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=HL7 EHR/PHR Standards=
 
=HL7 EHR/PHR Standards=
 
==System Functionality Standards==
 
==System Functionality Standards==
*[http://www.hl7.org/implement/standards/product_brief.cfm?product_id=269 HL7 Electronic Health Record System Functional Model (EHR-S FM) Release 2, April 2014 (also published as ISO 10781)]
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*[http://www.hl7.org/implement/standards/product_brief.cfm?product_id=528 HL7 Electronic Health Record System Functional Model (EHR-S FM) Release 2.1, Apr 2020 (will be advanced to ISO as ISO 10781)]
*[[media:EHRS_FM-Functional_Profiles-20170116.pdf|EHR-S FM Functional Profiles, revised 16 Jan 2017]]
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*[[media:EHRS_FM-Functional_Profiles-20200729.pdf|EHR-S FM Functional Profiles, revised 29 Jul 2020]]
*[[media:EHRS_FM-National_Initiatives-20170508.pdf|EHR-S FM Known National Initiatives, revised 8 May 2017]]
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*[[media:EHRS_FM-National_Initiatives-20200204.pdf|EHR-S FM Known National Initiatives, revised 4 Feb 2020]]
 
*[[media:LegacyVistA_To_HL7_EHR-FM.xlsx|US Department of Veterans Administration - VISTA Legacy EHR System Functions - Mapping to EHR-S FM Release 1.1]]
 
*[[media:LegacyVistA_To_HL7_EHR-FM.xlsx|US Department of Veterans Administration - VISTA Legacy EHR System Functions - Mapping to EHR-S FM Release 1.1]]
 
*[http://www.hl7.org/implement/standards/product_brief.cfm?product_id=88 HL7 Personal Health Record System Functional Model (PHR-S FM) Release 1, May 2014 (also published as ISO 16527)]
 
*[http://www.hl7.org/implement/standards/product_brief.cfm?product_id=88 HL7 Personal Health Record System Functional Model (PHR-S FM) Release 1, May 2014 (also published as ISO 16527)]
 
  
 
==Record Interoperability Standards==
 
==Record Interoperability Standards==
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="Reducing Clinician Burden" Project=
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=HL7 EHR Work Group - Reducing Clinician Burden Project=
Project team meets 1st and 3rd Mondays each month at 3PM ET, 5 and 19 November, 3 and 17 December, 7 JanuaryPlease join us.
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Note that the HL7 EHR WG Reducing Clinician Burden Project now has its own Wiki page:  https://wiki.hl7.org/Reducing_Clinician_Burden
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==HL7 RCB Project - Presentations==
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*[[media:Reducing_Clinician_Burden-Overview-20200803.pdf|DRAFT Reducing Clinician Burden Project Overview, updated 3 Aug 2020]]
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*[[media:V3Diagnostic_Advanced_Payment_ModelsHL7.pdf|Payment Reform in the Era of Advanced Diagnostics, Artificial Intelligence and Machine Learning, James Sorace MD MS, presented 3 Aug 2020]]
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*[[media:HL7_RCB_Presentation-Mullins-20200720.pdf|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]]
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*[https://confluence.hl7.org/download/attachments/39160937/20200518%20Da%20Vinci%20-%20RCB%20Presentation.pptx?version=1&modificationDate=1589915917527&api=v2 HL7 Da Vinci Project Overview (focused on Provider/Payer Exchange), Viet Nguyen MD, presented 18 May 2020]
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*[https://confluence.hl7.org/display/DVP/Da+Vinci+2020+Calendar HL7 Da Vinci Project Calendar, Viet Nguyen MD, presented 18 May 2020]
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*[[media:DQ_and_RCB_Complexity_Simplified_May_4_2020.pdf|Data Quality and Clinician Burden - Overview, Examples, and Basic Recommendations, Reed Gelzer MD, presented 4 May and 1 Jun 2020]]
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*[[media:EHR_WG_Update_20April2020.pdf|Exploring FHIR to Reduce Burden for Quality Measurement, Floyd Eisenberg MD PhD, presented 20 Apr 2020]]
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*[[media:HL7_Interactive_fhir_FINAL_14April2020_with_results-1.pdf|Exploring FHIR to Reduce Burden for Quality Measurement - Survey Results, Floyd Eisenberg MD PhD, presented 20 Apr 2020]]
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*[[media:Association_Between_EHR_Usability_and_Burnout_DS_20191118.pdf|Association between EHR Usability and Burnout, David Schlossman MD, presented 18 Nov 2019]]
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*[[media:HL7_EHR-S_FM_Usability_FP_Relationship_to_RCB_Project_DS_20191007.pdf|Increasing EHR System Usability Through Standards - As One Approach to Reducing Clinician Burden, David Schlossman MD, presented 7 Oct 2019]]
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*[[media:Schlossman_AMDIS_RCB_Presentation_final.pdf|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]]
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*[[media:HL7_EHR_S_and_Usability_DS_20190617.pdf|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]]
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 +
==HL7 RCB Project - Analysis Worksheets==
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*[[media:Reducing_Clinician_Burden_Analysis_Worksheet-20200803.xlsx|DRAFT Reducing Clinician Burden Analysis Worksheet, updated 3 Aug 2020]]
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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 #119 have been reviewed and are incorporated in this versionSee "References" Tab.
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*[[media:Reducing_Clinician_Burden-Cause_Matrix-20200615.pdf|DRAFT Reducing Clinician Burden - Cause Matrix, updated 15 Jun 2020]]
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This one page DRAFT outlines key causal factors for clinician burden and is offered for your review and comment.
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*[[media:IPS-Burden_Comments-20200330.pdf|RCB-related Comments on ISO DIS 27269 - International Patient Summary, published 30 Mar 2020]]
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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.
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*[[media:HL7_EHR_WG-A_Perspective_on_History_and_the_Future-20200730.pdf|“A Perspective on the History and Progression of EHR System Functionality Standards, Certification and Adoption”, updated 30 Jul 2020]]
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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.
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==HL7 RCB Project - Reducing Clinician Burden "Comment Only" Ballot==
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*[[media:HL7_RCB_R1_O1_2020SEP.pdf|Ballot Overview and Response Document - September 2020 Ballot Cycle - To Gain Insights/Input from the HL7 International Community on Workable Strategies for Clinician Burden Reduction]]
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The ballot opens on Friday, 14 August, and closes on Monday, 14 September 2020.
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==HL7 RCB Project - White Paper==
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*[[media:RCB_Project_Clinical_Workflow_Paper_JMIR_Format_21Jan2020-Final.docx|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]]
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This White Paper has been released for Project Team review and comment.
  
