The Standards and Interoperability The Standards and Interoperability Framework Portal in the United States Framework Portal in the United States
Health Information KnowledgebaseHealth Information KnowledgebaseUse Case Simplification Work GroupUse Case Simplification Work Group
Standards and Interoperability Framework InitiativeStandards and Interoperability Framework Initiative
J. Michael Fitzmaurice, Ph.D. , AHRQJohn Donnelly, Intepro Solutions
Robin Barnes, Data Consulting Group
September 29, 2011
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Agency for Healthcare Research Agency for Healthcare Research and Quality (AHRQ)and Quality (AHRQ)
MissionMission
Improve the quality, safety, efficiency and Improve the quality, safety, efficiency and effectiveness of health care for all Americanseffectiveness of health care for all Americans
AHRQ-USHIK PresentationAHRQ-USHIK Presentation
– J. Michael Fitzmaurice PhD, AHRQJ. Michael Fitzmaurice PhD, AHRQ– John Donnelly, IntePro SolutionsJohn Donnelly, IntePro Solutions– Robin Barnes, Data Consulting GroupRobin Barnes, Data Consulting Group
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GovernanceGovernance
AHRQ provides overall direction and support with advice from its users, AHRQ provides overall direction and support with advice from its users, partners, and leadership teampartners, and leadership team
USHIK has been supported by DoD, VA, CMS, NCI, HHS ASPE, its registered USHIK has been supported by DoD, VA, CMS, NCI, HHS ASPE, its registered authorities, and othersauthorities, and others
USHIK follows the ISO/IEC 11179 standard for metadata registriesUSHIK follows the ISO/IEC 11179 standard for metadata registries Each registered authority controls its own data in USHIKEach registered authority controls its own data in USHIK Information models guide the context in which the data are used, e.g., use Information models guide the context in which the data are used, e.g., use
cases, developing committees, othercases, developing committees, other
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Example: AHRQ-USHIK Data ElementExample: AHRQ-USHIK Data Element
Data element nameData element name: : Gender codeGender code AttributesAttributes (Metadata): (Metadata):
– DefinitionDefinition For eligibility, id gender of For eligibility, id gender of the individual the individual
membermember– ContextContext NCPDP Data DictionaryNCPDP Data Dictionary– Registered AuthorityRegistered Authority NCPDPNCPDP– Effective date Effective date 2001-11-272001-11-27– Data typeData type Patient IdentityPatient Identity– Representation LayoutRepresentation Layout X(1)X(1)– Value DomainValue Domain Gender, coded_VDGender, coded_VD– CodesCodes M (male), F (female), M (male), F (female),
blank blank (unknown)(unknown)
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How does each authority express How does each authority express gender?gender?
X12 NCPDPHL7 HITSP
USHIK Gender
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Comparison Matrix Aids in Harmonizing Data Elements
www.USHIK.org
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Do the data elements in my EHR fit Do the data elements in my EHR fit Meaningful Use specifications?Meaningful Use specifications?
X12N NCPDPHL7 HITSP
USHIK
Are my EHR’s data defined the same as for Meaningful Use reqs?
Meaningful Use
What Portals are in USHIK?
1.1. USHIKUSHIK: HHS Secretary’s adopted, endorsed, recognized data elements: HIPAA, CHI, HITSP, and all other data elements
2.2. HITSPHITSP: HITSP data elements linked to all 13 HITSP use cases, interoperability specifications, and other documents
3. Patient Safety Common Formats: Specifications for electronically reporting patient safety events in hospitals among Patient Safety Organizations
4.4. MeaningfulMeaningful UseUse (pilot): Example: quality measures and the data elements associated with their numerators, denominators, inclusions, and exclusions
5.5. StateState All-PayerAll-Payer ClaimsClaims DataData (pilot): Data element specifications from all-payer data bases of 7 states
6.6. StandardsStandards andand InteroperabilityInteroperability FrameworkFramework (New) Data element Specs from Transitions of Care, Lab Results Interface, and CDA Harmonization initiatives
Application Projects Highlighted Application Projects Highlighted
HITSP:HITSP: ONC, AHIC Use Case’s resolved into ONC, AHIC Use Case’s resolved into Interoperabilty Specs and other constructsInteroperabilty Specs and other constructs
S&I Framework: S&I Framework: ONC, Use Case’s resolved ONC, Use Case’s resolved into Requirements, Standards Analysis and into Requirements, Standards Analysis and Reference Implementation artifactsReference Implementation artifacts
