Data Provenance Tiger Team

June 16, 2014

Johnathan Coleman - Initiative Coordinator

Lynette Elliott – Tiger Team Support

Bob Yencha – Subject Matter Expert

Ioana Singureanu – Modeling Facilitator

Kathleen Connor – Subject Matter Expert

Neelima Chennamaraja - Modeling Facilitator

2

Agenda

Topic Time Allotted

General Announcements 1 minuteHL7 Project Scope Statement Update, Timeline 1 minutes

Task Activity 50 minutesNext Steps/Wrap Up 5 minutes

3

Meeting Etiquette

• Please mute your phone when you are not speaking to prevent background noise.– All meetings are recorded.

• Please do not put your phone on hold. – Hang up and dial back in to prevent

hold music.• Use the “Chat” feature to ask questions

or share comments.– Send chats to “All Participants” so

they can be addressed publicly in the chat, or discussed in the meeting (as appropriate).

Click on the “chat” bubble at the top of the meeting window to

send a chat.

The Star and Swoosh, Putting the I in Health IT, the Putting the I in Health IT composite logo, HealthIT.gov, the HealthIT.gov composition logo, HealthITBuzz, and the HealthITBuzz composite logo are service marks or registered service marks of the U.S. Department of Health and Human Services.

Office of the National Coordinator for Health Information Technology

May- Jun ‘14 Jul- Aug ‘14 Sept- Oct ‘14 Nov- Dec ‘14M

ilest

ones

HL7 Ballot (Aug 8- Sept 8)

Dat

a Pr

oven

ance

HL7 Project Scope Statement (May 18)

Consensus/ End-to-end Review

HL7

HL7 Notification of Intent to Ballot (June 29)

HL7 Initial Content Deadline (Jul .13)

HL7 WG Meeting (Sept 14-19)

HL7 Final Content Due (Aug. 3)

Data Provenance Tiger Team HL7 September 2014 Ballot

HL7 Ballot Reconciliation (Sept. 8-Nov. 21)

Today

HL7 DSTU Publication Dec. ‘14

Tiger Team Timeline

Day Date Mon 28-Apr Kick off

Mon 5-May No meeting - HL7

Mon 12-May Set-up, begin analysis Model and example doc review, gather requirements & related materials for review

Mon 19-May Analysis Requirements review

Tue 27-May Analysis Address requirementsMon 2-Jun Analysis Address requirements

Mon 9-Jun Harmonization requests dueAnalysis

HL7 Harmonization Committee Schedule:Initial Proposal Deadline: Sunday, June 15, 2014, MidnightTechnical review: Tuesday or Wednesday June 17-18, 2014

Mon 16-Jun Analysis

Mon 23-Jun Analysis

Mon 30-Jun Analysis Final Harmonization Proposal Deadline: Sunday, July 6, 2014, MidnightHarmonization Mtg: Tuesday through Friday, July 15-18, 2014

Mon 7-Jul Analysis/review draft ballot

Mon 14-Jul Review draft ballotMon 21-Jul Review draft ballot

Mon 28-Jul Final ballot review and sign-off Next 3 days will be used to finalize pubs packageFri 1-Aug Ballot Submission

Agenda

Modeling:

• Clarify assumptions on use of header, section and entry data elements– Capture of provenance “known facts” in existing

CDA structures

– Begin to frame “best practice” guidance on what is available today

– Identify areas for future work and recommendations to full initiative

Framing Concepts for CDA IG

• Context conduction & inheritance within the document– How this will play out in new uses of parts of

document

The Star and Swoosh, Putting the I in Health IT, the Putting the I in Health IT composite logo, HealthIT.gov, the HealthIT.gov composition logo, HealthITBuzz, and the HealthITBuzz composite logo are service marks or registered service marks of the U.S. Department of Health and Human Services.

Office of the National Coordinator for Health Information Technology

8

Entry/Observation

Section

Header

author

informant

authenticator

provider

organization

device

provider

organization

device

providerRepresentedorganization

legalAuthenticator provider

Representedorganization

author

informant

provider

organization

device

provider

organization

device

author

informant

providerorganization

device

provider

organization

device

Todays topics

• Role of authenticator and legalAuthenticator– Header only - not on sections or entries– Where do these roles come into play with the

changes in the above– Relationship to custodian?– Relationship to author?

Todays topics

• Assignment in clinical organizations and workflow is clear– Inclusion of information from multiple sources is

included into a new clinical document that can be legally authenticated as “fit for use for clinical care”

• Guidance questions to be resolved– Who/what is legalAuthenticator in clinical vs. non-

clinical settings e.g. an HIE where document is assembled as result of query, no clinical review is performed

Todays topics

• Author - generally– Authors create new info (may be a device)

• Author at Header?– Assembler vs. “traditional” view of device

participation• Does NOT create new information, repackages existing

content• What is level of detail about assembler we want to

capture and communicate?• Use of assignedAuthor?