*[[media:Reducing_Clinician_Burden-Overview-20181026.pdf|DRAFT Reducing Clinician Burden Project Overview, dated 26 Oct 2018]]
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==Burden Reduction (and other) Initiatives in Response to the COVID-19 Pandemic==
*[[media:Reducing_Clinician_Burden_Analysis_Worksheet-20181026.xlsx|DRAFT Reducing Clinician Burden Analysis Worksheet, DRAFT IN PROGRESS + COMMENTS ARE WELCOME!!, dated 26 Oct 2018]]
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*[https://www.cms.gov/files/document/cms-waivers-and-covid-19-response.pdf (US) Centers for Medicare and Medicaid Services (CMS) - Waivers and COVID-19 Response, Online Presentation, 7 April 2020]
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*[https://www.cms.gov/newsroom/press-releases/cms-announces-relief-clinicians-providers-hospitals-and-facilities-participating-quality-reporting (US) CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19, posted 22 Mar 2020]
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*[https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19 (US) Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge, posted 30 Mar 2020]
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*[https://www.hcinnovationgroup.com/interoperability-hie/standards/article/21131620/hitac-brainstorms-ways-onc-can-help-frontline-providers-in-covid19-response (US) Health Information Technology Advisory Committee (HITAC) Brainstorms Ways ONC Can Help Front-Line Providers in COVID-19 Response, published 27 Mar 2020]
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*[https://www.fiercehealthcare.com/payer/humana-aims-to-ease-administrative-financial-burdens-providers-amid-covid-19-crisis?utm_medium=nl&utm_source=internal&mrkid=4643083&mkt_tok=eyJpIjoiWmpNME1HRmlPV1E0TkRBeiIsInQiOiJPVXlncCtyNWVqZWdvNFZwQUxxQlpPOWFlOUNwUExHeVZuR2hCV1E4clV4MVVuMXZVQUNQTzIySWpmbEN6N2pkYXhnUkMwSEg1a0V4TTNyaEw1YjE0bnFZdm02Y2Ewb1djeSszUTlKcytjbldJSU9JTVZRQVFsSm1wa1N3bVlBVyJ9 (US Health Plan) Humana easing administrative, financial burdens on providers amid COVID-19 crisis, published 2 Apr 2020]
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*[https://www.medicaid.gov/resources-for-states/disaster-response-toolkit/coronavirus-disease-2019-covid-19/index.html (US) CMS - COVID-19 Disaster Response Toolkit, posted 7 April 2020]
  
