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 2.1, Apr 2020 (will be advanced to ISO as ISO 10781)
• EHR-S FM Functional Profiles, revised 29 Jul 2020
• EHR-S FM Known National Initiatives, revised 4 Feb 2020
• 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 EHR Work Group - Reducing Clinician Burden Project

Note that the HL7 EHR WG Reducing Clinician Burden Project now has its own Wiki page: https://wiki.hl7.org/Reducing_Clinician_Burden

HL7 RCB Project - Presentations

• Reducing Clinician Burden Project Overview, updated 8 Feb 2021
• Burden Reduction Opportunities in the World of US Core Data for Interoperability (USCDI)? Presentation for Discussion, Gary Dickinson, updated 26 Oct 2020
• Interoperability and Burden Reduction - Emerging Opportunities for Collaborative Care, Denise St Clair PhD, US Centers for Medicare and Medicaid Services, Office of Burden Reduction and Health Informatics, presented 21 Sep 2020
• Reducing Clinical Burden thru Knowledge Engineering - Curating Clinical Knowledge, Frank Opelka MD FACS, American College of Surgeons, presented 21 Sep 2020
• Problem Concept Maps: An Ontology to Facilitate Auto-Summarization of Electronic Health Information, Joel Buchanan MD, University of Wisconsin/Madison, presented 21 Sep 2020
• The Problem-Oriented Health Record (POHR) and a Pathway to Reducing Clinician Burden (with Links), Lincoln Weed, Chris Weed, presented 17 Aug 2020
• The Problem-Oriented Health Record (POHR) and a Pathway to Reducing Clinician Burden (with Notes), Lincoln Weed, Chris Weed, presented 17 Aug 2020
• Payment Reform in the Era of Advanced Diagnostics, Artificial Intelligence and Machine Learning, James Sorace MD MS, presented 3 Aug 2020
• Examining the Health IT Vendor’s Perspective - Lessons learned as a physician working for a health IT vendor, Ryan Mullins MD CPE, presented 20 Jul 2020
• HL7 Da Vinci Project Overview (focused on Provider/Payer Exchange), Viet Nguyen MD, presented 18 May 2020
• HL7 Da Vinci Project Calendar, Viet Nguyen MD, presented 18 May 2020
• Data Quality and Clinician Burden - Overview, Examples, and Basic Recommendations, Reed Gelzer MD, presented 4 May and 1 Jun 2020
• Exploring FHIR to Reduce Burden for Quality Measurement, Floyd Eisenberg MD PhD, presented 20 Apr 2020
• Exploring FHIR to Reduce Burden for Quality Measurement - Survey Results, Floyd Eisenberg MD PhD, presented 20 Apr 2020
• Association between EHR Usability and Burnout, David Schlossman MD, presented 18 Nov 2019
• Increasing EHR System Usability Through Standards - As One Approach to Reducing Clinician Burden, David Schlossman MD, presented 7 Oct 2019
• Reducing Clinician Burden Project - New Directions in Alleviating Clinical Workflow and Documentation Burdens - Association of Medical Directors of Information Systems (AMDIS) Presentation, David Schlossman MD, presented 20 Jun 2019
• Update on HL7 EHR System Usability Functional Profile Project, HL7 Da Vinci Project, CMS Patients over Paperwork RFI, David Schlossman MD, presented 17 Jun 2019

HL7 RCB Project - Analysis, Derivations and Worksheets

• DRAFT Reducing Clinician Burden Analysis Worksheet, updated 25 Jan 2021

This version of the RCB Analysis Worksheet includes the ONC FINAL "Strategy on Reducing Burden Relating to the Use of Health IT and EHRs". Each of the four ONC Initiatives(I), along with Strategies(S) and Recommendations(R) are inserted within the related RCB topic area and are identified as Ix.Sx.Rx. NOTE also that all reference sources up through #122 have been reviewed and are incorporated in this version. See "References" Tab.

• DRAFT Reducing Clinician Burden - Cause Matrix, updated 25 Jan 2021

This one page DRAFT outlines key causal factors for clinician burden and is offered for review and comment.

