EHR Interoperability WG

Following is a collection of documents and development work of the HL7 Electronic Health Record (EHR) Interoperability Work Group (an activity of the HL7 EHR Work Group). The Work Group meets Tuesdays at 2PM ET for 60 minutes. All are welcome! (Please subscribe to the HL7 EHR Interoperability listserver for meeting announcements, agendas and updates on 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.

Co-Facilitators

Gora Datta, gora@cal2cal.com

Gary Dickinson, gary.dickinson@ehr-standards.com

HL7 EHR System Functional Model Release 2

Ballot in Progress

• December 2011 Ballot Package, Ready for Joint Ballot (HL7, ISO TC215, CEN TC251, IHTSDO, CDISC), HL7 Ballot Scheduled to Open in April 2012

HL7 EHR Interoperability Activities

• EHR Interop Activities Slide Set, revised 15 May 2011
• DRAFT HL7 Services-Aware Interoperability Framework (SAIF)/EHR Interoperability/Lifecycle Model Process/Record Strata Services, revised 11 Jan 2011
• DRAFT Meta-Data Crosswalk - EHR Interoperability Model DSTU, Records Management/Evidentiary Support (RM-ES) Functional Profile, Clinical Document Architecture Release 2 (CDA), by Michelle Dougherty, RM-ES Co-Facilitator, revised Oct 2010
• Clinical Document Architecture Release 3 Formal Proposals, including embedded Access Controls and Lifecycle Audit events, as per HL7 EHR Interoperability and Lifecycle Model DSTUs, revised 1 Oct 2009
• DRAFT Evidence of EHR Lifecycle Events in support of CDA Release 3 Formal Proposal (incomplete), revised 13 Apr 2010
• DRAFT Paper vs. Electronic - Key Characteristics, revised 17 May 2010

US ONC Standards and Interoperability Framework

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

• Link to ONC S&I Framework Initiative Wiki Pages

Cross Initiative - Use Case Simplification Subgroup

• Link to ONC S&I Framework Cross Initiative Use Case Simplification Wiki Page
• DRAFT Use Case Simplification - Overview, revised 17 August 2011
• DRAFT Use Case Simplification - Core Matrix - Version 1.1, revised 17 August 2011

EHR System Function and Information Model (EHR-S FIM), R2.1 or 3.0

EHR-S FIM Release 2.1 or 3.0 has the purpose to (Steve Hufnagel, Facilitator):

- add core information models for each EHR-S FM function
- make the EHR-S FM easier  to use for 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, DCLS).

• EHRS FIM (for R2.1 or R3), 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

Immunization, Diabetes, ISO 13940 Continuity-of-Care harmonization are proposed as a set of increasingly complex demonstration prototypes.

IMMUNIZATION MAGAGEMENT PROTOTYPE ANALYSIS FILES (as they become available):

• File:CP.1.2 Manage Allergy, Intolerance and Adverse Reaction List.pptx
• File:CP.1.3 Manage Medication List.pptx
• File:CP.1.6 Manage Immunization List.pptx
• File:CP.3.3 Manage Clinical Documents and Notes.pptx
• File:CP.6.2 Manage Immunization Administration.pptx
• File:CPS.1.7.2 Manage Patient Advance Directives.pptx
• File:CPS.3.9 Clinical Decision Support System Guidelines Updates .pptx
• File:CPS.9.4 Standard Report Generation.pptx
• File:AS.4.1 Manage Registry Communication.pptx

Clinical Information Modeling Initiative

• CIMI Initial Public Release, Stan Huff, MD, dated 14 December 2011
• CIMI - Seeking Clarity (Questions and Issues), Gary Dickinson, revised 8 January 2012

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

HL7 EHR/PHR Standards

System Functionality Standards

• Electronic Health Record (EHR) System Functional Model, Normative HL7/ANSI Standard, published Mar 2007 (5 MB)
• Personal Health Record (PHR) System Functional Model, Draft Standard for Trial Use, published Dec 2008 (3.6MB)