==Meeting Notes==
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*[https://www.logicahealth.org/covid-19-interoperability-project/ Logica COVID-19 Interoperability Project, posted 4 Apr 2020]
*[[media:Reducing_Clinician_Burden-Baltimore_Meeting_Notes-20181004.docx|DRAFT Meeting Notes - Reducing Clinician Burden - HL7 Baltimore Meeting, 4 Oct 2018]]
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*[https://covid-19-ig.logicahealth.org/?mc_cid=709e81f39c&mc_eid=10d45eb01b Logica COVID-19 FHIR Implementation Guide, posted 4 Apr 2020]
*[[media:Reducing_Clinician_Burden-Meeting_Notes-20181015.docx|DRAFT Meeting Notes - Reducing Clinician Burden Teleconference, 15 Oct 2018]]
 
  
==Reference Sources==
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=="See What We Mean"==
*[[media:Dr_Freedman_2018-10-4_Reducing_Clinician_Burden-version2.pptx|Reducing Clinician Burden - Baltimore Presentation, David J Freedman DPM FACFAS FASPS CPC CPMA, dated 4 Oct 2018]]
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*[https://ehrseewhatwemean.org/ "See What We Mean" Video Clips, developed by Medstar Health - National Center for Human Factors in Healthcare - EHR Safety and Usability Team]
*[https://www.healthaffairs.org/do/10.1377/hblog20180927.405697/full/ Health Affairs - Patient-Centered, Value-Based Health Care Is Incompatible With The Current Climate Of Excessive Regulation, John O'Shea, published 3 Oct 2018]
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*[https://nam.edu/implementing-optimal-team-based-care-to-reduce-clinician-burnout/ 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]
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==HL7 RCB Project - Reducing Burden - Success Stories==
*[https://news.aamc.org/patient-care/article/electronic-health-records-what-will-it-take/?utm_source=newsletter&utm_medium=email&utm_campaign=AAMCNews&utm_content=082218 Association of American Medical Colleges, AAMCNews - Electronic health records: What will it take to make them work? Peter Jaret, published 21 Aug 2018]
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*[[media:Reducing_Clinician_Burden-Success_Story_Template-20190128.docx|DRAFT Reducing Clinician Burden - Success Story Template, updated 28 Jan 2019]]
*[http://whitepapers.himssmedia.com/sites/whitepapers.himssmedia.com/files/Vocera_HIMSS_Analytics_HIMSS18-Survey-Report.pdf?aliId=986721793 HIMSS Analytics Research Findings - Frequent Interruptions Distract Clinicians from Patient Care, Contribute to Stress and Burnout, published 22 May 2018]
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*[[media:RCB_Story_-_Duke_Heart_Procedures.docx|Duke University - Duke Heart Business Unit – Procedure Reporting, James E Tcheng MD FACC FSCAI, 4 Feb 2019]]
*[https://ehrintelligence.com/news/physicians-seek-mips-changes-reduced-administrative-burden 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]
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*[[media:19_HL7_RCB_Duke-dist.pdf|Duke University - Reducing Clinician Burden - Cardiovascular Procedure Reporting at Duke, James E Tcheng MD FACC FSCAI, 18 Sep 2019 (Posted with Permission)]]
*[https://www.healthdatamanagement.com/list/7-challenges-physicians-face-getting-access-to-patient-data Health Data Management - Seven Challenges Physicians Face Accessing Patient Data, Joseph Goedert, published 18 Apr 2018]
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*[[media:UGM_2019_ProviderBurnoutandEd_final-resized.pdf|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)]]
*[https://ehrintelligence.com/news/nqf-advises-cms-align-quality-measures-cut-administrative-burden EHR Intelligence - NQF Advises CMS Align Quality Measures, Cut Administrative Burden, Kate Monica, published 3 Apr 2018]
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*[[media:Monica_Jones-SNOMED_Clinical_Forum-20190409a.pdf|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)]]
*[https://link.springer.com/article/10.1007/s11606-017-4228-2 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]
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*[[media:HL7_-_CCA_Optimization_Presentation_7.15.19.pdf|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)]]
*[http://www.physicianspractice.com/himss/reducing-clinician-burnout-five-ehr-related-areas Physician Practice - Reducing Clinician Burnout in Five EHR-Related Areas, Gabriel Perna, published 9 Mar 2018]
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*[[media:AHA-well-being-playbook.pdf|American Hospital Association - Well-Being Playbook, A Guide for Hospital and Health System Leaders, May 2019]]