• RCB-related Comments on ISO DIS 27269 - International Patient Summary, published 30 Mar 2020

These comments on the DRAFT International Patient Summary were prepared in correspondence with findings of the HL7 RCB Project and clinician burdens associated with patient summary creation, exchange and use, particularly with regard to aspects of information overload, data integrity, patient/provider identity matching, preservation of clinical data context, reconciliation of medications, medication allergies, all allergies, problems/diagnoses and more.

• DRAFT Clinical Documentation - Collect, Share, Use - Information Flow and Lifecycle Example - including Intersections with Clinician Burden and Safety Concerns, updated 30 Dec 2020

This worksheet shows a typical end-to-end information flow for clinical documentation, starting at the point of origination (authorship) of a health record entry - following with points of update, verification, attestation, exchange (transmit and receipt) - ending at the point where record entry content is accessed/used for subsequent patient care, interventions and decision making.

• DRAFT Clinical Documentation - Ensuring End-to-End Fidelity, updated 30 Dec 2020

This graphic asks the question "How Might We Ensure End-to-End Fidelity as We Collect, Share and Use Clinical Documentation?", considering what the author sees/intends and how that corresponds to what the end user sees.

• DRAFT Clinical Documentation - Collect, Share, Use - Data Segmentation for Clinical Integrity, updated 30 Dec 2020

This graphic shows a Clinical Documentation Instance and subsequent clinical and non-clinical flow based on its segments: •provenance, •clinical facts, findings and observations, •order detail, •prior authorization detail, •billing/claims detail, •quality/performance data, •public health data, •administrative data, •finance/cost data, •registry data... Each segment represents a purpose of collection and a corresponding purpose of use, based on stakeholder needs.

• “A Perspective on the History and Progression of EHR System Functionality Standards, Certification and Adoption”, updated 30 Jul 2020

This document is part of an initial dialogue between the HL7 RCB Project and the US Centers for Medicare and Medicaid Services (CMS) Office of Burden Reduction and Health Informatics and offers a timeline of HL7 EHR WG standards development activities from 2000 until the present.

• "Data Usability Characteristics/Qualities", Gary Dickinson, submitted 16 Nov 2020

These comments were submitted to the Sequoia Project, Data Usability Workgroup, as part of their consideration of characteristics/qualities of health data that make it usable - for particular end uses/end users (e.g., clinicians in clinical practice) and are derived from analysis of the RCB Project.

• "Re-Envisioning HL7", Gary Dickinson, submitted 30 Nov 2020

These comments were submitted to HL7 leadership as part of the ongoing effort to re-envision HL7 and are derived (in part) from analysis of the RCB Project.

HL7 RCB Project - Conversations

• Conversation with the American Medical Association, Questions and Topics for Collaboration, updated 25 Jan 2021
• DRAFT Burden Impact Statement, updated 20 Jan 2021

Based on our conversation with the AMA, we have drafted a Burden Impact Statement, designed for consideration by HL7 Work Groups and Project Teams as new HL7 Work Items are introduced. This has yet to be formalized and is offered as a DRAFT for review and comment.

HL7 RCB Collaborative Project Candidate - Medication List Management and Reconciliation

• DRAFT Medication Reconciliation Overview, updated 12 Nov 2020
• DRAFT Medication Reconciliation Use Case Scenario Worksheet, updated 19 Jan 2021

The Medication Reconciliation Burden Reduction Focus Team meets most Thursdays at 5PM ET (US). Teleconference access is as noted above. If you are a clinician with medication reconciliation experience, please join us.

HL7 RCB Project - Reducing Clinician Burden "Comment Only" Ballot

• RCB Ballot Document - September 2020 Ballot Cycle - To Gain Insights/Input from the HL7 International Community on Workable Strategies for Clinician Burden Reduction
• RCB Ballot Comments (from Participants)

This ballot closed on Monday, 14 September 2020.

HL7 RCB Project - White Paper

• DRAFT Reducing Clinician Burden by Improving Electronic Health Record Usability and Support for Clinical Workflow, David Schlossman MD PhD, Lisa Masson MD, James Tcheng MD, Luann Whittenburg RN PhD, Barry Newman MD, Gary Dickinson FHL7, released 1 Jun 2020

This White Paper has been released for Project Team review and comment.

