office of the National Coordinator for Health Information Technology (ONC); Medicare Access and CHIP Reauthorization Act of 2015; Request for Information Regarding Assessing Interoperability for MACRA
• Comments on Interoperability Assessment for MACRA, Gary Dickinson, CentriHealth, 3 Jun 2016
• Comments on Proposed ONC Interoperability Standards Measurement Framework, Gary Dickinson, CentriHealth, 31 July 2017

Blockchain for Health/Healthcare (Public Journal)

• The Potential for Blockchain to Transform Electronic Health Records, John D. Halamka MD, Andrew Lippman, Ariel Ekblaw, published by Harvard Business Review, 3 March 2017
• Use of Blockchain for Medication Reconciliation, Ariel Ekblaw, Asaph Azaria, John D. Halamka MD, Andrew Lippman, Joint Submission by Massachusets Institute of Technology (MIT) Media Lab and Beth Israel Deaconess Medical Center (BIDMC), Winner of ONC Blockchain Challenge, August 2016

International Patient Summary (INTERPAS/IPS)

• DRAFT Data Integrity Conformance Criteria for the International Patient Summary (applicable to EHR, PHR or other system as source/sender or receiver), revised 23 Oct 2016
• International Patient Summary (IPS) – Ensuring Content Authenticity in Primary Clinical Use, Gary Dickinson, CentriHealth, revised 9 Nov 2017

PUBLICATION PACKAGE - Meaningful Use 2015 Edition Functional Profile

Leads: Gary Dickinson, Anneke Goossen, Michael Van Der Zel

• Meaningful Use 2015 Edition Functional Profile - Overview, dated 12 Dec 2017
• Meaningful Use 2015 Edition - Compiled Profile, dated 12 Dec 2017
• Meaningful Use 2015 Edition - Analysis Worksheet, dated 12 Dec 2017

Meaningful Use 2015 Edition Functional Profile (of ISO/HL7 10781 EHR-S FM Release 2)

Leads: Gary Dickinson, Mark Janczewski MD, Anneke Goossen

• Meaningful Use 2015 Edition Functional Profile - Ballot Reconciliation Worksheet - revised 5 Sep 2017
• DRAFT Meaningful Use 2015 Edition Functional Profile Analysis Worksheet (with Ballot Reconciliation updates), revised 5 Sep 2017
• Meaningful Use 2015 Edition Functional Profile - Ballot Package, Dec 2016
• Meaningful Use 2015 Edition, Certified Health Information Technology (CHIT), Test Procedures

Meaningful Use 2014 Edition Functional Profile (of ISO/HL7 10781 EHR-S FM Release 2)

Leads: Gary Dickinson, Diana Warner, Hetty Kahn, Anneke Goossen

• Meaningful Use Functional Profile - Overview - 28 Jul 2014
• Meaningful Use Functional Profile - Test Procedure Analysis Worksheet - Ready for Informative Ballot, revised 14 Jul 2014
• Meaningful Use Stage 1 (2011), EHR Certification Criteria, 45 Test Procedures
• Meaningful Use Stage 2 (2014), EHR Certification Criteria, 50 Test Procedures
• DRAFT Crosswalk - US Meaningful Use Stage 2 Certification Criteria (as proposed for 2014 on) and ISO/HL7 10781 EHR System Functional Model Release 2 Functions and Conformance Criteria, revised 7 May 2012

EHR as Legal Record Project

Leads: Gary Dickinson, Reed Gelzer MD, Diana Warner

• EHR as Legal Record Documents and Drafts

Record Entry Lifecycle Event Metadata using FHIR (Fast Health Interoperable Resources) - Project Now Complete