*[https://www.healthcare-informatics.com/article/ehr/clinicians-cms-onc-right-ship-simplify-reporting-ease-regulatory-burdens Healthcare Informatics - Clinicians to CMS, ONC: “Right the Ship” to Simplify Reporting, Ease Regulatory Burdens, Heather Landi, published 13 Feb 2018]
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*[[media:AHA-HL7_Burnout_Webinar-Arespacochaga-20190818.pdf|American Hospital Association - Well-Being Playbook Presentation, Elisa Arespacochaga, 19 Aug 2019 (Posted with Permission)]]
*[https://link.springer.com/article/10.1007%2Fs11606-018-4337-6 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]
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*[[media:UGM040_Understanding_the_Impact_of_the_EHR_on_Physician_Wellness_and_Burnout.pdf|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)]]
*[https://www.aafp.org/dam/AAFP/documents/advocacy/legal/administrative/LT-CMS-ONC-AdminSimplification-020718.pdf 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]
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*[https://www.dropbox.com/s/vxz2gywht2d0r9p/amber%20sieja-univ%20colorado-hl7%20talk%20-%20sprint%20ehr%20optimization%20program-20191216.pdf?dl=0 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)]
*[http://bulletin.facs.org/2018/02/regulatory-burden-reduction/ American College of Surgeons - Regulatory Burden Reduction, Lauren Foe MPH, published 1 Feb 2018]
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*[https://ehrintelligence.com/news/ehr-use-administrative-burden-accelerating-physician-burnout EHR Intelligence - EHR Use, Administrative Burden Accelerating Physician Burnout, Kate Monica, published 16 Jan 2018]
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==HL7 RCB Project - Survey and Responses==
*[https://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-0038-1637007.pdf 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]
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*[[media:Reducing_Clinician_Burden-Survey_Responses-20190819.docx|RCB Project Survey and Responses, dated 19 Aug 2019]]
*[http://med.stanford.edu/content/dam/sm/ehr/documents/EHR-Poll-Presentation.pdf Stanford Medicine/The Harris Poll - How Doctors Feel About Electronic Health Records, Results of a national physician poll, 2018]
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*[[media:ACS-CMS_Mango_v3.0-Opelka-201906.pdf|"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)]]
*[https://www.darkdaily.com/ehr-systems-continue-to-cause-burnout-physician-dissatisfaction-and-decreased-face-to-face-patient-care-1222/ Dark Daily - EHR Systems Continue to Cause Burnout, Physician Dissatisfaction, and Decreased Face-to-Face Patient Care, published 22 Dec 2017]
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*[https://ehrintelligence.com/news/aapa-ehr-toolkit-offers-best-practices-for-ehr-design-usability EHR Intelligence - American Association of Physician Assistants - AAPA EHR Toolkit Offers Best Practices for EHR Design, Usability , Kate Monica, published 8 Dec 2017]
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==HL7 RCB Project - Focus Team Drafts==
*[https://www.hitechanswers.net/breaking-news-cms-finalizes-policies-reduce-provider-burden-lower-drug-prices/ HITECH Answers - CMS Finalizes Policies that Reduce Provider Burden and Lower Drug Prices, published 2 Nov 2017]
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*[[media:Schlossman_HL7_RCB_Project_Focus_Teams_Report_20190508.pdf|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]]
*[http://www.annfammed.org/content/15/5/419.full.pdf 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]
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*[https://drive.google.com/drive/folders/113pFh5kjX-dLR2K8jLlG-FJkLm-_5IN4?ogsrc=32 DRAFT Team Report - Clinical Documentation: Quality and Usability - Lisa Masson MD, Lead, updated 7 Jan 2019]
*[https://nam.edu/burnout-among-health-care-professionals-a-call-to-explore-and-address-this-underrecognized-threat-to-safe-high-quality-care/ 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]
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*[[media:EHR_based_cognitive_support_to_Enhance_the_clinician_experience.pdf|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]]
*[http://annals.org/aim/fullarticle/2614079/putting-patients-first-reducing-administrative-tasks-health-care-position-paper 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]
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*[[media:Reducing_Clinician_Burden_Project--Clinical_Workflow_and_Usability_Focus_Group_Report.docx|DRAFT Team Report - Clinical Workflow (Usability Focus) - David Schlossman MD, Lead, updated 21 Jan 2019]]
*[https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-lshc-physician-survey-hit-factsheet.pdf Deloitte Survey of US Physicians - Findings on health information technology and electronic health records, published 3 Oct 2016]