HL7 RCB Project - Reducing Burden - Success Stories

• DRAFT Reducing Clinician Burden - Success Story Template, updated 28 Jan 2019
• Duke University - Duke Heart Business Unit – Procedure Reporting, James E Tcheng MD FACC FSCAI, 4 Feb 2019
• Duke University - Reducing Clinician Burden - Cardiovascular Procedure Reporting at Duke, James E Tcheng MD FACC FSCAI, 18 Sep 2019 (Posted with Permission)
• University of Michigan - "Home for Dinner" - Reducing After Hours Documentation with Focused Training, Greta Branford MD, Marie Baldwin MSHROD, 26 Aug 2019 (Posted with Permission)
• National Health Service - Rotherham Foundation Trust (UK) - Benefits of SNOMED CT from a clinical perspective, The Rotherham experience, Monica Jones, 9 Apr 2019 (Posted with Permission)
• University of Pennsylvania - Getting Time Back in Your Day! Implementing a Multi-Faceted Approach to Optimizing Epic in the Ambulatory Setting, Jeff Tokazewski MD, Carole Rosen, Shane Thomas, 15 Jul 2019 (Posted with Permission)
• American Hospital Association - Well-Being Playbook, A Guide for Hospital and Health System Leaders, May 2019
• American Hospital Association - Well-Being Playbook Presentation, Elisa Arespacochaga, 19 Aug 2019 (Posted with Permission)
• Stanford University/Stanford Health Care - Understanding the Impact of the EHR on Physician Burnout and Wellness, Christopher Sharp MD, Lindsay Stevens MD, 28 Aug 2019 (Posted with Permission)
• SPRINT – An Organizational Strategy that Increases Satisfaction, Improves Teamwork and Reduces Burnout, Amber Sieja MD, University of Colorado School of Medicine, UCHealth (Posted with Permission)
• Addressing EHR-related burnout at the Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada, Gillian Strudwick RN PhD FAMIA,Tania Tajirian MD CCFP FCFP DTMPH, Brian Lo MHI, 25 Jan 2021 (Posted with Permission)

Burden Reduction (and other) Initiatives in Response to the COVID-19 Pandemic

• (US) Centers for Medicare and Medicaid Services (CMS) - Waivers and COVID-19 Response, Online Presentation, 7 April 2020
• (US) CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19, posted 22 Mar 2020
• (US) Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge, posted 30 Mar 2020
• (US) Health Information Technology Advisory Committee (HITAC) Brainstorms Ways ONC Can Help Front-Line Providers in COVID-19 Response, published 27 Mar 2020
• (US Health Plan) Humana easing administrative, financial burdens on providers amid COVID-19 crisis, published 2 Apr 2020
• (US) CMS - COVID-19 Disaster Response Toolkit, posted 7 April 2020

• Logica COVID-19 Interoperability Project, posted 4 Apr 2020
• Logica COVID-19 FHIR Implementation Guide, posted 4 Apr 2020

"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 - Survey and Responses

• RCB Project Survey and Responses, dated 19 Aug 2019
• "The Value Expression" Presentation to CMS, Frank Opelka MD, Medical Director, American College of Surgeons, Quality and Health Policy, published Jun 2019 (Posted with Permission)

HL7 RCB Project - Focus Team Drafts

• DRAFT Reducing Clinician Burden - New Approaches to Clinical Workflow, Clinical Documentation, and Electronic Health Record Usability, Clinical Workflow and Documentation Focus Team Report, David Schlossman MD, Lisa Masson MD, Leads, updated 8 May 2019
• 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 Outline - Legal aspects and risks - Barry Newman MD, updated 1 April 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

US Office of National Coordinator for Health Information Technology (ONC) Strategy for Reducing Burden

