HITSP Project Orientation Joyce Sensmeier MS RN-BC CPHIMS

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HITSP Project Orientation Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS Vice President, Informatics, HIMSS

Agenda 1. Welcome 2. HITSP Charter and Goals 3. Relationship between HITSP, HISPC and CCHIT 4. What is the HITSP process/structure? 5. TC Specific Work: a) What is a Harmonized Use Case? b) What is a HITSP Construct? c) Familiarization with existing HITSP Constructs 6. TC Tools: a) ANSI Member Library: http: //members. ansi. org/default. aspx b) ANSI Public Library: www. hitsp. org c) Standing Meetings and Numbers 7. Questions Evaluation of Standards Harmonization Process for HIT 1

In 2005, HHS awarded contracts to seed a public-private effort to build a nationwide health information network Evaluation of Standards Harmonization Process for HIT 2

A public-private “Community” was then established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability The Certification Commission for Healthcare Information Technology (CCHIT) The Health Information Security and Privacy Collaboration (HISPC) Healthcare Information Technology Standards Panel (HITSP) American Health Information Community Nationwide Health Information Network Architecture Projects (NHIN) Evaluation of Standards Harmonization Process for HITSP includes 372 different member organizations and is administered by a Board of Directors 23 SDOs (6%) 292 Non-SDOs (79%) 31 Govt. bodies (8%) 14 Consumer groups (4%) 12 Project Team (3%) The Community is a federally-chartered commission and will provide input and recommendations to HHS on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected, in a smooth, marketled way. 3

The HITSP team is charged with completing eleven different tasks, with current efforts focused on the harmonization process Eleven Tasks are included in this contract: The Community HHS Secretary Mike Leavitt, Chair 1. HHS ONCHIT 1 PO, Dr. John Loonsk HITSP Dr. John Halamka, Chair Member populated Technical Committees Project Management Team Executive in Charge, F. Schrotter, ANSI Program Manager, L. Jones GSI Deputy PM, J Corley, ATI Project Manager, Julie Pooley, Booz Allen Harmonization Process Definition Technical Manager Michelle Deane, ANSI Harmonization Process Delivery Technical Manager Joyce Sensmeier, HIMSS Comprehensive Work Plan 2. Conduct a Project Start Up Meeting 3. Deliver Recommended Use-Cases 4. Participate in related meetings and activities, including the AHIC Meetings 5. Develop a Gap Analysis 6. Standards Selection, Evaluations and Testing 7. Define a Harmonization Approach 8. Develop Interoperability Specifications 9. Develop and Evaluate a Business Plan for the self-sustaining processes 10. Submit Monthly Reports – ongoing efforts 11. Assist with communications – ongoing efforts Evaluation of Standards Harmonization Process for HIT 4

HITSP formed Technical Committees to focus on AHIC breakthrough areas Overview/Structure and Current Use Cases 4 Care Delivery Technical Committee: – EHR - Lab Reporting -- Deploy standardized, widely available, secure solutions for accessing laboratory results and interpretations in a patient-centric manner for clinical care by authorized parties. – Emergency Responder – EHR -- Covers the use of the ER-EHR from the perspective of on-site care providers and emergency care clinicians. Definitive care clinicians involved in the care and treatment of emergency incident victims, medical examiner/fatality managers investigating cause of death, and public health practitioners using information contained in the ER-EHR, are included because of their interactions with the other portions of this use case. – Medication Management – Focuses on patient medication and allergies information exchange, and the sharing of that information between consumers, clinicians (in multiple sites and settings of care), pharmacists, and organizations that provide health insurance and pharmacy benefits. Evaluation of Standards Harmonization Process for HIT 5

HITSP formed Technical Committees to focus on AHIC breakthrough areas Overview/Structure and Current Use Cases 4 Consumer Empowerment Technical Committee: – Consumer Empowerment -- Deploy to targeted populations a prepopulated, consumer-directed and secure electronic registration summary. Deploy a widely available pre-populated medication history linked to the registration summary. – Consumer Access to Clinical Information – Includes three scenarios which describe highlights of the processes, roles and information exchanges which could enable a consumer’s access to clinical information via a personal health record (PHR). The three scenarios are: Consumers receive and access clinical information; Consumers create provider lists and establish provider access permissions; and Consumers transfer PHR information. Evaluation of Standards Harmonization Process for HIT 6