Lead: Gary Dickinson

• Fast Health Interoperable Resources (FHIR) Main Page
• Current FHIR Resource Index
• DRAFT EHR-S FM Record Lifecycle Events on FHIR - OVERVIEW, Gary Dickinson, 26 Jun 2015
• FHIR DSTU-2 Record Lifecycle Event Implementation Guide (Ballot Draft), 3 Apr 2015
• DRAFT FHIR DSTU-2 Record Lifecycle Event Implementation Guide, Gary Dickinson, 10 Sep 2015
• DRAFT FHIR W5 Report Analysis and Planning for October FHIR Connectathon 10 - OVERVIEW, Gary Dickinson, 11 Sep 2015
• FHIR W5 Report (Continuous Build Version), FHIR Management Group
• DRAFT FHIR W5 Analysis Worksheet, Gary Dickinson, 21 Aug 2015
• DRAFT Use Case - Security Audit Prompts Investigation, Glen Marshall, 10 Sep 2015
• DRAFT Use Case - Pharmacy Medication Tracking, Julia Chan, 11 Sep 2015
• Reflections on AuditEvent and Provenance, Grahame Grieve, 12 Aug 2015
• DRAFT FHIR W5 Recommendations, Gary Dickinson, 30 Sep 2015
• DRAFT AuditEvent.Object.lifecycle Code Set (as proposed), Gary Dickinson, 15 Mar 2015
• DRAFT EHR-S FM Record Lifecycle Events on FHIR - USE CASE WORKSHEET, Gary Dickinson, 29 Aug 2014
• DRAFT S&I Data Provenance System Event Matrix, Gary Dickinson, 30 Nov 2015
• Introduction to ISO/HL7 Standards for EHR Record Lifecycle and Lifespan, Gary Dickinson, presented 26 Jun 2014 to S&I Data Provenance Community Teleconference
• EHR Record Lifecycle Events and Data Provenance Across S&I Initiatives, Gary Dickinson, 2 July 2014
• S&I Data Provenance Examples - User Stories with Record Lifecycle & Provenance Events, Gary Dickinson, 18 Aug 2014
• Record Entry Lifecycle Event Metadata using FHIR Project Scope Statement, 22 Jul 2014
• Patient, Provider, Community Pharmacy Perspectives - Presentation, Version 11, Julia Chan, work in progress
• Patient, Provider, Community Pharmacy Perspectives - Scenario Worksheet, Julia Chan, work in progress
• FHIR Resources - States and State Transitions - 1 min Video - Julia Chan, work in progress
• FHIR Financial Domain - Resource/Attribute States and Statuses - Julia Chan

Record Lifecycle, Provenance and Vocabulary Alignment - Project Now Complete

Record Lifecycle, Security, Privacy, and Provenance Vocabulary Alignment

Leads: Reed Gelzer, MD, Diana Proud-Madruga

• EHR Record Lifecycle Event Model supporting Vocabulary, Mike Davis and Diana Proud-Madruga, 11 May 2016
• 2014-06-10 EHR Interop Teleconference: Methodology for Action / Operation Taxonomy by Tony Weida, [1]
• 2014-06-10 EHR Interop Teleconference: Verb Harmonization Matrix, Definitions and Notes
• 2014-06-03 EHR Interop Teleconference: EHRS FM Verbs vs. Record Lifecycle Events vs. Security Verbs

REFERENCES

• Project Scope Statement for Vocabulary Alignment Project, revised 22 Jul 2014, as approved by Security WG
• Way with Verbs, Diana Proud-Madruga, linked 27 May 2014
• EHR Action Verbs and Security Operations, Tony Weida, presented 7 May 2014 to HL7 EHR WG meeting in Phoenix
• Mind Map of HL7 Security and Privacy Ontology, Diana Proud-Madruga, presented 7 May 2014 to HL7 EHR WG meeting in Phoenix
• EHRS FM Verbs vs. Record Lifecycle Events vs. Security Verbs, Steve Hufnagel, presented 7 May 2014 to HL7 EHR WG meeting in Phoenix
• EHRS FM Release 2 Verb Hierarchy
• HL7 Electronic Health Record Lifecycle Model - Draft Standard for Trial Use, published Jan 2008
• Lifecycle Events in ISO/HL7 Standards, revised 26 Jun 2014
• EHRS FM Functions – Relationship to Record Lifecycle Events and Audit Triggers, revised 23 April 2014
• EHRS FM Record Infrastructure - Record Lifecycle Events (RI.1.1.x) with Corresponding Metadata Requirements (RI.1.1.x.1) - Worksheet, revised 25 Feb 2013
• EHRS FM Record Lifecycle Events - Opportunity for Standards Convergence?, revised 30 May 2013
• 2014-06-10 EHRS-FM vs. Record Lifecycle vs Security Verb Harmonization Matrix & Definitions.xlsx
• 2014-09-02-P EHR Verb Categorization by Record Entry Events.docx

US ONC Standards and Interoperability Framework

2011-2016 Use Case Initiatives - Transitions of Care, Lab Results, Provider Directory, Digital Certificate, et al.