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*[[media:Schlossman_HL7_RCB_Presentation_18MAR2019.pdf|DRAFT Root Cause Analysis - Clinical Workflow - David Schlossman MD, Lead, updated 18 Mar 2019]]
*[https://ehrintelligence.com/news/tips-for-reversing-physician-burnout-caused-by-ehr-use EHR Intelligence - Tips for Reversing Physician Burnout Caused by EHR Use, Sheri Stoltenberg, published 16 Oct 2016]
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*[[media:Legal_Burdens_Related_to_EHR's-Initial_Outline-BN-Draft-04012019.docx|DRAFT Team Outline - Legal aspects and risks - Barry Newman MD, updated 1 April 2019]]
*[https://www.fiercehealthcare.com/it/marc-probst-we-re-not-close-to-solving-interoperability FierceHealthcare - Intermountain's Marc Probst - We're not close to solving interoperability, Dan Bowman, published 28 Sep 2016]
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*[[media:Physician_Burden_Issue.docx|DRAFT Team Report - Lock-In, Data Liquidity and Switching Costs - Michael Brody DPM, Lead, updated 15 Dec 2018]]
*[https://www.medscape.com/viewarticle/868421#vp_1 EHR Burden Weighs Heavily on Physicians, Leads to Burnout, Diana Phillips, published 6 Sep 2016]
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*[[media:Data_Quality_interest_group_report_for_March_4_RCB_Meeting.docx|DRAFT Team Report - Data Quality - Reed Gelzer MD, Lead, updated 4 Mar 2019]]
*[https://ehrintelligence.com/news/ehr-use-continues-to-contribute-to-physician-burnout EHR Intelligence - EHR Use Continues to Contribute to Physician Burnout, Kyle Murphy PhD, published 20 Jun 2016]
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*[https://www.himss.org/news/five-usability-barriers-preventing-health-it-supporting-clinician-needs 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]
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==US Office of National Coordinator for Health Information Technology (ONC) Strategy for Reducing Burden==
*[https://www.healthaffairs.org/do/10.1377/hblog20160421.054511/full/ Health Affairs - Make The Clinician Burnout Epidemic A National Priority; Andrew Shin, Tejal Gandhi, Shoshana Herzig; published 21 Apr 2016]
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*[https://www.healthit.gov/topic/2020-2025-federal-health-it-strategic-plan ONC DRAFT Federal Health IT Strategic Plan, 2020-2025 - published 15 Jan 2020]
*[https://www.nejm.org/doi/full/10.1056/NEJMp1509961 Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine, Lisa Rosenbaum, M.D.; published 22 Oct 2015]
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*[https://www.healthit.gov/topic/usability-and-provider-burden/strategy-reducing-burden-relating-use-health-it-and-ehrs ONC FINAL "Strategy on Reducing Burden Relating to the Use of Health IT and EHRs", including Findings, Strategies and Recommendations, published 21 Feb 2020]
*[https://jamanetwork.com/journals/jama/fullarticle/2434673? 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]
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*[https://healthit.gov/burdencomments Summary of Public Comments on ONC DRAFT Strategy, published 26 Mar 2019]
*[https://journals.lww.com/cinjournal/Citation/2015/08000/Nursing_Centric_Technology_and_Usability_A_Call_to.1.aspx 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]
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*[[media:HL7_Response_Letter_ONC_Reducing_Burden_Strategy_FINAL.docx|HL7 Comments on ONC DRAFT Strategy, compiled by HL7 Policy Advisory Committee, submitted 28 Jan 2019]]
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4537152/ 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]
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*[[media:CentriHealth-Comments_on_ONC_DRAFT_Burden_Reduction_Strategy.pdf|CentriHealth Comments on ONC DRAFT Strategy, submitted 28 Jan 2019]]
*[https://academic.oup.com/jamia/article/22/6/1179/2357601 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]
+
*[https://www.urban.org/policy-centers/health-policy-center/projects/electronic-health-record-reporting-program ONC/Urban Institute - Health Policy Center - DRAFT Electronic Health Record Reporting Program, published Jun 2020]
*[https://academic.oup.com/jamia/article/22/5/1102/932174 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]
+
*[[media:Ehr_draft_voluntary_user-reported_criteria-GLD-20200810.pdf|EHR Standards Consulting - Comments on the ONC/Urban Institute DRAFT Electronic Health Record Reporting Program, submitted 10 Aug 2020]]
*[http://jabfm.org/content/28/3/316.full.pdf+html 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]
+
 