HITSP formed Technical Committees to focus on AHIC breakthrough areas Overview/Structure and Current Use Cases 4 Population Health Technical Committee: – Biosurveillance -- Transmit essential ambulatory care and emergency department visit, utilization, and lab result data from electronically enabled health care delivery and public health systems in standardized anonymized format to authorized public health agencies with less than one day lag time. – Quality – This use case depicts two scenarios related to quality measurement, feedback and reporting with respect to a patient’s encounter with the healthcare delivery system: quality measurement of hospital-based care and of care provided by clinicians. Evaluation of Standards Harmonization Process for HIT 7

Technical Committees Structure/Leadership 4 Care Delivery – 175 members – Co-chairs – James Ferguson, Kaiser Permanente, Jamie. Ferguson@kp. org – Steve Hufnagel, Do. D/Medical Health System (MHS), SHufnagel@tiag. net – Steve Wagner, Department of Veterans Affairs, Steve. Wagner@va. gov 4 Consumer Empowerment – 174 members – Co-chairs – Elaine Blechman, Ph. D, University of Colorado, Boulder eblechman@THESMARTPHR. COM – – Charles Parisot, EHR Vendor Association, charles. parisot@med. ge. com Scott Robertson, Kaiser Permanente, scott. m. robertson@kp. org Evaluation of Standards Harmonization Process for HIT 8

Technical Committees Structure/Leadership 4 Population Health – 135 members – Co-chairs – Floyd Eisenberg, MD, MPH, Siemens Medical Solutions, Floyd. Eisenberg@siemens. com – – Peter Elkin, MD, Mayo Clinic College of Medicine, Elkin. Peter@mayo. edu Shaun Grannis, MD, MS Indiana University School of Medicine & The Regenstrief Institute, sgrannis@regenstrief. org 4 Security and Privacy – 118 members – Co-chairs – Glen Marshall, Siemens Medical Solutions, glen. f. marshall@siemens. com – John Moehrke, GE Healthcare, John. Moehrke@med. ge. com – Walter Suarez, MD, Institute for HIPAA/HIT Education and Research, walter. suarez@sga. us. com 4 Total Technical Committee Membership – 381 individuals Evaluation of Standards Harmonization Process for HIT 9

HITSP Coordinating Committees and Leadership 4 Foundations Committee – Steve Wagner – 4 Harmonization Readiness Committee Bob Dolin – Lynne Gilbertson 4 HITSP Process Review Committee 4 Business Plan Committee – Lynne Gilbertson – Steve Lieber – Erik Pupo 4 HITSP-CCHIT Joint Work Group – Jamie Ferguson, Kaiser Permanente CCHIT Orientation Material 4 International Landscape Committee – Bill Braithwaite 4 Governance Committee – Evaluation of Standards Harmonization Process for HIT Michael Aisenberg 10

HITSP project team and staff supports each Technical Committee 4 HITSP Technical Committee- Care Delivery – Don Van Syckle, DVS Consulting, don@dvsconsult. com 4 HITSP Technical Committee- Consumer Empowerment – John Donnelly, Inte. Pro Solutions, Inc. , jtdonnelly@intepro. biz – Mike Nusbaum, M. H. Nusbaum & Associates Ltd. , michael@mhnusbaum. com 4 HITSP Technical Committee- Population Health – Lori Reed-Fourquet, e-Health. Sign LLC, Lori. fourquet@sbcglobal. net 4 HITSP Cross-Technical Committee Coordination – Bob Yencha, Alschuler Associates, bob@alschulerassociates. com 4 HITSP Security and Technical Committee – Johnathan Coleman CISM, CISSP, Security Risk Solutions, Inc. , jc@securityrisksolutions. com – Sarah Quaynor, ANSI, sarah. quaynor@GSIHEALTH. COM 4 HITSP Emergency Responder-EHR – Michael Glickman, Computer Network Architects, Inc. , mglickman@CNAInc. com – Seb Haileleul, Patriot Technology, Shailel 01@yahoo. com 4 HITSP Medication Management – Suzi Hines, Principal, Sage Consulting, LLC, sfhines@bellsouth. net Evaluation of Standards Harmonization Process for HIT 11

HITSP Technical Committees Terms of Reference 4 Perform high level Requirements Analysis and Design of HITSP Interoperability Specifications, transaction packages, transactions, components, constructs including requirements analysis, and minimum data set. 4 Identify and analyze gaps and duplications within the standards industry as they are related to each specific Use Case. 4 Provide a description of the gaps, including missing or incomplete standards. 4 Provide a description of the duplications, overlaps, or competition among standards for the relevant Use Case. 4 Review and scope statements of work for each new use case. 4 Provide a listing of all standards that satisfy the requirements imposed by the relevant use cases as well as readiness criteria that shall be used to evaluate the standard. 4 Select and evaluate recommended standards to meet the relevant Use Case. 4 Develop, review and evaluate ‘interoperability specifications’ for the selected standards. 4 Submit recommendations to HITSP for review, approval and resolution. 4 Ensure timely response and disposition of comments. 4 Ensure on-going process for addressing corrections/change requests and resolutions. Evaluation of Standards Harmonization Process for HIT 12