Todays topics

• Informant– Suppliers vs. custodians– Single provider vs. teams

13

Data Provenance Tiger TeamNext Steps

• Monitor wiki for updated draft based on todays work– Please use the comment capture form on the wiki

• Requests for community input– Submit any potential requirement not previously discussed

or included in draft IG for discussion on next meeting on the wiki Requirements page

– Identify any other candidate source IGs for review

• Next Meeting – Monday, June 16 @ 3:00PM ET

14

• Questions?

Data Provenance Tiger TeamBackground Slides

The following slides are included as references and for quick access when/if needed

16

CDA R2 Definitions

• 4.2.2.1 – authenticator– Represents a participant who has attested to the

accuracy of the document, but who does not have privileges to legally authenticate the document. An example would be a resident physician who sees a patient and dictates a note, then later signs it.

• 4.2.2.8 – legalAuthenticator– Represents a participant who has legally

authenticated the document.

17

CDA R2 Definitions

• 4.2.2.2 – author– Represents the humans and/or machines that

authored the document.• 4.2.2.3 – custodian– Represents the organization that is in charge of

maintaining the document. The custodian is the steward that is entrusted with the care of the document. Every CDA document has exactly one custodian.

18

CDA R2 Definitions

• 4.2.2.6 – informant– An informant (or source of information) is a

person that provides relevant information, such as the parent of a comatose patient who describes the patient's behavior prior to the onset of coma.

Reference Choices

Related Provenance

21

Document contains excerpts of other documents

Document Informant: State HIE

Section Informant: Organization

overrides

Entry Informant: Sub-organization

overrides

Sub-organization of…

Document Author Device: Aggregation SoftwareRepresented organization

Section Author Device: Software

Represented organization Entry Author:

Aggregation Software

Represented organization

• One document that contains content from multiple related documents

Document Record Target: Patient identifiers by organization

Entry Record:Org-specific patient id

Assigning organization

Related Documents: Summary 1, Summary 2

Document Id: Summary HIE

Document contains excerpt s from other documents• One document that contains excerpts from multiple related documents

Related Documents: Summary 1, Summary 2, Summary 3, Summary 4

Summary 1: Allergies

Summary 2: Results

Summary 3: Results

Summary 4: Results

Related Docum

ents

Org A

Org B

Org C

Org D

Additional provenance template …• …to indicate the source of each external entry

Related Documents: Summary 1, Summary 2, Summary 3, Summary 4

Summary 1: Allergies

Summary 2: Results

Summary 3: Results

Summary 4: Results

Related Docum

ents

Org A

Reference/externalDocument

Summary 1: Allergy

Summary 1: Allergy

Reference/externalDocument

Reference/externalDocument

Reference/externalObservation

Reference/externalObservation

Representing Assembly Software in DPROV CDA

Requirement

• Need to convey that Assembly Software generated a CDA document

• Two Approaches:– Author ASSEMBLER– Participant ASSEMBLER

Document Author and Participant

Author ASSEMBLER

Header [1…*] Assigned Author Role:• Each Assigned Author played by [0…1] Person or Device • Scoped by [0…1] Organization• If no Authoring Device or Person, Author Entity can be

null• If Device is Assigned Author, then may be:

– Played by [0…*] MaintenanceEntity – Scoped by [1…1] Person

• Section [0…*]• Entry [0…*]

Participant ASSEMBLER

• Header [1…*] and Entry [0…*] participants• ParticipationType = DEV• ParticipationFunction = ASSEMBLER• Organization responsible for ASSEMBLER’s

participation

[0…1] Person is only choice of Participant Assigned Entity at Header • Can leave Null[0…1] Device with additional software information supported at Entry for Participant ASSEMBLER

Author ASSEMBLER

PRO

Author ASSEMBLER can be conveyed at Header/Section/Entry• Header ASSEMBLER Entity

conveys additional information about Software and who maintains it

• May be useful for determining:– Type of Assembly Software

Algorithm used– How it’s maintained – Organization responsible for

deploying the ASSEMBLER

CON

Author ASSEMBLER connotes that the ASSEMBLER is creating new info• Authors create new info (may be

a device)ASSEMBLER vs. “traditional” view of device participation• Does NOT create new

information, repackages existing content

What level of detail about ASSEMBLER need to be captured and communicated?

Participant ASSEMBLER

PRO

Participant ASSEMBLER can be conveyed at Header and /Entry• Does not misrepresent the

ASSEMBLER as an Author• Header Participant

ASSEMBLER may include Organization responsible for deploying the ASSEMBLER

CON

Participant ASSEMBLER can not be conveyed at Section Level• Cannot convey additional

information about the ASSEMBLER software algorithm or who maintains it

What needs to be conveyed about ASSEMBLER?

• Does it make sense to convey the Assembly Software at the section or entry?

• If ASSEMBLER generated a CDA Document, then ASSEMBLER also generated all contained sections and entries, even if those assembled into the Document were generated separately by same/different Assembly Software

• How critical is ASSEMBLER at Section Level if available at Entry Level?