Meaningful Use: Meaningful Use: CMS, Quality Measure CMS, Quality Measure numerators & denominators, exclusions etcnumerators & denominators, exclusions etc
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HITSP Project Background HITSP Project Background
Approach:Approach: – Use Case’s – AHICUse Case’s – AHIC– Standards Analysis – Standards Analysis – HITSPHITSP– Pilot Implementations – NwHINPilot Implementations – NwHIN
Artifacts: Artifacts: Interoperability Specs; Interoperability Specs; Transactions/Transaction Packages; Transactions/Transaction Packages; ComponentsComponents
Data:Data: Transaction Metadata; Clinical Data Transaction Metadata; Clinical Data13
HITSP Project OrganizationHITSP Project Organization
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Care Management and Health Records Technical Committee
Infrastructure, Security and Privacy Technical Committee
Administrative and Financial Technical Committee
Mod
eling
Messagin
g and
Datatyp
es
Term
inology A
nd
Kn
owled
ge Rep
resentation
Work
flow an
d P
rocess
Use CaseUse CaseUse CaseUse Case Use CaseUse CaseUse CaseUse Case Use CaseUse CaseUse CaseUse Case
Consu
mer
Persp
ectiv
e TC
Provi
der
Persp
ectiv
e TC
Popula
tion
Persp
ectiv
e TC
Secu
rity & P
rivacy
DomainTCs
FoundationsCommittee
Perspective Technical
Committees
HITSP Deliverables HITSP Deliverables
Use Case ArtifactsUse Case Artifacts– 15+ Interoperability Specs15+ Interoperability Specs – 30+ Transaction Packages / Transactions30+ Transaction Packages / Transactions– 40+ Components40+ Components– 20+ Capabilities [combines Content and Transport] 20+ Capabilities [combines Content and Transport]
Technical Notes (7)Technical Notes (7) Acronym and Data Element GlossariesAcronym and Data Element Glossaries http://hitsp.orghttp://hitsp.org
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USHIK Focus and Deliverables USHIK Focus and Deliverables
HITSP Data Component ArtifactsHITSP Data Component Artifacts – Constrain or use existing standards and IG’s from Constrain or use existing standards and IG’s from
SDO’s, IHE, CAQHSDO’s, IHE, CAQH– HL7 CDA, HL7 2.x, ASTM CCR, ANSI X12, etcHL7 CDA, HL7 2.x, ASTM CCR, ANSI X12, etc– Re-purposing structure for CDA data elementsRe-purposing structure for CDA data elements
C154 C154 C83 C83 C32, C37, C48, C78 C32, C37, C48, C78
Clinical Data Portal: Clinical Data Portal: – Clinical Data “Concepts” Clinical Data “Concepts” – ““Model” Primarily Use Case specificModel” Primarily Use Case specific– Leverage HITSP GlossariesLeverage HITSP Glossaries16
USHIK Demonstration USHIK Demonstration
HITSP PortalHITSP Portal
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USHIK/HITSP PortalUSHIK/HITSP Portal
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S&I Framework Project S&I Framework Project Background Background
Approach:Approach: – Use Case’s, Standards Analysis, Reference and Use Case’s, Standards Analysis, Reference and
Pilot Implementations –> Pilot Implementations –> Single Contiguous Single Contiguous ProgramProgram
– Cross-Use Case Harmonization; Use Case Cross-Use Case Harmonization; Use Case Simplification WG for re-purposingSimplification WG for re-purposing
Artifacts: Artifacts: Use Case Requirements, Clinical Use Case Requirements, Clinical InformationInformation Model (CIM). Standards Analysis Model (CIM). Standards Analysis Worksheet, Reference Impl Guide, Pilots ResultsWorksheet, Reference Impl Guide, Pilots Results
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S&I Framework Project S&I Framework Project OrganizationOrganization
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S&I Framework Deliverables S&I Framework Deliverables
Use Case and Implementation ArtifactsUse Case and Implementation Artifacts– 2 Clinical Operations Initiatives2 Clinical Operations Initiatives
Transitions of Care (ToC), Lab Results Interface (LRI)Transitions of Care (ToC), Lab Results Interface (LRI)
– 2 IT Infrastructure Initiatives2 IT Infrastructure Initiatives Provider Directories, Certificate InteroperabilityProvider Directories, Certificate Interoperability
– 1 Population Health Initiative (new)1 Population Health Initiative (new) Query HealthQuery Health
Cross-Initiative Workgroups and FunctionsCross-Initiative Workgroups and Functions http://wiki.siframework.orghttp://wiki.siframework.org
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USHIK Focus and Deliverables USHIK Focus and Deliverables
S&I Cross-Initiative ArtifactsS&I Cross-Initiative Artifacts– Use Case Simplification Matrix Use Case Simplification Matrix
Actors, Actions, Data Element Sets (DES)Actors, Actions, Data Element Sets (DES)
Clinical Information Model (CIM)Clinical Information Model (CIM) Transitions of Care (ToC), Lab Results Interface (LRI)Transitions of Care (ToC), Lab Results Interface (LRI)