• ONC DRAFT Federal Health IT Strategic Plan, 2020-2025 - published 15 Jan 2020
• ONC FINAL "Strategy on Reducing Burden Relating to the Use of Health IT and EHRs", including Findings, Strategies and Recommendations, published 21 Feb 2020
• Summary of Public Comments on ONC DRAFT Strategy, published 26 Mar 2019
• HL7 Comments on ONC DRAFT Strategy, compiled by HL7 Policy Advisory Committee, submitted 28 Jan 2019
• CentriHealth Comments on ONC DRAFT Strategy, submitted 28 Jan 2019
• ONC/Urban Institute - Health Policy Center - DRAFT Electronic Health Record Reporting Program, published Jun 2020
• EHR Standards Consulting - Comments on the ONC/Urban Institute DRAFT Electronic Health Record Reporting Program, submitted 10 Aug 2020

US Department of Health and Human Services (HHS) Patients over Paperwork Initiative

• FINAL RULE - Medicare and Medicaid Programs; Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction..., 20 Sep 2019

More RCB Perspectives and Resources

• Video - An EHR State of Mind, Zubin Damania MD, posted 19 Oct 2015
• Video - Professional Satisfaction – Saturday Night Belongs to Epic, Christine Sinsky MD, VP/American Medical Association, posted 27 Jan 2016
• Video - Professional Satisfaction – EHR Should Make Our Lives Delightful, Christine Sinsky MD, VP/American Medical Association, posted 27 Jan 2016
• Video - Creating Joy in Medical Practice - An Interview, Christine Sinsky MD, VP/American Medical Association, posted 25 Jan 2018
• Video - Strategies to Address Burnout Must be Practical and Local, Christine Sinsky MD, VP/American Medical Association, posted 25 Jan 2018
• Video - AMDIS/HIMSS Physician Executive Symposium - An Interview, Christine Sinsky MD, VP/American Medical Association, posted 28 March 2018
• American Medical Association - Education Hub - Electronic Health Record Optimization: Strategies for Thriving - Strategies to help health care organizations maximize the benefits and minimize the burdens of the EHR, published 30 Aug 2018
• Video - Freeing physicians to do their jobs - 2019 EHR National Symposium - Stanford Medicine, posted 28 Oct 2019
• Statista - Stress and burnout - Statistics & Facts, John Elflein, published 16 Aug 2019
• World Health Organization - Safe Health Workers, Safe Patients?, posted 16 Sep 2020

HL7 RCB Project - Reference Sources

RCB Reference Sources (and related links) are available at the RCB Wiki: https://wiki.hl7.org/Reducing_Clinician_Burden

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

• TEFCA Draft 1, DRAFT Documents and Request for Comment, published 5 Jan 2018
• TEFCA Draft 2, DRAFT Documents and Request for Comment, published 19 Apr 2019
• HL7 Response Letter, HL7 Policy Advisory Committee, published 17 Jun 2019
• Comments on TEFCA Draft 2, Gary Dickinson, CentriHealth, dated 17 Jun 2019
• TEFCA Scatter vs Individual at the Center, Gary Dickinson, CentriHealth, dated 17 Jun 2019

US Office of National Coordinator (ONC) - 21st Century Cures Act: Interoperability, Information Blocking...

• US Office of National Coordinator for Health Information Technology - 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program, published 1 May 2020
• ONC 21st Century Cures Act - Interoperability, Information Blocking... - Implementation Timeline, published 1 May 2020
• ONC 21st Century Cures Act - Interoperability, Information Blocking... - Enforcement Discretion Dates and Timelines, published 1 May 2020
• HL7 Response Letter, HL7 Policy Advisory Committee, published 3 Jun 2019
• Comments on ONC NPRM - 21st Century Cures Act: Interoperability, Information Blocking, et al, Gary Dickinson, CentriHealth, published 3 Jun 2019

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

• ISA Editions 2015-2020

US Office of National Coordinator (ONC) - Interoperability Forums

• 1st: 15-16 Aug 2017
• 2nd: 6-8 Aug 2018
• 3rd: 21-22 Aug 2019

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 Centers for Medicare and Medicaid Services (CMS) - Interoperability and Patient Access...

• 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 on the Federally- Facilitated Exchanges, and Health Care Providers, published 1 May 2020

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)