*[http://annals.org/aim/fullarticle/2089368/clinical-documentation-21st-century-executive-summary-policy-position-paper-from 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]
+
==US Department of Health and Human Services (HHS) Patients over Paperwork Initiative==
*[https://www.aace.com/files/ehr-priorities.pdf American Medical Association - Improving Care: Priorities to Improve Electronic Health Record Usability, published 2014]
+
*[https://www.govinfo.gov/content/pkg/FR-2019-09-30/pdf/2019-20736.pdf FINAL RULE - Medicare and Medicaid Programs; Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction..., 20 Sep 2019]
*[https://www.rand.org/content/dam/rand/pubs/research_reports/RR400/RR439/RAND_RR439.pdf 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]
+
 
*[https://www.researchgate.net/publication/49761386_The_Complexity_of_Disease_Combinations_in_the_Medicare_Population 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]
+
==More RCB Perspectives and Resources==
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000760/ 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]
+
*[https://www.youtube.com/watch?v=xB_tSFJsjsw Video - An EHR State of Mind, Zubin Damania MD, posted 19 Oct 2015]
*[[media:Reducing_Clinician_Burden-20180222.pdf|CMS/ONC Reducing Clinician Burden Conference - Comments Submitted by CentriHealth, Gary Dickinson, dated 22 Feb 2018]]
+
*[https://www.youtube.com/watch?v=tpu5qcqspGA Video - Professional Satisfaction – Saturday Night Belongs to Epic, Christine Sinsky MD, VP/American Medical Association, posted 27 Jan 2016]
 +
*[https://www.youtube.com/watch?v=LMdxi7Hky-s&feature=youtu.be Video - Professional Satisfaction – EHR Should Make Our Lives Delightful, Christine Sinsky MD, VP/American Medical Association, posted 27 Jan 2016]
 +
*[https://www.youtube.com/watch?v=POZvCRdNbI8 Video - Creating Joy in Medical Practice - An Interview, Christine Sinsky MD, VP/American Medical Association, posted 25 Jan 2018]
 +
*[https://www.youtube.com/watch?v=dmIe4idZE6U Video - Strategies to Address Burnout Must be Practical and Local, Christine Sinsky MD, VP/American Medical Association, posted 25 Jan 2018]
 +
*[https://www.youtube.com/watch?v=FIFnY5mzXF0 Video - AMDIS/HIMSS Physician Executive Symposium - An Interview, Christine Sinsky MD, VP/American Medical Association, posted 28 March 2018]
 +
*[https://edhub.ama-assn.org/steps-forward/module/2702761 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]
 +
*[https://www.youtube.com/watch?v=CCZlFE_R5yg Video - Freeing physicians to do their jobs - 2019 EHR National Symposium - Stanford Medicine, posted 28 Oct 2019]
 +
*[https://www.statista.com/topics/2099/stress-and-burnout/ Statista - Stress and burnout - Statistics & Facts, John Elflein, published 16 Aug 2019]
 +
 
