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HSSP Practitioners Guide Volume II Immunization and Adverse Event Reporting Prototype From HL 7 HSSP Practitioners Guide Volume II Immunization and Adverse Event Reporting Prototype From HL 7 and HITSP Artifacts For presentation at HL 7 Rio Workgroup Meeting, May 2010 Six Weeks to Rio, 19 March 2010 Minutes PHONE: +1 770 -657 -9270 Pass code 071582# WEB: http: //my. dimdim. com/hssp HL 7 “EHR SD RM” Lead Project Details available at www. hssp. wikispaces. com/Reference+Architecture Stephen. Hufnagel. [email protected] osd. mil, Editor Gov. Projects, EHR, PHER, HSSP co-sponsors EHR SD RM - EHR Way Forward … Future State Reference Architecture Slide 0

Agenda Item Max Time q Roll Call and Introductions min 3 q Overview Agenda Agenda Item Max Time q Roll Call and Introductions min 3 q Overview Agenda min 2 q Overview of HSSP Practitioners Guide Volume I q Overview of Services Aware Interoperability Framework (SAIF) 10 min q Overview of EHR System Design Reference Model (EHR SD RM) 10 min q Overview of candidate HSSP Services for use in HSSP Practitioners Guide Volume II 10 min q Overview of DRAFT Table of Contents for HSSP Practitioners Guide Volume II 13 min q Wrap Up EHR SD RM - EHR Way Forward … Future State Reference Architecture 10 min 2 min Slide 1

The Practical Guide for SOA in Health Care A real-world approach to planning, designing, The Practical Guide for SOA in Health Care A real-world approach to planning, designing, and deploying SOA. Version 1. 0, December 2008 An informative reference for leaders and decision-makers. Produced by the Healthcare Services Specification Project (HSSP): A collaborative effort between Health Level Seven (HL 7) and the Object Management Group. The figure illustrates a macro-view of a SOA. It depicts five overlapping boundaries, each of which represents a context within the business and architecture: • The Inter-organisational Boundary (outermost) represents inter-organisational considerations, such as policies, sharing agreements, and business partners. • The System Boundary represents the physical platforms on which software and systems run, including servers, networks, and so on. • The Application Boundary represents the software running on those platforms, inclusive of applications and data. • The Business Process / Orchestration Boundary manages the intersection between software and workflow, and would manage coordination among multiple software components that all must interact to satisfy business needs. • Finally, the Service Implementation Boundary depicts EHR SD RM - EHR Way Forward … Future State Reference Architecture themselves, interacting across a Slide 2 the implementations

The Practical Guide for SOA in Health Care Table 3. Sample. Health Business Function The Practical Guide for SOA in Health Care Table 3. Sample. Health Business Function Map Healthcare-Unique Services Business Svcs SOA Infrastructure Svcs Order Entry Order Fulfill ment Patient Evaluat ion (DSS) Lab Data Retriev al Pharmacy Data Retrieval EHR Alert/ Event Mgmt Master Person Index Termi Demo Billing Sched Auditi Except nology grap uling ng ion Service hics Service Mgmt Business Process Mgmt (BPM) Authe Serv nticat ices ion Dire ctor y Access Control Pharmacy X X X X Laboratory X X X X Patient Administration X X X X X Order Entry/Mgmt X X X X Scheduling X X X X X Registration X X X X X Care Management X X X X X Referrals/Referral Mgmt X X X X X Nursing X X X X X Emergency Department X X X X X Patient Billing X X X X Imaging/Radiology X X X X X Clinical Decision Support X X X X Facilities Management X X X X Nutrition Mgmt (Dietetics) X X X X X Business Line EHR SD RM - EHR Way Forward … Future State Reference Architecture X Slide 3

The Practical Guide for SOA in Health Care EHR SD RM - EHR Way The Practical Guide for SOA in Health Care EHR SD RM - EHR Way Forward … Future State Reference Architecture Slide 4

