hed uc2 finalized technical solution

Long-term Industry Need

HeD UC2 Scope Potential future or parallel work

Updated vMR

Model

HeD UC2 Data

Requirements

QRDA Semantics

C-CDA Semantics

HeD UC2 Finalized Technical SolutionThe revised solution approach still aligns with the long-term industry need, but has been limited to a more manageable and Use Case-appropriate scope:

Foundational Model

(e.g. FHIM)Future

Standards?

QRDAC-CDA

Harmonized vMR/QDM

Model

Request Service: DSS Request ElementRequest Items Organizer/Container: vMR

Request Item Payload: vMR Clinical Statement

vMR Payload

This approach would support vMR as the payload standard with mappings to CCDA and QRDA

CDS Request

CDS Response

HeD Schema/vMR

Response Service: DSS Response ElementResponse Items Organizer/Container: Harmonized vMR/HeD Schema

Response Item Payload: vMR Clinical Statements

Appendix

4

Use Case 2: CDS Guidance Service Transactions - Standards per Transaction

# Transaction Service Organizer/Container Item PayloadsReference

Information Model

1CDS Request (patient data

and potentially context)

• Decision Support Service (DSS)

• Context Aware Retrieval Application (Infobutton)

• CDS Knowledge Artifact Implementation Guide (HeD UC1 IG)

• Consolidated CDA• Virtual Medical Record

(vMR)


• Virtual Medical Record (vMR)• Consolidated CDA (hL7 Clinical

Statements)• HL7 Version 3 Standard: Order Set

Publication, Release 1

• Federal Health Information Model (FHIM)

• HL7 v2.x• HL7 v3

2 CDS Response (guidance

and/or other response elements)

• Decision Support Service (DSS)


• CDS Knowledge Artifact Implementation Guide (HeD UC1 IG)

• HL7 Version 3 Standard: Order Set Publication, Release 1

• Consolidated CDA• Virtual Medical Record

(vMR)


• Virtual Medical Record (vMR)• Consolidated CDA (HL7 Clinical

Statements)• HL7 Version 3 Standard: Order Set

Publication, Release 1

• Federal Health Information Model (FHIM)

• HL7 v2.x • HL7 v3

Use Case 2: CDS Guidance Service Transactions - Standards per Transaction

# Transaction Transport Authentication/Authorization Encryption Vocab & Code Set

1CDS Request (patient data

and potentially context)

• SOAP• REST

• SAML • TLS • LOINC• SNOMED CT• CVX• Manufacturers of Vaccines (MVX)• OID• RxNorm• ICD-9-CM and ICD-10-CM• HCPCS• C80 - Clinical Document and

Message Terminology Component • NQF Value Sets

• ICD-10-PCS• UCUM• CPT• C154• NDC• FDA Route Administration• HL7 Vocabulary• Diagnostic and Statistical Manual

of Mental Disorders, Fourth Edition (DSM-IV)

2 CDS Response (guidance

and/or other response elements)

• SOAP • REST

• SAML • TLS • LOINC• SNOMED CT• CVX• Manufacturers of Vaccines (MVX)• OID• RxNorm• ICD-9-CM and ICD-10-CM• HCPCS• C80 - Clinical Document and

Message Terminology Component • NQF Value Sets

• ICD-10-PCS• UCUM• CPT• C154• NDC• FDA Route Administration• HL7 Vocabulary• Diagnostic and Statistical Manual

of Mental Disorders, Fourth Edition (DSM-IV)

CDS Guidance Request Transaction: Service Standards RationaleStandard

Summary of Findings from UCR

CrosswalkKeep? Rationale

Decision Support Service (DSS)HITSC Rating:*M: 78.69A: 88.6SI: 33.33T: 72.71

(Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions

(P) Partially Fits: Response Metadata;

(N) Does not Fit:

Yes • One significant gap is DSS will tie to SOAP. There is significant industry movement towards REST.

• DSS has 2 levels, one is model of the service which is implementation agnostic. Could support standard with implementation based on REST, but it would have to be developed.

• DSS is designed to be able to support patient data, unlike Infobutton.

