SDS & Harmonization HeD Agenda

• Timeline Overview• HeD UC2 vMR Mapping Template Update• Sub Work Stream and Work Products review• DSS Profile Update

1

SDS & Harmonization HeD Agenda

• Timeline Overview• HeD UC2 vMR Mapping Template Update• Sub Work Stream and Work Products review• DSS Profile Update

2

3

HeD Use Case 2 Timeline

vMR Extension & Alignment

DSS

HeD UC2 Guidance

Community Review & Ballot Preparations

DSS Update & Profile Development6/4-6/25

Jun ‘13 Jul ‘13 Aug ‘13

Develop Mapping Template6/4-6/10

Update Mapping Template with vMR6/6-6/19

Update Mapping Template with C-CDA/QRDA Semantics6/10-7/1

Update vMR XML IG 7/12-7/19

Determine Container vs Payload Data

Elements 6/19-6/22

Develop vMR Container Profiles

6/22-6/28

Update vMR DAM with Semantics

7/2-7/11

Develop vMR Payload Profiles by Functional

Interaction Type7/12-7/22

Vendor Outreach to Determine Functional Interaction Types for Inclusion

6/5-6/19

DSS Update & Profile Review & Packaging

6/25-7/9

vMR XML HeD UC1 IG Review &

Packaging7/22-8/2

New DSS IG Review & Packaging

7/22-8/2

vMR DAM Review & Packaging

7/12-7/25

vMR XML IG Review & Packaging

7/22-8/2

Extend vMR for HeD UC2

6/19-6/26 Update HeD UC1 IG 7/12-7/19

Key Milestone Dates for September BallotAdministrative Deadlines:• HL7 Notification of Intent to Ballot: July 7• HL7 Initial Content Deadline: July 14

Content Deadlines:• End-to-End Review Period:

– Initial DSS Update & Profile Review & Packaging : 6/25 – 7/9– Initial vMR DAM Review & Packaging: 7/12 – 7/25– Initial vMR XML IG Review & Packaging : 7/22 – 8/2– Initial vMR XML HeD UC1 IG Review & Packaging: 7/22 – 8/2– New DSS IG Review & Packaging: 7/22 – 8/2

• There will be end to end reviews of each section as they are completed at earlier dates

• HL7 Final Content Deadline: August 4• HL7 Examples Deadline: August 19• HeD Consensus Review Period: August 19 – September 2

– Comments will be received during balloting from August 19 – August 26– Comments will be vetted by the community August 27 – September 2

• Submit Comments to HL7 on September 3 4

SDS & Harmonization HeD Agenda

• Timeline Overview• HeD UC2 vMR Mapping Template Update• Sub Work Stream and Work Products review• DSS Profile Update

5

HeD UC2 vMR Mapping Template

Dave Shields has created a tool/spreadsheet to map the UC2 data elements to vMR, aligned with CCDA and QRDA, for specific templates.

• Important to drive forward and meet our deadlines while staying grounded with the requirements in UC2

HeD UC2 vMR Mapping Template Continued…

Data Element Set/ Section Data Elements Data Element Descriptions Problem List Immunizations Vital Sign Advanced Directives

Person Type A type of person (e.g., Patient, Relative)

Person Evaluated Person IDThe evaluated Person’s unique identifier, normally used for internal implementation tracking purposes. Does not need to be the evaluated Person’s "real" identifier, although it may be used for that purpose.

Person Address Location information for the evaluated person

Person Birth date/time Specific or ranges of birth dates and times of evaluated persons

Person Gender One or more gender categories of evaluated persons

Person Current Age Specific age or age range of evaluated persons

Person Deceased Indicator Indicator of whether or not the evaluated person is alive or is deceased

• A tab has been created labeled “HeD UC2 Data Elements”• This tab contains all UC2 Data Elements as well as the templates(tabs)

contained in the spreadsheet• This tab can keep track of which data elements have been mapped to specific

templates• Data elements not mapped to any specific template will be easily identifiable

HeD UC2 vMR Mapping Template Continued… All columns have been defined on what information to capture

20 templates have been initially chosen for mapping• Ken has made a suggestion to change the tabs to “Categories” instead of

“Templates”o Each category will have specific templates related to that category in one tab, with the

columns repeated for each templateo Each category is it’s own tab in order to divide the work. o Can combine all categories and templates into one master tab

• It was decided that initially, vMR data elements would be the base and would be mapped to CCDA and QRDA

• HeD UC2 data elements would then be mapped for each template afterwardso Bryn Rhodes has done an initial mapping of vMR data elements to HeD UC2 clinical data

elements. Bryn will complete the rest of the data elements.