• Link to ONC S&I Framework Initiative Wiki Pages

Cross Initiative Work Group - S&I Simplification

• Link to ONC S&I Simplification (cross-initiative Work Group) Wiki Page
• Link to ONC S&I Simplification Reference Materials Wiki Page
• S&I Simplification Overview, published 8 Aug 2014
• DRAFT Simplification Core Matrix, Version 3.4, published 28 Dec 2015

ISO/HL7 10781:2017 EHR-S FIM Release-3 2014-Planning

Gary Dickinson, co-chair and Steve Hufnagel PhD, project-facilitator

EHR-S FIM is EHR System Function-and-Information Model, release-3 planned for '2017 joint ISO/HL7-International ballot

• Release 3 - Analysis of Immunization Administration (CP.6.2) Conformance Criteria, Gary Dickinson, revised 20 Feb 2015
• Release 3 - EHR-WG_Jan-2014_TSC-Presentation
• Release 3 - Jan 2014 Immunization-Management Prototype-Report for San Antonio WG Presentation
• Release 3 - Dec 2013 Immunization-Management Prototype Requirements-Specifications, Use-Cases, Information Models and Scenarios
• Release 3 - Dec 2013 EHR-S FIM Summary Report
• Release 3 - Dec 2013 EHR-S FIM Summary Presentation
• Release 3 - Dec 2013 EHR and PHR System Reference Model, presented l7-Dec-2013
• Release 3 - Nov 2013 EHR-S FIM Summary Report
• Release 3 - Nov 2013 EHR-S FIM Summary Presentation
• Release 3 - Nov 2013 CP.6.2 Immunization-Management Interoperability-Specification Prototype
• Release 3 - Oct 2013 EHR-S FIM Summary Report
• Release 3 - Oct 2013 EHR-S FIM Summary Presentation
• Release 3 - Jun 2013 EHR-S FIM Overview and Objectives, Steve Hufnagel, revised 4 June 2013

EHR-S and PHR-S FIM, Release-3 2012 Prototype

Steve Hufnagel, Facilitator and Gary Dickinson, co-chair

PURPOSE

- add conceptual information and data model for each Release 2.0 EHR-S FM function
- make the EHR-S FM easier  to use for architects, analysts and engineers
- verify and validate EHR-S FM Release 2.0
- DSTU demonstration for Service Aware Interoperability Framework (SAIF) 
- Support specific profiles (e.g., WG project DAMS, DIMS, DCMS).

REFERENCE DOCUMENTS

• EHRS FIM (for EHR-S FM R2.1), Immunization Example, revised 8 Nov 2011
• File:HL7 Project Scope Statement for EHR-S FIM 2012-1-3.doc
• File:EHR-S FIM Request for PSS co-sponsorship 2012-01-02-E.pptx
• File:ISO 13940 Continuity-of-Care Concepts Jan-11.pptx
• UML: You can download the current Sparx EA EAP file for the models at: https://www.dropbox.com/s/vzilknooyzv9c5f/EHR-S%20FIM.eap

IMMUNIZATION MAGAGEMENT PROTOTYPE

• Executive Summary for EHR-S FIM Immunization Management Capability and its Function and Information Models, 9-Feb-12 (Original), 15-Mar-12 (Last Update)
• CP.1.2_Manage_Allergy,_Intolerance_and_Adverse_Reaction_List, 23-Jan-12 (Original), 24-Feb-12 (Last Update)‎
• CP.1.3_Manage_Medication_List, 23-Jan-12 (Original), 24-Feb-12 (Last Update)
• CP.1.6 Manage Immunization List, 14-Jan-12 (Original), 24-Feb-12 (Last Update)
• CP.3.3 Manage Clinical Documents and Notes, 14-Jan-12 (Original), 24-Feb-12 (Last Update)
• CP 6.2 Manage Immunization Administration, 5-Dec-11 (Original), 28-Feb-12 (Last Update)
• CPS.1.7.2 Manage Patient Advance Directives, 20-Jan-12 (Original), 24-Feb-12 (Last Update)
• CPS.3.9 Clinical Decision Support System Guidelines Updates, 27-Jan-12 (Original), 24-Feb-12 (Last Update)
• CPS.9.4_Standard_Report_Generation, 27-Jan-12 (Original), 24-Feb-12 (Last Update)
• AS.4.1_Manage_Registry_Communication, 27-Jan-12 (Original), 24-Feb-12 (Last Update)

ORDERS MAGAGEMENT PROTOTYPE

• Executive Summary for EHR-S FIM Orders Management Capability and its Function and Information Models, 18-Apr-12 (Original), 5-Jul-12 (Last Update)

RESULTS MAGAGEMENT PROTOTYPE

• Executive Summary for EHR-S FIM Orders Management Capability and its Function and Information Models, 29-May-12 (Original), 5-Jul-12 (Last Update)

RECORDS INFRASTRUCTURE (RI) PROTOTYPE

• RI.1.1.3 Translate Record Entry Content, 13-Mar-12 (Original), 23-Aug-12 (Last Update)

US HITECH Act - EHR Incentive Program - Stage 1 - Final Regulations (2011 Edition)

