“ jericho / ut austin pilot”

“Jericho / UT Austin Pilot”

Privacy with Dynamic Patient Review

September 17, 2013

Presented by:David Staggs and Michael Dufel

Jericho Systems Corporation

209/17/2013

Agenda

• Administrative issues • Pilot scope• Pilot data flow • Test scenarios• Transaction and Document tests• Discussion • Pilot Timeline• Plan of Action

309/17/2013

Pilot Administrivia

• This pilot is a community led pilot– Limited support provided by the ONC

• Johnathan Coleman (Security Risk Solutions)• Zachary May (ESAC)• Penelope Hughes (ONC)• Libbie Buchele (ONC Sponsor)

• In conjunction with DS4P bi-weekly return of an All Hands meeting• Access to DS4P Wiki, teleconference, and calendar • Meeting times: Tuesdays 11AM (ET)

– Dial In: +1-650-479-3208Access code: 662 197 169URL:https://siframework1.webex.com/siframework1/onstage/g.php?t=a&d=662197169

https://siframework1.webex.com/siframework1/onstage/g.php?t=a&d=662197169




409/17/2013

Scope of the Pilot

1. Define the exchange of HL7 CDA-compliant PCD between a data custodian and a PCD repository that includes a report on the outcome of the request to the healthcare consumer (subject).

2. Additional goal: use identifiers to identify the subject/ PCD repository for use in reporting the outcome of the “secondary user” request use case to subject by subsequent EHR custodians.

3. Stretch goal: mask and/or redact the clinical document based on data segmentation and PCD choices retrieved from the PCD repository.

509/17/2013

Pilot Data Flow

Custodian of Data being Provided at

Patient

PCD Repository2nd Requestor

1st Requestor

B

, = Clinical data

A,B =PCD data

= audit record

And Subsequent Custodian of Data being Provided at

Test Approach

Sections included in each test scenario in the DS4P Pilot Execution Script:

1. Scenario

2. Actors

3. Preconditions

4. Test steps

5. Test results

6. Log Capture

7. Data Set Verification

09/17/2013 6

Test Cases

09/17/2013 7

DS4P Pilot Execution Script:

1. Consent To Patient Discovery : No Consent

2. Consent To Patient Discovery : 1st Requestor (1st)

3. Consent To Patient Discovery : 2nd Requestor (2nd)

4. Consent To Document Query : No Consent

5. Consent To Document Query : 1st To PC - Allow

6. Consent To Document Query : 2nd To PC - Deny

7. Consent To Document Query : 2nd to SC - Deny

8. Consent To Document Retrieve : No Consent

9. Consent To Document Retrieve : 1st to PC - Allow

10. Consent To Document Retrieve : 2nd To PC - Deny

11. Consent To Document Retrieve : 2nd to SC - Deny

12. Consent To Document Retrieve : With Segmentation

Test Cases (Visual Representation)

09/17/2013 8

Scenario PCD ITI-55 ITI-38 ITI-391st Requestor → PC Y 2 5 92nd Requestor → PC Y 3 6 102nd Requestor → SC Y 7 111st Requestor → PC N 1 4 8Clinical Data Segmentation Y 12

PC = Primary Custodian

SC = Secondary Custodian

Original Query & Response

909/17/2013

Complete solution must retrieve PCD during ITI 55, ITI 38, ITI 39

J-UT Pilot Sequence Detail (A)

09/17/2013 10Retrieving & applying PCD, reporting during patient discovery

J-UT Pilot Sequence Detail (B)

09/17/2013 11

Retrieving & applying PCD, reporting when returning document list

J-UT Pilot Sequence Diagram (C)

09/17/2013 12Retrieving & applying PCD, reporting when returning a clinical document

1309/17/2013

Transaction Tests (Last Meeting)• NwHIN messages

o Test messages must comply with NwHIN specification• Request for PCD from Document Custodian

o ITI 55: Data Set Ao ITI 38: Data Set Bo ITI 39: Data Set C

• ATNA audit record from Document Custodiano ITI 55: Audit data Set Ao ITI 38: Audit data Set Bo ITI 39: Audit data Set C

1409/17/2013

Document Tests

• HL7 Documents o HL7 Documents must comply with HL7 specification

• Clinical document from Document Custodiano Must include a reference to the patient consent repository

• PCD document from PCD Repositoryo Must follow HL7 Privacy Consent Directive o Must include specific elements

1509/17/2013

Discussion

• Review of J-UT DS4P Test Document Draft o Overviewo Scenario Testso Transaction Tests o Document Testso Appendixes: Test Results

