ihe profiles and cda hl7 uk 2007 keith w. boone interoperability architect, ge healthcare co-chair,...
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IHE Profiles and CDA
HL7 UK 2007HL7 UK 2007Keith W. BooneKeith W. BooneInteroperability Architect, GE HealthcareInteroperability Architect, GE Healthcare
Co-chair, IHE Patient Care Coordination TC Co-chair, IHE Patient Care Coordination TC
Co-chair, HL7 Structured DocumentsCo-chair, HL7 Structured Documents
Member, ANSI/HITSP CE, CD and PH TCsMember, ANSI/HITSP CE, CD and PH TCs
Member, ASTMMember, ASTM
Agenda
• IHE Profiles
• Templates
• IHE CDA Based Templates
• IHE Privacy and Security Framework
• Basic Patient Privacy Consents
IHE Actor and Transaction Diagrams
DisplayInformation
Source
Request Specific Information for Display [ITI-11]
Request Document for Display [ITI-12]
• Actors– Analogous to HL7 Application Roles– A UML "Interface"
• Transactions– A sequence of one or more standards
based interactions– Somewhat analogous to HL7 Interactions
Cross Enterprise Document Sharing - XDS
DocumentSource
DocumentRepository
DocumentRegistry
Provider and RegisterDocument Set [ITI-15]
Register Document Set [ITI-14]
DocumentConsumer
Query Registry[ITI-16]
Retrieve Document[ITI-17]
Patient IdentitySource
Patient IdentityFeed [ITI-8]
[ITI-8] HL7 V2 ADT
[ITI-14, 15, 16] ebRIM (Registry Information Model)ebRS (Registry Services)
[ITI-17] HTTP
Cross Enterprise Document SharingMetadata
Who What Where WhenDocument Patient
Identifiers, Name, Address, Gender, Date of Birth
AuthorInstitution, Person, Role, Specialty
Legal Authenticator
Service EventConfidentialityDocument
TypeClassFormatLanguageTitleURI
Healthcare Facility
Practice Setting
Service start Service endCreation
Folder Owner Code(s)Description
Update
Submission Set
Patient IdentifierAuthor
Institution, Person, Role, Specialty
Content Source Submitted
Searchable Metadata, Searchable Metadata, Stored MetadataStored Metadata
Consistent Time - CT
Time Client Time ServerMaintain Time [ITI-1]
[ITI-1] RFC-1305 (NTP), RFC-2030 (SNTP)
Audit Trails and Node Authentication - ATNA
Time Server
Secure NodeAudit
Repository
Maintain Time [ITI-1]
Record Audit Event [ITI-20]
Authenticate Node [ITI-19]
[ITI-1] RFC-1305 (NTP), RFC-2030 (SNTP)
[ITI-19] RFC-2246 (TLS), X.509
[ITI-20] RFC-3164 (Syslog), RFC-3881
Patient Identity Cross Referencing - PIX
Patient IdentitySource
Patient IdentityCross
ReferenceManager
Patient IdentifyCross
ReferenceConsumer
Patient Identity Feed [ITI-8]
PIX Update Notification [ITI-10]
PIX Query [ITI-9]
[ITI-8] HL7 V2.3.1 ADT or HL7 V3 Patient Administration
[ITI-9] HL7 V2.5 Query or HL7 V3 Patient Administration
[ITI-10] HL7 V2.5 ADT or HL7 V3 Patient Administration
Patient Demograpics Query - PDQ
PatientDemographics
Supplier
PatientDemographics
Consumer
Patient Demographics Query [ITI-21]
Patient Demographics and Visit Query [ITI-22]
[ITI-20,21] HL7 V2.5 ADT or HL7 V3 Patient Administration
Request Form for Data Capture - RFD
Form Archiver
Form Reciever
Form Filler ArchiveForm
Submit Form
Form Manager Retrieve Form
XForms 1.0, WSDL, XML
Query for Existing Data - QED
Diagnostic DataRepository
Clinical DataConsumer
ImmunizationsData
Repository
Vital Signs DataRepository
Problems andAllergies Data
Repository
MedicationsData
Repository
ProfessionalServices Data
Repository
QueryVital Signs
[PCC-1]
Query Medications[PCC-2]
QueryImmunizations
[PCC-3]
QueryDiagnostic Data
[PCC-4]
QueryProfessional
Services[PCC-6]
QueryProblems
and Allergies[PCC-1]
HL7 V3 Care Record, Care Record QueryASTM/HL7 Continuity of Care Document
Putting it Together
EHR
RegistrationSystem
AuditSystem
eMPI
TimeServer
eMPI
HIE
AuditSystem
CDA Templates
• What is a Template?