Security and Privacy Technical Committee Terms of Reference/Charter 4 Harmonize HITSP standards for EHR-Lab reporting, Population Health and Consumer Empowerment with relevant Security and Privacy standards, including the HIPAA Security and Privacy Rules, and basic consents, where appropriate. 4 Assemble HITSP Security and Privacy Technical Committee (S&PTC) with adequate representation from each TC. 4 Convene regular meetings of the S&PTC to review current Interoperability Specifications and identify areas of Security and Privacy that were deferred. 4 Begin work on identifying security standards, approaches, and identifying unresolved issues (e. g. policy issues). Leverage activities of other Security and Privacy related workgroups. 4 In developing Security and Privacy related content, it will be important to maintain traceability on how existing and emerging HITSP constructs may be affected. Evaluation of Standards Harmonization Process for HIT 13

The actual harmonization process is a series of steps taken by industry stakeholders within the context of HITSP Harmonization Process Steps Receive Request I II III Harmonization Identification Request Requirements of Candidate Standards Analysis IV V Gaps, Duplications Standards Selection and Overlaps Resolution VI VII Construction of Inspection Interoperability Test Specification VIII Interoperability Specification Release and Dissemination IX Program Management Begin Support Evaluation of Standards Harmonization Process for HIT 14

HITSP 2007/2008 Timeline Overview (as of Oct 2007) 10/09/07 WE HITSP Board 07/09/07 HITSP Board 05/11/07 HITSP Panel MAY 5/08 – 5/10 TC F 2 F Arlington VA 09/07/07 HITSP Panel 07/16/07 HITSP Panel JUN E JUL Y AUG SEP T OCT 2/11/08 HITSP Board 2/20/08 HITSP Panel 12/13/07 HITSP Panel 10/15/07 HITSP Panel NOV DEC JAN FEB 1/23 – 1/25 TC F 2 F Chicago 10/29 – 10/31 TC F 2 F Lombard IL 09/04 – 09/06 TC F 2 F Arlington VA 6/18 – 6/20 TC F 2 F San Diego CA ARE HERE 3/27/08 HITSP Panel MAR APR 3/24 – 3/26 TC F 2 F DC Area Security and Privacy for 2006 Use Cases -- EHR Lab and BIO EHR and BIO v 3. 0 S&P v 1. 0 For major updates only…. 05/17 – 06/14 RDSS Public Comment IS Construct Development Inspect Test and Public Comment Resolution and Panel Approval 07/20 – 08/17 05/17 – 07/19 Update EHR and BIO constructs Inspect Test and Public Comment 12/10 – 1/11 08/20 – 10/15 Comment Resolution and Panel Approval Implementation Support, Testing, and Gap Resolution 1/14 – 3/27 Consumer Sharing , Quality and ER-EHR Use Cases ER-EHR, CS Media and Quality v 1. 0 and CS Network v 3. 0 7/20 – 8/17 Public Comment Requirements Design and Stndrds Selection IS Construct Dev 05/07 – 07/10 7/11 – 9/14 Inspect Test and Public Comment Resolution and Panel Approval 9/17 – 10/12 Implementation Support, Testing, and Gap Resolution (with annual updates as required) 10/15 – 12/13 Medication Management Use Case Medications Management v 1. 0 9/17 – 10/12 Requirements Design and Stndrds Selection 6/18 – 9/14 Public Comment IS Construct Development 9/17 – 12/7 Evaluation of Standards Harmonization Process for HIT Inspect Test and Public Comment 12/10 – 1/11 Comment Resolution and Panel Approval Implementation Support, Testing, and Gap Resolution 1/14 – 3/27 15

HITSP 2007/2008 Schedule of Meetings 10/15/07 HITSP Panel 10/09/07 HITSP Board 12/13/07 HITSP Panel OCT 10/29 – 10/31 TC F 2 F Lombard, IL DEC 2/08/08 3/27/08 HITSP Board HITSP Panel 2/20/08 HITSP Panel JAN 1/23 – 1/25/08 TC F 2 F Chicago FEB MAR 3/24 – 3/26/08 TC F 2 F DC Area 12/2/08 9/29/08 6/16/08 HITSP Board 12/8/08 6/23/08 10/6/08 HITSP Panel MAY JUNE SEP OCT DEC 5/12 – 5/14/08 9/8 – 9/10/08 TC F 2 F 6/11 – 6/13/08 TC F 2 F 10/28 – 10/30/08 TBD TC F 2 F Chicago DC Area Evaluation of Standards Harmonization Process for HIT 16