Standards Analysis ResultsStandards Analysis Results– CDA Consolidation Ballot templatesCDA Consolidation Ballot templates– DES correlation to SDO and HITSP standardsDES correlation to SDO and HITSP standards
Currently HL7 CDA, HL7 v2.x, HITSP C154 Currently HL7 CDA, HL7 v2.x, HITSP C154 22
USHIK Demonstration USHIK Demonstration
S&I Framework PortalS&I Framework Portal
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Meaningful Use Project Meaningful Use Project Background Background
Approach:Approach: – Product Certification as per HITSP interoperability Product Certification as per HITSP interoperability
requirements (ONC/NIST)requirements (ONC/NIST)– Administrative/Operational process changes Administrative/Operational process changes – Quality Measures in harmonization with existing Quality Measures in harmonization with existing
AHRQ authored measures (CMS/AHRQ/NQF) AHRQ authored measures (CMS/AHRQ/NQF)
Artifacts: Artifacts: Quality measures expressed as Quality measures expressed as “eMeasures” leveraging HITSP and S&I Framework “eMeasures” leveraging HITSP and S&I Framework recognized data definitions and vocabulariesrecognized data definitions and vocabularies
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Meaningful Use Measures Meaningful Use Measures
Meaningful Use GuidanceMeaningful Use Guidance– Administrative/Operative and Clinical measuresAdministrative/Operative and Clinical measures– eMeasure Numerators, Denominators, Exclusions, eMeasure Numerators, Denominators, Exclusions,
InclusionsInclusions
Targeting EP and EH provider typesTargeting EP and EH provider types– PQRI, RHQDAPU, NQFPQRI, RHQDAPU, NQF
Time Period Based Registration & Attestation Time Period Based Registration & Attestation Requirements to Qualify Requirements to Qualify
http://healthit.hhs.gov/portal/server.pt?http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3584open=512&mode=2&objID=358425
USHIK Focus and Deliverables USHIK Focus and Deliverables
Quality Measure DefinitionQuality Measure Definition– Description, objective, numerical componentsDescription, objective, numerical components
Help with knowing “what measures are for what Help with knowing “what measures are for what purpose”purpose”– MU, PQI, other quality improvement/payment MU, PQI, other quality improvement/payment
programsprograms
Help with knowing more about the data elements Help with knowing more about the data elements used in the measureused in the measure– Base Standards used (e.g SNOMED, LOINC)Base Standards used (e.g SNOMED, LOINC)– Where else these data elements are usedWhere else these data elements are used
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USHIK S&I Framework Portal (pilot)USHIK S&I Framework Portal (pilot)
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USHIK Demonstration USHIK Demonstration
MUMM PortalMUMM Portal
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MUMM Portal with Diabetes Measure MUMM Portal with Diabetes Measure SelectionSelection
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At the bottom left of each page, pleasefind a notepad/pencil icon stating “Giveyour feedback”
Lessons Learned
Use information models Trade off value of what USHIK supplies
against the cost of supplying it Intellectual property has value—protect its
value Work with users
– Anticipate their needs Save them time– Give them accuracy Save them money– Seek their feedback
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FinaleFinale
Data Dictionaries promote understandingData Dictionaries promote understanding Metadata registries promote interoperability, Metadata registries promote interoperability,
reuse, and one-stop shopping for informationreuse, and one-stop shopping for information Researchers, vendors, health decision makersResearchers, vendors, health decision makers
– need health data that are more uniform, accurate, need health data that are more uniform, accurate, valid, and computerizedvalid, and computerized
Don’t we all!Don’t we all! See the S&I Framework and other Portals at See the S&I Framework and other Portals at
ushik.ahrq.govushik.ahrq.gov
Questions?Questions?
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The Standards and Interoperability The Standards and Interoperability Framework Portal in the United States Framework Portal in the United States
Health Information KnowledgebaseHealth Information KnowledgebaseUse Case Simplification Work GroupUse Case Simplification Work Group
Standards and Interoperability Framework InitiativeStandards and Interoperability Framework Initiative
J. Michael Fitzmaurice, Ph.D. , AHRQJohn Donnelly, Intepro Solutions
Robin Barnes, Data Consulting Group
Thank You