• How can it be expressed?
• What can I do with it?
What is a Template?
A template is an expression of a set of constraints on the RIM that is used to apply additional constraints to a portion of an instance of data which is expressed in terms of some other Static Model.
HL7 Specification and Use of Reusable Constraint Templates
Expression of Templates
• Formal Written Definition– In human readable form
• Explicit or Implicit HL7 Static Model– Application results in a Static Model
• Implementation Specific Representations– Static Model– W3C Schema– ISO Schematron
Features of a Template
• Has an Identity• Can Require, Prohibit, or Suggest (constrain)
– RIM Attributes– Relationships– Other Templates– Specify Cardinality– Conditional and Co-relationships
• Can Inherit from other Templates
IHE Patient Care Coordination Templates
• Are Content Profiles or Modules• Have a formal Written Definition• Result in an Implicit HL7 Static Model• Use ISO Schematron for Implementation• Inherit from ASTM/HL7 CCD when possible• Provide Constraints on
– Documents– Sections– Entries
Document Level Templates
• Template ID• Summary Description• Format Code for use with XDS• Standards Used• Data Element Table (needs Definitions)• Specification
– Sections– (Header) Entries
• Conformance• Sample XML (abbreviated)• Schematron
Document Template Specification
IHE PCC Document Templates (12)
• Medical Documents Specification • Medical Summary Specification • Referral Summary Specification • Discharge Summary Specification • PHR Extract Specification • PHR Update Specification • Emergency Department Referral Specification • Antepartum Summary • Triage Note • Nursing Note • Composite Triage and Nursing Note • ED Physician Note
Section Level Template
• Template ID• Parent Template(s)• Summary Description• LOINC Code• Required and Optional Sub-sections• Required and Optional Entry Templates • Sample XML (abbreviated)• Schematron
Section Template Example
IHE PCC Section Templates (71)
• Reasons for Care (4)• Other Condition Histories (12)• Medications (5)• Physical Exams (28)• Relevant Studies (5)• Plans of Care (7)• Procedures Performed (3)• Impressions (3)• Administrative and Other Information (4)
Reasons for Care
The sections described below describe various reasons why healthcare is being provided to the patient.
Reason for Referral
Coded Reason for Referral
Chief Complaint
Hospital Admission Diagnosis
Other Condition Histories
History of Present Illness Hospital Course Active Problems Discharge Diagnosis Resolved Problems Encounter Histories History of Outpatient Visits History of Inpatient Visits List of Surgeries Coded List of Surgeries Allergies and Other Adverse Reactions Family Medical History Coded Family Medical History Social History
The sections defined below provide historical information about the patient's conditions.
Functional StatusCoded Functional StatusPain Scale Assessment Braden Score Assessment Geriatric Depression Scale Physical Function Review of Systems Hazardous Working Conditions Pregnancy History Estimated Delivery Date Section Medical Devices Foreign Travel History of Tobacco Use Current Alcohol/Substance Abuse
Medications
This section contains section content modules that describe activities surrounding the use of medication.
Medications
Admission Medication History
Medications Administered
Hospital Discharge Medications
Immunizations
Physical Exams
Physical Exam Physical Exam (with subsections) Hospital Discharge Physical Exam Vital Signs Coded Vital Signs General Appearance Visible Implanted Medical Devices Integumentary System Head Eyes Ears, Nose, Mouth and Throat Ears Nose Mouth, Throat, and Teeth
Neck Endocrine System Thorax and Lungs Chest Wall Breasts Heart Respiratory System Abdomen Lymphatic System Vessels Musculoskeletal System Neurologic System Genitalia Rectum
Relevant Studies
Results
Coded Results
Hospital Studies Summary
Coded Hospital Studies Summary
Consultations
Plans of Care
This section provides content modules for sections that describe the plan of care intended for the patient.