• Bryn will populate each template with the applicable data elementso The HeD Internal team will then being filling out the CCDA and QRDA columnso David Tao has provided a document with Guidance for this mapping

8

vMR Template Assingments

9

vMR Category Owner

Problems

Immunizations

Body Site

Vital Signs

Demographics

Allergies Mark Roche

Medications

Procedures - Radiology Mark Roche

Procedures - Interventions Mark Roche

Lab Results

Other Observations

Encounters

• Draft lists of templates should be ready for this meeting next week (6/19)– We will utilize this meeting next week to vet the list of templates with full

Standards SWG

• In addition to identifying the template name/subject, a full description of the template should be provided

vMR Template Assingments

10

vMR Category Owner

Findings

Adverse Events

Family History

Social History

Physical Exam

Micro Biology Results

CDS Results

Encounter Diagnosis

• Draft lists of templates should be ready for this meeting next week (6/19)– We will utilize this meeting next week to vet the list of templates with full

Standards SWG

• In addition to identifying the template name/subject, a full description of the template should be provided

SDS & Harmonization HeD Agenda

• Timeline Overview• HeD UC2 vMR Mapping Template Update• Sub Work Stream and Work Products review• DSS Profile Update• Planned Meetings for the Week

11

HeD UC2 GuidanceSubworkstream

vMR ExtensionsSubworkstream

vMR-QRDA-CCDA AlignmentSubworkstream

DSS Subworkstream

IG and Standards Development Activities to support HeD UC2 Solution

New Decision Support

Service (DSS) IG

Updated DSS

Standard

Updated vMR DAM

Updated vMR XML

IG

Updated HeD UC1

IG

DSS Profile for CDS Request with SOAP

DSS Profile for CDS Response with SOAP

DSS Profile for CDS Request with REST

DSS Profile for CDS Response with REST

vMR Container Profiles for Response & Request

vMR guidance for request payload

Semantics guidance, leveraging modified vMR

DAM

Examples based on functional interaction

type

Add in section detailing how DSS is intended to

work with REST for general use

Modify DSS to accommodate REST, as

necessary

Extend vMR with context (for request)

and actions (for response) as specified

in UC2

Modify vMR to align with QRDA & C-CDA

semantics

Align XML IG with updated vMR DAM as

necessary

Align HeD UC1 IG with updated vMR DAM as

necessary

HeD S/vMR guidance for response payload

HeD UC2 vMR Templates

Open Question: How will the newly identified & defined templates

feed into the final work products DSS IG vMR DAM vMR XML IG HeD UC2 IG

13

SDS & Harmonization HeD Agenda

• Timeline Overview• Sub Work Stream and Work Products review• HeD UC2 vMR Mapping Template Update• DSS Profile Update

14

DSS Profile Update

15

Task Owner & Resources

Duration Target Start Date

Target End Date

Dependencies

Develop DSS Profile for Request with REST Bryn Rhodes

10 Days 6/4 6/21 DSS Update with REST guidance

Develop DSS Profile for Response with REST Bryn Rhodes

10 Days 6/10 6/24 DSS Update with REST guidance

Update DSS Standard with REST guidance, including modifications to the standard itself (as necessary) and guidance on use of REST for general use cases (not HeD UC2-specific)

Bryn Rhodes/Dave Shields (as needed)

15 Days 6/4 6/24 Defining model for additional elements

Appendix

HeD UC2 Finalized Technical SolutionBased on feedback from all proposed solutions, the HeD Leadership Team is proposing the following solution:

• Create implementation guidance that leverages vMR as the base model but is aligned with C-CDA and QRDA (semantics, terminologies, and templates) to the highest extent possible.

– Solution will be to update the vMR model to align with the semantics of C-CDA and QRDA to the extent possible and reasonable

– vMR is a streamlined data model for CDS. This model is at a similar level of granularity to models such as Green CDA

• Pursue both SOAP and REST for the updated DSS IG for September 2013– Based on pilots, a choice may be made between SOAP and REST

• We will utilize the Functional Interaction Types to guide the IG development– Use as building blocks of data that are coordinated to meet functional interaction types– Have a section in the IG having profiles that people vote on for different interaction types if we

feel confident. If we don’t feel confident, then they will strictly be examples– Leverage pilots from UC1 for functional interaction types. Can start with Immunization

Forecasting and Quality Measure Evaluation. See what feedback we get and if any other interaction types would be useful