Record Interoperability Standards

• 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

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 August 2011

US HITECH Act - EHR Incentive Program - Final Regulations

Bookmarked Rules and White Board Story Courtesy of Robin Raiford

• Meaningful Use - CMS Electronic Health Record Incentive Program - Stage 1 - Final, published 28 Jul 2010
• Meaningful Use - CMS Stage 1 - Measures, published 28 Jul 2010
• Meaningful Use - ONC Standards, Implementation Specifications and Certification Criteria, published 28 Jul 2010
• Meaningful Use - ONC Certification Program - Final, published 7 Jan 2011
• HITECH White Board Story, Version 1, published 2 August 2010
• HITECH White Board Story, Version 2, published 5 June 2011

Key Reference Documents

• "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)

2006-2009 US ONC/AHIC/HITSP Use Cases

• Full Narratives and Descriptions

Worksheets for Use Case Sketch Analysis

• DRAFT 2006 Biosurveillance - Partial
• DRAFT 2006 Consumer Empowerment - Partial
• DRAFT 2006 Lab Results Reporting - Partial
• DRAFT 2007 Consumer Access to Clinical Information - Skeletal
• DRAFT 2007 Emergency Responder - Skeletal
• DRAFT 2007 Medication Management - Skeletal
• DRAFT 2007 Quality Reporting - Partial
• DRAFT 2008 Consultations and Transfer of Care - Skeletal
• DRAFT 2008 Immunization and Response Management - Skeletal
• DRAFT 2008 Patient/Provider Secure Messaging - Skeletal
• DRAFT 2008 Personalized Health Care- Skeletal
• DRAFT 2008 Public Health Case Reporting - Skeletal
• DRAFT 2008 Remote Monitoring - Partial
• DRAFT 2009 Newborn Screening - Skeletal
• DRAFT 2009 Clinical Research - Skeletal

Use Case Alignment with HL7 EHR/PHR Models

Year 1 Care Delivery - COMPLETE

> Sherry Selover, Lead - sherry.selover@selover.com

• Chapter 1 - Year 1 Care Delivery - EHR/Lab Results Reporting, published Aug 2007
• AHIC EHR/Lab Results Reporting Use Case, published Mar 2006
• ANSI HITSP IS01 - EHR/Lab Results Reporting Interoperability Specification, v2.1.1, published May 2008

Year 1 Population Health - COMPLETE

> Gora Datta, Lead - gora@cal2cal.com

• Chapter 2 - Year 1 Population Health - Biosurveillance, draft published Jul 2008
• AHIC Biosurveillance Use Case, published Mar 2006
• ANSI HITSP IS02 - Biosurveillance Interoperability Specification, v3, published Mar 2008

Year 1 Consumer Empowerment - COMPLETE

> Kim Salamone, Lead - KSalamone@hsag.com

• Chapter 3 - Year 1 Consumer Empowerment - Demographics and Medication History, draft published Apr 2008
• AHIC Consumer Empowerment Use Case, published Mar 2006
• ANSI HITSP IS03 - Consumer Empowerment Interoperability Specification, v3, published Dec 2007

Year 2 Quality Reporting - COMPLETE

> Kim Salamone, Lead - KSalamone@hsag.com

• Chapter 6 - Year 2 Quality Reporting, draft published Oct 2008
• AHIC Quality Use Case, published Jun 2007
• ANSI HITSP IS06 - Quality Use Case Interoperability Specification, published Dec 2007

Year 3 Remote Monitoring - COMPLETE

> Sherry Selover, Lead - sherry.selover@selover.com

• Chapter 77 - Year 3 Remote Monitoring, draft published Dec 2008
• AHIC Remote Monitoring Use Case, published Mar 2008
• ANSI HITSP IS77 - Remote Monitoring Interoperability Specification, published Dec 2008