Care Plan Assessment and Plan Discharge Disposition Discharge Diet Advance Directives Coded Advance Directives Transport Mode
Procedures Performed
• Patient Education and Consents
• Coded Patient Education and Consents
• Procedures Performed
Impressions
• ACOG Visit Summary Flowsheet Section
• Progress Note
• ED Diagnoses
Administrative and Other Information
• Payers
• Referral Source
• Mode of Arrival
• ED Disposition
Entry Level Template
• Template ID• Summary Description• Standards• Parent Template(s)• Specification
– Example XML (abbreviated)– Line by Line Specification– Code Tables– References to Other Templates– (Schematron coming)
Entry Template Example
IHE PCC Entry Templates (50)
Language Communication Employer and School Contacts Healthcare Providers and
Pharmacies Patient Contacts Authorization Consent Service EventsAuthors and Informants Linking Narrative and Coded
Entries Severity Problem Status Observation Health Status Comments Patient Medication Instructions Medication Fulfillment
Instructions External References Internal References
Concern Entry Problem Concern EntryAllergy and Intolerance
Concern Problem Entry Allergies and Intolerances Medications Immunizations Supply Entry Product Entry Simple Observations Vital Signs Organizer Vital Signs Observation Family History Organizer Family History Observation Social History Observation Pregnancy Observation Estimated Delivery Date
Observation
ACOG Visit Summary Battery Advance Directive Observation Blood Type Observation Encounters Update Entry Procedure Entry Transport Intended Encounter Disposition Coverage Entry Payer Entry Pain Score Observation Braden Score Observation Braden Score Component Geriatric Depression Score
Observation Geriatric Depression Score
Component Survey Panel Survey Observation
IHE Security and Privacy Framework
• Consistent Time – NTP• Audit Trails and Node Authentication
– Bidirectional Certificate Based Node Authentication– Encrypted Communication (AES 128)– Audit Trails (RFC 3881)
• Basic Patient Privacy Consents– CDA Based Document– Header Entries Describe
• Consent Event• Document Sensitivity
• Document Digital Signature– XADES– XML Digital Signature– X.509– ASTM E1762
• Cross Enterprise User Authentication– SAML
BPPC Consent Framework
• For a Consent, Documentation is of:– A Consent Act
• Identifiers for the Consent Policies Agreed To
• Effective Time
– Performed by the Patient– Attested to by Patient or other Authority– Document Content is Human Readable description of Policy
• Within a Document, its Sensitivity– Is specified in authorization/consent– Indicates policies applied to "this" document
Sample Consent Matrix
Sensitivity
Functional Role HIV
Sta
tus
Sex
ual H
ealt
h In
form
atio
n
Men
tal H
ealt
h In
form
atio
n
Dev
elop
men
tal D
isab
ility
In
form
atio
n
Alc
ohol
/Dru
g A
buse
In
form
atio
n
Tre
atm
ent
Res
earc
h
Emergency Treatment Provider Treatment Provider Direct Care Provider Alcohol/Drug Abuse Provider Developmental Provider Mental Health Provider Sexual Health Provider Patient or Legal Representative Payer Researcher
More information….
• IHE Wiki: http://wiki.ihe.net/index.php?title=PCC • IHE Web site: http://www.ihe.net
http://www.himss.org/IHE http://www.rsna.org/IHE
• e-Mail Listsmailto:pcctech@rsna.org?subject=subscribe mailto:pccplan@rsna.org?subject=subscribe
• Technical Frameworks• Technical Framework Supplements – Trial Implementation• Non-Technical Brochures :
– Calls for Participation– IHE Fact Sheet and FAQ– IHE Integration Profiles: Guidelines for Buyers– IHE Connect-a-thon Results– Vendor Products Integration Statements
Questions?
Questions?
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