 +
==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)=
 
=US Office of National Coordinator (ONC), Trusted Exchange Framework/Common Agreement (TEFCA)=
*[https://www.hhs.gov/about/news/2018/01/05/draft-trusted-exchange-framework-and-common-agreement-released-hhs.html TEFCA Press Release, DRAFT Documents and Request for Comment, published 5 Jan 2018]
+
*[https://www.hhs.gov/about/news/2018/01/05/draft-trusted-exchange-framework-and-common-agreement-released-hhs.html TEFCA Draft 1, DRAFT Documents and Request for Comment, published 5 Jan 2018]
*[[media:CentriHealth-Comments_on_ONC_DRAFT_TEFCA.pdf|CentriHealth Comments on DRAFT TEFCA, Gary Dickinson, dated 20 Feb 2018]]
+
*[https://www.healthit.gov/topic/interoperability/trusted-exchange-framework-and-common-agreement TEFCA Draft 2, DRAFT Documents and Request for Comment, published 19 Apr 2019]
*[[media:Hrba_tefca_comments_20180220.pdf|Health Record Banking Alliance (HRBA) Comments on DRAFT TEFCA, dated 20 Feb 2018]]
+
*[[media:HL7_Response_Letter_TEFCA_2_06.14.19_FINAL.pdf|HL7 Response Letter, HL7 Policy Advisory Committee, published 17 Jun 2019]]
 +
*[[media:CentriHealth-Comments_on_TEFCA_2-20190617.pdf|Comments on TEFCA Draft 2, Gary Dickinson, CentriHealth, dated 17 Jun 2019]]
 +
*[[media:TEFCA_Scatter_vs_Individual_at_the_Center-20190617.pdf|TEFCA Scatter vs Individual at the Center, Gary Dickinson, CentriHealth, dated 17 Jun 2019]]
  
  
=US Office of National Coordinator (ONC), Technical Interoperability Forum, 15-16 August 2017=
+
=US Office of National Coordinator (ONC) - 21st Century Cures Act: Interoperability, Information Blocking...=
*[https://oncprojectracking.healthit.gov/wiki/pages/viewpage.action?pageId=35127443 Agendas, Panel Presentations, Discussions and Input]
+
*[https://www.govinfo.gov/content/pkg/FR-2020-05-01/pdf/2020-07419.pdf 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]
 +
*[https://www.healthit.gov/cures/sites/default/files/cures/2020-03/HighlightedRegulatoryDates.pdf ONC 21st Century Cures Act - Interoperability, Information Blocking... - Implementation Timeline, published 1 May 2020]
 +
*[https://www.healthit.gov/cures/sites/default/files/cures/2020-04/Enforcement_Discretion.pdf ONC 21st Century Cures Act - Interoperability, Information Blocking... - Enforcement Discretion Dates and Timelines, published 1 May 2020]
 +
*[[media:HL7_Response_Letter_TEFCA_2_06.14.19_FINAL.pdf|HL7 Response Letter, HL7 Policy Advisory Committee, published 3 Jun 2019]]
 +
*[[media:CentriHealth-Comments_on_ONC_NPRM-20190603.pdf|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 Forum, 6-8 August 2018=
+
=US Office of National Coordinator (ONC) - Interoperability Standards Advisory (ISA)=
*[https://www.healthit.gov/news/events/oncs-2nd-interoperability-forum Agendas, Panel Presentations, Discussions and Videos]
+
*[https://www.healthit.gov/isa/isa-publications ISA Editions 2015-2020]
  
  
=US Office of National Coordinator (ONC), "Record to Rely On" Workshop, 29 November 2016=
+
=US Office of National Coordinator (ONC) - Interoperability Forums=
 +
*[https://oncprojectracking.healthit.gov/wiki/pages/viewpage.action?pageId=35127443 1st: 15-16 Aug 2017]
 +
*[https://www.healthit.gov/news/events/oncs-2nd-interoperability-forum 2nd: 6-8 Aug 2018]
 +
*[https://www.healthit.gov/news/events/oncs-3rd-interoperability-forum 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==
 
==Leads:  Mark Knee JD, Elise Sweeney Anthony JD, Mike Lipinski JD==
 
*[[media:ONC-EHR_as_Record_to_Rely_On-Slides-20161129.pdf|Truth (Authenticity) as Evidence for Trust (Assurance), slide set developed/presented by Gary Dickinson, dated 29 Nov 2016]]
 
*[[media:ONC-EHR_as_Record_to_Rely_On-Slides-20161129.pdf|Truth (Authenticity) as Evidence for Trust (Assurance), slide set developed/presented by Gary Dickinson, dated 29 Nov 2016]]
Line 99: Line 157:
  
  
=US Office of National Coordinator - Interoperability Standards Advisory (ISA)=
+
=US Centers for Medicare and Medicaid Services (CMS) - Interoperability and Patient Access...=
*[https://www.healthit.gov/isa/sites/default/files/2018%20ISA%20Reference%20Edition.pdf ISA 2018 Edition]
+
*[https://www.govinfo.gov/content/pkg/FR-2020-05-01/pdf/2020-05050.pdf 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]
*[https://www.healthit.gov/standards-advisory ISA 2017 Edition]
+
 