• Has broader scope than Infobutton•

* M: Maturity A: Adoptability SI: S&I Specific T: Total

Context Aware Retrieval Application (Infobutton)

HITSC Rating*M: 90.08A: 92.11SI: 47.62T: 82.07

(Y) Fits: Context; Supporting Evidence; Supporting Resource

(P) Partially Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response

(N) Does not Fit: Clinical; Actions; Attribute Value List; Response Meta Data

No

• Can send some patient data, but not designed to support rich patient data payload like DSS

CDS Guidance Response Transaction: Service Standards RationaleStandard



Decision Support Service (DSS)HITSC Rating:*M: 78.69A: 88.6SI: 33.33T: 72.71


(P) Partially Fits: Response Metadata;

(N) Does not Fit:

Yes • One significant gap is DSS will tie to SOAP. There is significant industry movement towards REST.

• DSS has 2 levels, one is model of the service which is implementation agnostic. Could support standard with implementation based on REST, but it would have to be developed.

• DSS is designed to be able to support patient data, unlike Infobutton.

• Has broader scope than Infobutton



HITSC Rating:*M: 90.08A: 92.11SI: 47.62T: 82.07




No

• Can send some patient data, but no designed to support rich patient data payload like DSS

CDS Guidance Request Transaction: Organizer/Container RationaleStandard



CDS Knowledge Artifact Implementation Guide (HeD UC1 IG)HITSC Rating:*M: 61.39A: 86.84SI: 35.71T: 64.62

(Y) Fits: (Sender) CDS Response; (Receiver) CDS Response; Clinical; Supporting Evidence; Supporting Resource; Actions; Attribute Value List;

(P) Partially Fits: Context; Response Metadata

(N) Does not Fit: Exceptions

No • UC1 is not designed to carry patient data

• If CCDA is chosen, would probably have to use related HL7 Clinical statements for the Item Payload bucket.

• If vMR is chosen, would probably have to use the vMR Clinical Statements for the Item Payload bucket

• External options may exist for transforming CCDA request into a vMR component

• Develop options for both CCDA and vMR


Consolidated CDAHITSC Rating:*M: 53.59A: 80.70SI: 33.33T: 58.48

(Y) Fits: Clinical;

(P) Partially Fits:

(N) Does not Fit: Context, Supporting Evidence; Supporting Resource; Actions; Attribute Value List; Response Metadata; Exceptions

Yes • Can transform CCDA request into a vMR component from the execution system

• Not everything from CCDA goes easily into vMR, but vMR is designed to easily accept CCDA components

CDS Guidance Request Transaction: Organizer/Container Rationale (continued…)Standard



Virtual Medical Record (vMR)HITSC Rating:*M: 78.06A: 81.58SI: 33.33T: 70.08

(Y) Fits: Clinical; Attribute Value List

(P) Partially Fits: CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Context; Supporting Evidence; Supporting Resource; Actions;

(N) Does not Fit: Response Metadata; Exceptions

Yes • Lighter weight than the other options• Developed specifically for clinical decision

support computability• Intended to be used for this initiative, and

has recently been enhanced in this respect


CDS Guidance Response Transaction: Organizer/Container RationaleStandard



CDS Knowledge Artifact Implementation Guide (HeD UC1 IG)HITSC Rating:*M: 61.39A: 86.84SI: 35.71T: 64.62

(Y) Fits: (Sender) CDS Response; (Receiver) CDS Response; Clinical; Supporting Evidence; Supporting Resource; Actions; Attribute Value List;

(P) Partially Fits: Context; Response Metadata

(N) Does not Fit: Exceptions

Yes • Fits Clinical; Supporting Evidence; Supporting Resource; Actions data requirements

• Attribute value list is not supported in UC1 schema, however the schema does allow extensions using XSD

• Would use subset of HeD UC1 schema that may require further modifications



(Y) Fits: Clinical;

(P) Partially Fits:


Probably No

• There is a profile in IHE that uses DSS and returns IHE as an output. But hasn’t been finalized within IHE

• Lacks the ability to group and organize things the way that UC1 does

• Do not anticipate using, unless modification or subset of UC1 approach does not work

CDS Guidance Response Transaction: Organizer/Container Rationale (continued…)

StandardSummary of

Findings from UCR Crosswalk

Keep? Rationale





No(Probably)

• Does fit this situation, however CDS Knowledge artifact may be the better option

• UC1 action would need to be modified to represent payload for UC2 regarding vMR

• May need a model agnostic response • Do not anticipate using, unless

modification or subset of UC1 approach does not work


HL7 Version 3 Standard: Order Set Publication, Release 1HITSC Rating:*M: 46.20A: 75.44SI: 33.33T: 53.31