Agenda q Roll Call and Introductions 3 min q Overview Agenda q Overview of Agenda q Roll Call and Introductions 3 min q Overview Agenda q Overview of HSSP Practitioners Guide Volume I 10 min q Services Aware Interoperability Framework (SAIF) q Overview of EHR System Design Reference Model (EHR SD RM) 10 min q Overview of candidate HSSP Services for use in HSSP Practitioners Guide Volume II 10 min q Overview of DRAFT Table of Contents for HSSP Practitioners Guide Volume II 13 min q Wrap Up EHR SD RM - EHR Way Forward … Future State Reference Architecture 2 min 10 min 2 min Slide 5

The HL 7 Services-Aware Interoperability Framework (SAIF) SAIF Contains: q Enterprise Conformance and Compliance The HL 7 Services-Aware Interoperability Framework (SAIF) SAIF Contains: q Enterprise Conformance and Compliance Framework (ECCF) is based on RM-ODP q Behavioral Framework (BF) – Interoperability Scenarios supporting the RM-ODP Computational Viewpoint q Governance Framework (GF) – Governance is the overarching policy structure and set of related processes by which a group exercises its authority and demonstrates accountability for accepted responsibilities within a particular jurisdiction. SAIF Principles: q Applicable within each of HL 7’s three Interoperability Paradigms (IPs), – (i. e. , messages, documents, and services). q Provide support for measurable conformance and compliance. q Define appropriate governance structures and processes. q Provide support for directly implementable solutions. q Address the growing disparity between the various solution sets emerging from EHR SD RM - EHR Way Forward … Future State Reference Architecture HL 7. Slide 6

HL 7 SAIF Specification Stack Views Conformance and Compliance Framework (ECCF) Computational Implementation Policy HL 7 SAIF Specification Stack Views Conformance and Compliance Framework (ECCF) Computational Implementation Policy Content Behavior Enterprise / Information Engineering Topic Business View “WHY” View “WHAT” View “HOW” View “WHERE” Business Context, Reference Context Domain Analysis (Information) Model Collaboration Analysis, Functional Profile(s), Service Roles and Relationships Existing Platform capabilities Business Governance Project-oriented Domain Information Model, Constrained Information Model, Localized Information Model, Hierarchical Message Definition Collaboration Types, Interface Specification and Functional Groups, Interaction Types and Collaboration Participations, Contracts Parts Existing Platform models, libraries, etc. Rules, Procedures Specification Localized Information Model, Transforms, Schema Collaboration scripts, Orchestrations, Realized Interfaces Execution Context, Platform Bindings, Deployment Model Conceptual Independent Platform. Specific Consistency EHR SD RM - EHR Way Forward … Future State Reference Architecture Slide 7 Traceable Platform-

HL 7 SAIF Responsibilities Conformance and Compliance Framework (ECCF) Behavior Policy Content Implementation “Why” HL 7 SAIF Responsibilities Conformance and Compliance Framework (ECCF) Behavior Policy Content Implementation “Why” “What” “How” “Where” Traceable Consistency EHR SD RM - EHR Way Forward … Future State Reference Architecture Slide 8

HITSP Within HL 7 SAIF ECCF Specification Stack Specification Enterprise / Business View “WHY” HITSP Within HL 7 SAIF ECCF Specification Stack Specification Enterprise / Business View “WHY” Information View “WHAT” Business Context, Reference Context Topic Domain Analysis (Information) Model Policy Conceptual HITSP Harmonizatio n Framework Platform- HITSP IS Independent Rules, Procedures Platform. Specific HITSP DA HITSP CAP Project-oriented Domain Information Model, Constrained Information Model, Localized Information Model, Hierarchical Message Definition HITSP Component Localized Information Model, Transforms, Schema Behavior Harmonization Collaboration Analysis, Functional Profile(s), Service Roles and Requests/ Use Relationships Case Engineering View “WHERE” Implementation Existing Platform capabilities HITSP CAP HITSP Transaction, Transaction Package and Service Collaboration scripts, Collaboration Types, Interface Specification and Functional Groups, Interaction Types and Collaboration Participations, Contracts Parts Traceable Business Governance Content Computational View “HOW” Existing Platform models, libraries, etc. Execution Context, Platform Bindings, Deployment Model Orchestrations, Realized Interfaces EHR-S FM is EHR System Functional Model EHR SD RM is EHR System Design Reference Model RIM is Reference Information Model FHIMS is Federal Health Information Model & Standards DA is Data Architecture Consistency EHR SD RM - EHR Way Forward … Future State Reference Architecture Slide 9 9