 +
 
 +
=HL7 FHIR Standard Release 4=
 +
*[http://hl7.org/fhir HL7 Fast Health Interoperable Resources (FHIR) R4 - Main Page, published Jan 2019]
 +
 
 +
==FHIR EHR-S Record Lifecycle Event Implementation Guide==
 +
*[http://hl7.org/fhir/ehrsrle/ehrsrle.html 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==
 +
*[http://hl7.org/fhir/ehrsrle/ehrsrle-auditevent.html FHIR EHR-S Record Lifecycle Event - AuditEvent Profile, published as part of FHIR R4, Jan 2019]
 +
*[http://hl7.org/fhir/ehrsrle/ehrsrle-provenance.html 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)==
 +
*[http://hl7.org/fhir/fivews.html 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 Standard for Trial Use Release 3 (STU-3)=
 
*[http://hl7.org/fhir Fast Health Interoperable Resources (FHIR) STU-3 - Main Page, published Mar 2017]
 
==EHR-S Record Lifecycle Event Implementation Guide==
 
*[http://hl7.org/fhir/ehrsrle/ehrsrle.html 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==
 
*[http://hl7.org/fhir/ehrsrle/ehrsrle-auditevent.html FHIR EHR-S Record Lifecycle Event - AuditEvent Profile, published as part of FHIR STU-3, Mar 2017]
 
*[http://hl7.org/fhir/ehrsrle/ehrsrle-provenance.html FHIR EHR-S Record Lifecycle Event - Provenance Profile, published as part of FHIR STU-3, Mar 2017]
 
==W5 Report (Who, What, When, Where, Why)==
 
*[http://hl7.org/fhir/w5.html 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==
*[http://hl7.org/fhir/safety.html FHIR Implementer's Safety Check List, published as part of FHIR STU-3, Mar 2017]
+
*[http://hl7.org/fhir/safety.html FHIR Implementer's Clinical Safety Check List, published as part of FHIR R4, Jan 2019]
  
  

Revision as of 13:45, 16 August 2020

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.


Contents

HL7 EHR/PHR Standards

System Functionality Standards

Record Interoperability Standards


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

HL7 RCB Project - Analysis Worksheets

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 #119 have been reviewed and are incorporated in this version. See "References" Tab.

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

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.

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.

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

The ballot opens on Friday, 14 August, and closes on Monday, 14 September 2020.

HL7 RCB Project - White Paper

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

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

"See What We Mean"

HL7 RCB Project - Reducing Burden - Success Stories

HL7 RCB Project - Survey and Responses

HL7 RCB Project - Focus Team Drafts

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

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

More RCB Perspectives and Resources

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)


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


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


US Office of National Coordinator (ONC) - Interoperability Forums


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


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


HL7 FHIR Standard Release 4

FHIR EHR-S Record Lifecycle Event Implementation Guide

FHIR AuditEvent and Provenance Profiles

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

FHIR Implementer's Safety Check List


Interoperability Assessment


Blockchain for Health/Healthcare (Public Journal)


International Patient Summary (INTERPAS/IPS)


PUBLICATION PACKAGE - Meaningful Use 2015 Edition Functional Profile

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


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

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


EHR as Legal Record Project

HL7 EHR and Records Management-Evidentiary Support (RM-ES) WGs

Leads: Gary Dickinson, Reed Gelzer MD, Diana Warner


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

Lead: Gary Dickinson


Record Lifecycle, Provenance and Vocabulary Alignment - Project Now Complete

Record Lifecycle, Security, Privacy, and Provenance Vocabulary Alignment

Leads: Reed Gelzer, MD, Diana Proud-Madruga

REFERENCES


US ONC Standards and Interoperability Framework

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

Cross Initiative Work Group - S&I Simplification


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


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

IMMUNIZATION MAGAGEMENT PROTOTYPE

ORDERS MAGAGEMENT PROTOTYPE

RESULTS MAGAGEMENT PROTOTYPE

RECORDS INFRASTRUCTURE (RI) PROTOTYPE


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


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


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


US ONC Final 10 Year Interoperability Roadmap


US ONC Advance Notice of Proposed Rulemaking

Metadata Standards to Support Nationwide Electronic Health Information Exchange


ISO 16223 - Standards Convergence to Promote EHR Interoperability


Key Reference Documents


2009 ANSI HITSP Foundations Framework Simplification Strategy