• Meaningful Use - CMS Stage 1 - Electronic Health Record Incentive Program - Final, published 28 Jul 2010
• Meaningful Use - CMS Stage 1 - Measures, published 28 Jul 2010
• Meaningful Use - ONC Stage 1 - Standards, Implementation Specifications and Certification Criteria, published 28 Jul 2010
• Meaningful Use - ONC Stage 1 - Certification Program - Final, published 7 Jan 2011
• HITECH White Board Story - Stage 1, Version 1, courtesy of the late Robin Raiford, published 2 Aug 2010
• HITECH White Board Story - Stage 1, Version 2, courtesy of the late Robin Raiford, published 5 Jun 2011

US HITECH Act - EHR Incentive Program - Stage 2 - Final Regulations (2014 Edition)

• Meaningful Use - CMS Stage 2 - Electronic Health Record Incentive Program - Final, Bookmarked Version courtesy of the late Robin Raiford (Advisory Board), Rule published 4 Sep 2012
• Meaningful Use - ONC Stage 2 - Standards, Implementation Specifications and Certification Criteria - Final, Bookmarked Version courtesy of the late Robin Raiford (Advisory Board), Rule published 4 Sep 2012
• HITECH White Board Story - Stage 2, Version 1, courtesy of the late Robin Raiford (Advisory Board), published 10 Feb 2014
• Quick Guide Comparison―Stage 1 to Stage 2 Objectives and Measures, courtesy of the late Robin Raiford (Advisory Board), published 7 Sep 2012

US HITECH Act - EHR Incentive Program - Stage 3 - Final Regulations (2015 Edition)

• Meaningful Use - CMS Stage 3 - Electronic Health Record Incentive Program - Final, published 16 Oct 2015
• Meaningful Use - ONC Stage 3 - Standards, Implementation Specifications and Certification Criteria - Final, published 16 Oct 2015

US ONC Final 10 Year Interoperability Roadmap

• Final 10 Year Interoperability Roadmap, published 6 Oct 2015
• "Comments on ONC Interoperability Roadmap", Gary Dickinson, CentriHealth, 3 Apr 2015

US ONC Advance Notice of Proposed Rulemaking

Metadata Standards to Support Nationwide Electronic Health Information Exchange

• 45 CFR Part 170 RIN 0991-AB78, as proposed, Federal Register publication date 9 Aug 2011

ISO 16223 - Standards Convergence to Promote EHR Interoperability

• DRAFT Standards Convergence Slide Set, revised 5 October 2009 ("Standards Convergence" accepted as Preliminary Work Item by ISO TC215, April 2010)
• DRAFT EHR Source Journal, Supplement to Standards Convergence Work Item, revised 3 Dec 2009

Key Reference Documents

• "End-to-End Interoperability of Health Data/Records - Validation Framework to ensure Affirmative Trust Decision", Gary Dickinson, CentriHealth, 14 May 2018
• "Safe, Effective and Secure Health Software and Health IT Systems, including those incorporating Medical Devices", Sari Palojoki, published Mar 2017
• "Benefits of Interoperable Electronic Health Information", outline prepared for US Department of Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation (ASPE), Gary Dickinson, CentriHealth, 22 November 2016
• "Comments on ONC 2015 Standards Advisory", Gary Dickinson, CentriHealth, 1 May 2015
• "Comments on MU3 NPRM for System Certification", Gary Dickinson, CentriHealth, 29 May 2015
• "Truth, Trust, Fitness for Use (Purpose)", Gary Dickinson, CentriHealth, 10 Mar 2015
• "Achieving Interoperability and Safe Exchange of Health Information/Records - How Meaningful Use Stage 2 Falls Short", Gary Dickinson, CentriHealth, 26 Aug 2013
• EU/US eHealth Cooperation Initiative - "Interoperability", Gary Dickinson, CentriHealth, 17 Feb 2014
• "Interoperability Framework Overview", Presentation to HIT Standards Committee, Doug Fridsma, MD, PhD, 24 Mar 2010
• "Coming to Terms" White Paper on Interoperability, Pat Gibbons ( Mayo Clinic) et al, published Mar 2007
• "Integrating Standards to Achieve Semantic Interoperability", NHS Connecting for Health (UK), Dr. Ken Lunn, Director of NHS Data Standards and HL7 Board Member, Presentation to HL7/OMG Service Oriented Architecture Conference, Apr 2008
• EHR WG Document Library

2009 ANSI HITSP Foundations Framework Simplification Strategy

• HITSP - Simplification Strategy Slide Set
• HITSP - 2006 Biosurveillance Example (Includes references from Slide Set)
• HITSP - Use Case Template (for additional ONC/AHIC or other Use Cases)