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 16 Jan 2017
• EHR-S FM Known National Initiatives, revised 16 Jan 2017
• 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

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 2017 Edition

FHIR STU-3

• Fast Health Interoperable Resources (FHIR) Main Page, published Mar 2017

EHR-S Record Lifecycle Event Implementation Guide

• FHIR EHR-S Record Lifecycle Event Implementation Guide, based on ISO/HL7 10781 Electronic Health Record System Functional Model (EHR-S FM) Release 2, Record Infrastructure Section, published as part of FHIR STU-3, Mar 2017

AuditEvent and Provenance Profiles

• FHIR EHR-S Record Lifecycle Event - AuditEvent Profile, published as part of FHIR STU-3, Mar 2017
• FHIR EHR-S Record Lifecycle Event - Provenance Profile, published as part of FHIR STU-3, Mar 2017

W5 Report (Who, What, When, Where, Why)

• FHIR W5 Report, Pursuing Alignment of W5 and Key Meta-Data Elements across FHIR Resources, published as part of FHIR STU-3, Mar 2017

FHIR Implementer's Safety Check List

• FHIR Implementer's Safety Check List, published as part of FHIR STU-3, Mar 2017

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

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

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 - In Progress, dated 24 April 2017
• Meaningful Use 2015 Edition Functional Profile - Ballot Reconciliation Worksheet - In Progress, dated 10 Apr 2017
• Meaningful Use 2015 Edition Functional Profile - Ballot Package, Dec 2016
• DRAFT Meaningful Use 2015 Edition Functional Profile Analysis Worksheet, revised 1 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

• "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
• "End-to-End Interoperability of Health Data/Records - Validation Framework to ensure Affirmative Trust Decision", Gary Dickinson, CentriHealth, 13 Nov 2015
• "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)