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