(Y) Fits: Supporting Evidence; Supporting Resource; Response Metadata

(P) Partially Fits: Clinical; Context; Actions

(N) Does not Fit: Attribute Value List; Exceptions

No(Probably)

• Some vendors may want to support this as an option, however CDS Knowledge Artifact is the better option

• Adoption of this standard is low, so there is not a driving reason to extend support to it

CDS Guidance Request Transaction: Item Payloads Rationale Standard



Context Aware Retrieval Application (Infobutton)HITSC RatingM: 90.08A: 92.11SI: 47.62T: 82.07




No • The information that is contained in infobutton is already represented in vMR, or if not can be

• Can use infobutton as a reference to modify vMR or CCDA






Yes • The vMR has relevant information in a reasonable format

• The contents and scope of the vMR are aligned with the requirements of the Use Case

• Maintained by CDS WG• As a reference model, part of its purpose

is to provide exchangeable representation clinical information

CDS Guidance Request Transaction: Item Payloads Rationale (Continued…)Standard




(Y) Fits: Clinical;

(P) Partially Fits:


Yes • Several stake holders have a business need to have this supported

• A methodology is needed to be able to reflect changes, which currently does not exist






No • Order Set does not hold patient data, not suitable for request transaction

CDS Guidance Response Transaction: Item Payloads Rationale Standard








No • The information that is contained in infobutton is already represented in vMR, or if not can be

• Can use infobutton as a reference to modify vMR or CCDA






Yes • The vMR has relevant information in a reasonable format

• The contents and scope of the vMR are aligned with the requirements of the Use Case

• Maintained by CDS WG• As a reference model, part of its purpose

is to provide exchangeable representation clinical information

CDS Guidance Response Transaction: Item Payloads Rationale (Continued…)Standard



Consolidated CDA


(Y) Fits: Clinical;

(P) Partially Fits:


Yes • Several stake holders have a business need to have this supported

• A methodology is needed to be able to reflect changes, which currently does not exist






Yes • Order set model contains recommendations for clinical actions, which is applicable to the types of outputs relevant in the Use Case

CDS Guidance Request Transaction: Transport RationaleStandard



SOAP



(P) Partially Fits:

(N) Does not Fit:

Yes • There is currently implementation guidance on DSS to be used with SOAP, not REST

• Has the capabilities and functions needed for this initiative


RESTHITSC Rating:*M: 100.00A: 100.00SI: 42.86T: 88.30


(P) Partially Fits:

(N) Does not Fit:

Yes • Industry is moving towards using REST• Guidance could be written for DSS to work

with REST

CDS Guidance Response Transaction: Transport RationaleStandard



SOAP



(P) Partially Fits:

(N) Does not Fit:

Yes • There is currently implementation guidance on DSS to be used with SOAP, not REST

• Has the capabilities and functions needed for this initiative


RESTHITSC Rating:M: 100.00A: 100.00SI: 42.86T: 88.30


(P) Partially Fits:

(N) Does not Fit:

Yes • Industry is moving towards using REST• Guidance could be written for DSS to work

with REST

CDS Guidance Request Transaction: Authentication/Authorization RationaleStandard



SAMLHITSC Rating:*M: 100.00A: 100.00SI: 100.00T: 100.00


(P) Partially Fits:

(N) Does not Fit:* M: Maturity A: Adoptability SI: S&I Specific T: Total

CDS Guidance Response Transaction: Authentication/Authorization RationaleStandard



SAMLHITSC Rating:*M: 100.00A: 100.00SI: 100.00T: 100.00


(P) Partially Fits:


CDS Guidance Request Transaction: Encryption

StandardSummary of


Keep? Rationale

TLSHITSC Rating:*M: 100.00A: 100.00SI: 42.86T: 88.30


(P) Partially Fits:


CDS Guidance Response Transaction: Encryption

StandardSummary of


Keep? Rationale

TLSHITSC Rating:*M: 100.00A: 100.00SI: 42.86T: 88.30


(P) Partially Fits:

(N) Does not Fit: * M: Maturity A: Adoptability SI: S&I Specific T: Total

hed uc2 finalized technical solution

Documents

request service

response metadata n

payload standard

cmhcpcsc80 clinical

order set publication

x hl7 v3

vmrrequest item payload

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