HITSP Definition of a Standard 4 A standard specifies a well-defined approach that supports a business process and: (1) has been agreed upon by a group of experts; (2) has been publicly vetted; (3) provides rules, guidelines, or characteristics; (4) helps to ensure that materials, products, processes, and services are fit for their intended purpose; (5) is available in an accessible format; and (6) is subject to an ongoing review and revision process. Evaluation of Standards Harmonization Process for HIT 17

Tier 1 Standards Readiness Criteria 4 The standards required to support each major Use Case event were organized within an agreed upon standards taxonomy 4 The standards selected for inclusion in the pool were examined using ‘HITSP approved’ Tier 1 and Tier 2 Harmonization Readiness Criteria Evaluation of Standards Harmonization Process for HIT 18

Tier 2 Standards Readiness Criteria 4 Suitability – The standard is named at a proper level of specificity and meets technical and business criteria of use case 4 Compatibility – The standard shares common context, information exchange structures, content or data elements, security and processes with other HITSP harmonized standards or adopted frameworks as appropriate 4 Preferred Standards Characteristics – Approved standards, widely used, readily available, technology neutral, supporting uniformity, demonstrating flexibility and international usage are preferred 4 Standards Development Organization and Process – Meet selected criteria including balance, transparency, developer due process, stewardship and others. 4 Total Costs and Ease of Implementation – Deferred to future work Evaluation of Standards Harmonization Process for HIT 19

HITSP Framework Basis for Interoperability Specification Template 4 HITSP receives Use Cases and Harmonization Requests from external sources, such as AHIC and ONC. 4 The Use Case or Request defines scenarios, business actors, and business and functional/interoperability requirements. 4 HITSP decomposes the Use Case requirements into scenario(s) and then into transactions providing context: technical actors, actions and content. It may create or reuse a transaction or a grouping of transactions (transaction package) based on commonality at this level. 4 Transactions are logical groupings of actions that are decomposed into components, which are groupings of base standards that work together, such as message and terminology. 4 Each HITSP construct, i. e. , transaction package, transaction or component, may constrain the construct or standard below it. Constraints follow a strict hierarchy and are only imposed by the next higher construct. 4 Transaction packages, transactions and components all are potential candidates for reuse if a new set of requirements and context are successfully fulfilled by the existing construct. 4 While reuse is a HITSP goal, it is established in the context of a Use Case and its functional/interoperability requirements. 4 HITSP constructs are version controlled and, if reused, will be uniquely identified. Evaluation of Standards Harmonization Process for HIT 20

HITSP Framework Evaluation of Standards Harmonization Process for HIT 21

Definitions and Rules Level Definition Use Case or Harmonization Request § Interoperability Specification § § Transaction Package § Example Rules Defines business/functional requirements Sets Context § ONC EHR- Lab Use Case Models business/ functional/ interoperability requirements Identifies technical/system requirements to meet use-case Identifies how to use one or more HITSP constructs to meet use-case requirements § HITSP EHR – Lab Interoperability Specification (IS 01) § Defines how two or more transactions are used to support a stand-alone information interchange within a defined context between two or more systems § Record Locator Service § Entity Identification Service § § § § Transaction § Logical grouping of actions, including necessary content and context, that must all succeed or fail as a group. § Query lab result § Send lab result § § Evaluation of Standards Harmonization Process for HIT Based on UML diagram to identify technical actors and actions Sets context Testable functional requirements Ids transactions or transaction packages Thin context and interoperability requirements Testable Based on analysis of like technical actors, context and content harmonized across transactions May be fulfilled by one or more transactions or composite standard Expresses constraints on the transactions or composite standard Fulfills all actions between two or more systems needed to meet one or more interoperability requirements Testable May be fulfilled by components or composite standard Expresses constraints on components or composite standard 22