1609/17/2013

Pilot Timeline

• General Timeline, conditioned on agreement of stakeholders

17

Plan of Action

• Upon agreement of the participants the POA is: • Identify the elements available from previous DS4P pilots• Scope level of effort, decide on extended scenario• Determine first draft of functional requirements• Review standards available for returning information on requests• Determine any gaps or extensions required in standards• Stand up information holders and requestors• Create XDS.b repository holding PCD• Identify remaining pieces, create test procedures • Document and update IG with results of our experience

09/17/2013

1809/17/2013

Backup Slides

DS4P Standards Material• Location of DS4P Standards Inventory:

http://wiki.siframework.org/Data+Segmentation+-+Standards+Inventory

• Location of DS4P Standards Mapping Issues:http://wiki.siframework.org/file/view/Copy%20of%20DataMappingsIssues%2005102012.xlsx/333681710/Copy%20of%20DataMappingsIssues%2005102012.xlsx

• General Standards Source List:http://wiki.siframework.org/file/view/General%20SI%20Framework%20Standards%20Analysis.xlsx/297940330/General%20SI%20Framework%20Standards%20Analysis.xlsx

• Standards Crosswalk Analysis http://wiki.siframework.org/Data+Segmentation+for+Privacy+Standards+and+Harmonization (at bottom of page, exportable)

• Implementation Guidancehttp://wiki.siframework.org/file/view/Data%20Segmentation%20Implementation%20Guidance_consensus_v1_0_4.pdf/416474106/Data%20Segmentation%20Implementation%20Guidance_consensus_v1_0_4.pdf

09/17/2013 19



http://wiki.siframework.org/file/view/Copy%20of%20DataMappingsIssues%2005102012.xlsx/333681710/Copy%20of%20DataMappingsIssues%2005102012.xlsx



http://wiki.siframework.org/file/view/General%20SI%20Framework%20Standards%20Analysis.xlsx/297940330/General%20SI%20Framework%20Standards%20Analysis.xlsx




http://wiki.siframework.org/Data+Segmentation+for+Privacy+Standards+and+Harmonization



http://wiki.siframework.org/file/view/Data%20Segmentation%20Implementation%20Guidance_consensus_v1_0_4.pdf/416474106/Data%20Segmentation%20Implementation%20Guidance_consensus_v1_0_4.pdf




2009/17/2013

DS4P References

• Use Case: http://wiki.siframework.org/Data+Segmentation+for+Privacy+Use+Cases

• Implementation Guide: http://wiki.siframework.org/Data+Segmentation+for+Privacy+IG+Consensus

• Pilots Wiki Page: http://wiki.siframework.org/Data+Segmentation+for+Privacy+RI+and+Pilots+Sub-Workgroup

http://wiki.siframework.org/Data+Segmentation+for+Privacy+Use+Cases

http://wiki.siframework.org/Data+Segmentation+for+Privacy+Use+Cases

http://wiki.siframework.org/Data+Segmentation+for+Privacy+IG+Consensus

http://wiki.siframework.org/Data+Segmentation+for+Privacy+IG+Consensus

http://wiki.siframework.org/Data+Segmentation+for+Privacy+RI+and+Pilots+Sub-Workgroup

http://wiki.siframework.org/Data+Segmentation+for+Privacy+RI+and+Pilots+Sub-Workgroup

2109/17/2013

Pilot Data Flow


Patient


1st Requestor

B

, = Clinical data

A,B =PCD data

= audit record


2209/17/2013

Pilot Data Flow


Patient


1st Requestor

Clinical exchange #

Clinical exchange #

B

, = Clinical data

A,B =PCD data

= audit record

And Subsequent Custodian of Data being Provided at Fetch PCD Fetch

PCD

Send auditSend audit

2309/17/2013

Pilot Data Flow (1)


Patient


1st Requestor

, = Clinical data

A,B =PCD data

= audit record

2409/17/2013

Pilot Data Flow (2)


Patient


1st Requestor

, = Clinical data

A,B =PCD data

= audit record

2509/17/2013

Pilot Data Flow (3)


Patient


1st Requestor

B

, = Clinical data

A,B =PCD data

= audit record


2609/17/2013

Pilot Data Flow (4)


Patient


1st Requestor

, = Clinical data

A,B =PCD data

= audit record


2709/17/2013

Pilot Data Flow (5)


Patient


1st Requestor

, = Clinical data

A,B =PCD data

= audit record


2809/17/2013

Pilot Data Flow (updated)


Patient


1st Requestor

B

, = Clinical data

A,B =PCD data

= audit record