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

New Decision Support

Service (DSS) IG

DSS Profile for CDS Request with SOAP

DSS Profile for CDS Response with SOAP

DSS Profile for CDS Request with REST

DSS Profile for CDS Response with REST

vMR Container Profile for Response

vMR Container Profile for Request

vMR guidance for request payload

HeD S/vMR guidance for response payload

Examples based on functional interaction type

Modify vMR to align with QRDA & C-CDA semantics

Updated DSS Standard

Add in section detailing how DSS is intended to

work with REST for general use

Modify DSS to accommodate REST, as

necessary

Updated vMR DAM

Extend vMR with additional context as

specified in UC2

Extend vMR to be able to relay actions as

specifed in UC2

Modify vMR to align with QRDA & C-CDA

semantics

Updated vMR XML IG

Align XML IG with updated vMR DAM as

necessary

Updated HeD UC1 IG

Align HeD UC1 IG with updated vMR DAM as

necessary

IG and Standards Development Activities to support HeD UC2 Solution

Activities by Work Product

HeD UC2 Critical Harmonization Activities & Timeline Considerations:New Decision Support Service (DSS) IG

Task Owner & Resources Duration Target Start Date

Target End Date

Dependencies

Update IG template to reflect necessary sections Support Team/Community

1 Week 5/29 6/4

Write Overview of Modular Transport Solution in IG Support Team

Develop DSS Profile for Request with SOAP Dave Shields

Develop DSS Profile for Response with SOAP Dave Shields

Develop DSS Profile for Request with REST Bryn Rhodes DSS Update with REST guidance (see next slide)

Develop DSS Profile for Response with REST Bryn Rhodes DSS Update with REST guidance (see next slide)

Group UC2 Data Elements by Request vs. Response and by Container vs. Payload

Rob McClure/Dave Shields/ Bryn Rhodes

Develop vMR Container Profile for Request Aziz Boxwala/Dave Shields

6/3 6/21 UC2 Data Element GroupingvMR Updates

Develop vMR Container Profile for Response Aziz Boxwala/Dave Shields

6/3 6/21 UC2 Data Element GroupingvMR Updates

Develop vMR Request Payload Profile for specific functional profile interaction types

Dave Shields/Claude Nanjo/ Victor Lee/Bryn Rhodes

vMR Updates

Develop HeD S/vMR Response Payload Profile for specific functional profile interaction types

Dave Shields/Claude Nanjo/ Victor Lee/Bryn Rhodes

vMR Updates

Map UC2 Payload Request & Response Data Elements to vMR model Victor Lee/Claude Nanjo/Bryn Rhodes

UC2 Data Element Grouping

Align vMR with QRDA and CCDA semantics (Done by functional Interaction Type)

Rob McClure/Dave Shields/Mark Roche/Claude Nanjo

HeD UC2 Critical Harmonization Activities & Timeline Considerations:Decision Support Service Standard Updates

Task Owner & Resources

Duration Target Start Date

Target End Date

Dependencies

Update DSS Standard with REST guidance, including modifications to the standard itself (as necessary) and guidance on use of REST for general use cases (not HeD UC2-specific)

Bryn Rhodes/Dave Shields (as needed)

Defining model for additional elements

HeD UC2 Critical Harmonization Activities & Timeline Considerations:vMR Domain Analysis Model Updates

Task Owner & Resources

Duration Target Start Date

Target End Date

Dependencies

Map UC2 Payload Request & Response Data Elements to vMR model Claude Nanjo UC2 Data Element Grouping

Map vMR DAM to semantics , terminologies and templates used by QRDA, C-CDA

Claude Nanjo/Victor Lee/Rob McClure

Extend vMR to include additional context as specified in UC2 for request

Claude Nanjo

Extend vMR capability to support communication of “actions” in response

Claude Nanjo

Update vMR with any required changes to semantics, terminologies and/or templates based on harmonization effort

Claude Nanjo/Victor Lee/Rob McClure

vMR DAM mapping to QRDA, C-CDA

HeD UC2 Critical Harmonization Activities & Timeline Considerations:New Decision Support Service (DSS) IG

Task Owner & Resources

Duration Target Start Date

Target End Date

Dependencies

Introduction

Introduction: Purpose

Introduction: Approach

Introduction: Intended Audience

Introduction: Intended Audience – Requisite Knowledge

Introduction: Organization of this Guide

Introduction: Organization of this Guide – Conformance Verbs (Key Words)

Introduction: Organization of this Guide – Cardinality

Introduction: Organization of this Guide – Definition of Actors

Implementation Approach

Implementation Approach: Pre Conditions

Implementation Approach: Constraints

Suggested Enhancements

Appendices: Definition of Acronyms and Key Terms

Appendices: Conformance Statement List

Appendices: Templates List

Appendices: Specifications References