Definitions and Rules (cont. ) Level Definition Example Rules Component § An atomic construct used to support an information interchange or to meet an infrastructure requirement (e. g. , security, logging/audit) § Lab result message § Lab result context § A standard capable of fulfilling a discrete function within a single category produced and maintained by a single standards organization. § Messaging standard § Security standard § Code set. Per HITSP definition the term “standard” refers, but is not limited to, : Base Standard § § Typically will use one “primary” standard and may have other “secondary” standards Expresses constraints on base or composite standards § Integration profiles § Implementation guides § Health transaction services Evaluation of Standards Harmonization Process for HIT Implementation Guides Code Sets Terminologies – Grouping of coordinated base standards, often from multiple standards organizations, maintained by a single organization. In HITSP, it can serve as a component, transaction or transaction package functional requirements. . – – § Specifications – Composite Standard – Integration Profiles Per Definition above 23

Familiarization with existing HITSP Constructs 4 Document Naming Convention: [Document Type]_HITSP_[Document Number]_[Version]_[year]_[Short_Title]_[Date] Example: IS_HITSP_02_v 1. 2_2006_Biosurveillance_10202006. pdf Document Type: IS (Interoperability Specification) Document Number: 02 Version: 1. 2 Year: 2006 Short Title: Biosurveillance Date: October 20 th, 2006 4 Document Types: IS: ISTP: IST: ISC: Interoperability Specification Transaction Package Transaction Component Evaluation of Standards Harmonization Process for HIT Collectively known as “Constructs” 24

Familiarization with existing HITSP Constructs 4 There are three approved Interoperability Specifications: – – – IS-01 v 1. 2 IS-02 v 1. 2 IS-03 v 1. 2 EHR-Lab-Result-Reporting Biosurveillance Consumer Empowerment 4 There is also a high-level Executive Summary of the three main ISs 4 Each IS has a number of HITSP Constructs which it calls upon to describe the implementation of lower level, specific interactions 4 The beginning of each IS contains a diagrammatic overview of the lower level constructs it calls upon and their relationship to the IS Evaluation of Standards Harmonization Process for HIT 25

Technical Committee Resources 4 The ANSI Public Document Library is used for publicly posting completed works and related materials. It can be found on the “Document Library” links from the main HITSP site: www. hitsp. org 4 HITSP Interoperability Specifications (ISs) and Executive Summary can also found at www. hitsp. org which links to them directly. 4 The Use Cases are located in the Public Document Library in the following link: – AHIC Harmonized Use Cases – – The Members Document Library is used for works in progress and can be found at: http: //members. ansi. org/sites/ Login using: ANSI_Membership{your ANSI assigned user ID} Password: {your ANSI assigned password} 4 Technical Committees have standing meeting times with dedicated conference bridge lines supported by various web-based collaboration tools including: – Go. To. Meeting: Up to 26 participants; “Meet Now” capability – Go. To. Webinar: Up to 1001 participants; Survey, Poll and Q &A Capabilities Evaluation of Standards Harmonization Process for HIT 26

Technical Committee Resources 4 Standing Conference Calls all scheduled for the TCs and Work Groups as follows: 4 For all standing meetings: Dial in: 1 -866 -469 -3239 4 Consumer Empowerment: Every Monday 12: 00 pm to 1: 00 pm EST – Participant code: 67737291 4 Care Delivery: Every Monday from 3: 00 -5: 00 pm EST. – Participant code: 57455041 4 Population Health: Every Monday from 1: 00 -3: 00 pm EST. – Participant code: 64035221 4 Security and Privacy: Every Thursday from 1 -2 pm EST – Participant code: 67278751 Evaluation of Standards Harmonization Process for HIT 27

Troubleshooting 4 For Technical Committee related questions please contact your TC facilitators or: Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS Vice President, Informatics HIMSS 230 East Ohio, Suite 500 Chicago, IL 60611 -3269 Phone: 312 -915 -9281 email: jsensmeier@himss. org Theresa Wisdom, MBA, RHIA Manager, Standards Harmonization HIMSS 230 East Ohio, Suite 500 Chicago, IL 60611 -3269 Phone: 312 -915 -9513 email: twisdom@himss. org Jessica Kant Coordinator, Standards Harmonization Healthcare Information & Management Systems Society 230 E. Ohio St. , Suite 500 Chicago, IL 60611 Phone: 312 -915 -9283 Fax: 312 -915 -9511 email: jkant@himss. org 4 For ANSI Document Library related questions please contact: Alison Ziegler Program Administrator, Standards Panels American National Standards Institute 25 West 43 rd Street New York, NY 10036 Phone: 212 -642. 4947 email: aziegler@ansi. org Evaluation of Standards Harmonization Process for HIT 28

Questions? Thank you for volunteering to participate in HITSP. We cannot succeed without you! Evaluation of Standards Harmonization Process for HIT 29

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