HL 7, HITSP, FHIMS and NHIN Within HL 7 SAIF ECCF Specification Stack Topic HL 7, HITSP, FHIMS and NHIN Within HL 7 SAIF ECCF Specification Stack Topic Specification Conceptual Independent Policy Business Context, Reference HL 7 EHR-S Context FM HITSP Harmonizatio n. Business Governance Framework HL 7 EHR SD RM Specific Content Domain Analysis (Information) Model HL 7 RIM FHA FHIMS HITSP DA HITSP CAP Project-oriented Domain Information Model, Constrained Information Model, Localized Information Model, Hierarchical Message Definition HITSP Component HITSP IS Rules, Procedures Platform- Information View “WHAT” Localized Information Model, Transforms, Schema Computational View “HOW” Engineering View “WHERE” Orchestrations, Realized Interfaces Bindings, Deployment Model Behavior Implementation Tomcat, Harmonization Collaboration Analysis, Functional Existing Platform capabilities Profile(s), Service Roles and JBoss, J 2 SE, Requests/ Use Relationships Eclipse, Case Glass. Fish HITSP Capability ESB, Open. SSO Collaboration Types, Interface Existing Platform models, Specification and Functional libraries, etc. Transaction, Groups, Interaction Types and Collaboration Participations, Transaction Contracts Parts NHIN Connect Package and Services Service Collaboration scripts, Execution Context, Platform EHR-S FM is EHR System Functional Model EHR SD RM is EHR System Design Reference Model RIM is Reference Information Model FHIMS is Federal Health Information Model & Standards DA is Data Architecture Consistency EHR SD RM - EHR Way Forward … Future State Reference Architecture Slide 10 10 Traceable Platform- Enterprise / Business View “WHY”

Agenda q Roll Call and Introductions min 3 q Overview Agenda min 2 q Agenda q Roll Call and Introductions min 3 q Overview Agenda min 2 q Overview of HSSP Practitioners Guide Volume I min 10 q Overview of Services Aware Interoperability Framework (SAIF) 10 min q EHR System Design Reference Model (EHR SD RM) q Overview of candidate HSSP Services for use in HSSP Practitioners Guide Volume II 10 min q Overview of DRAFT Table of Contents for HSSP Practitioners Guide Volume II 13 min q Wrap Up EHR SD RM - EHR Way Forward … Future State Reference Architecture 10 min 2 min Slide 11

Federal Enterprise Architecture (FEA) www. whitehouse. gov/omb/egov q Performance Reference Model - The FEA Federal Enterprise Architecture (FEA) www. whitehouse. gov/omb/egov q Performance Reference Model - The FEA PRM is a framework to measure the performance of major IT initiatives and their contribution to program performance. The PRM leverages performance measurement best practices from the public and private sectors, including the Balanced Scorecard, Baldrige Criteria, Value Measurement Methodology, program logic models, the value chain, and theory of constraints. There is an increased emphasis placed on linkage of investment to agency program performance and the PRM will help agencies produce enhanced performance information. Furthermore, the PRM will assist in: improving the alignment of program goals and objectives with Mission Area goals and objectives; improving communication of program contributions such as technology (input) to outputs and outcomes; and in identifying improvement opportunities that span traditional organizational boundaries. q Business Reference Model - The Business Reference Model (BRM) is a functional-driven framework for describing and organizing the day-to-day business operations of the Federal Government into Lines of Business (LOBs), independent of the agencies that perform the business operation. The BRM is the first layer of the Federal Enterprise Architecture and it is the organizing construct for the analysis of the other four reference models: performance, service components, data, and technology. q Service Component Reference Model - The Service Component Reference Model (SRM) is a functional framework to evaluate to identify government-wide opportunities to leverage IT investments and assets from a service perspective. This model helps understand the services delivered by the government and assess if there is an opportunity to group like services and create leverage opportunities, such as reuse or shared services. q Data Reference Model - The Data Reference Model (DRM) describes at an aggregate level, the data and information required to support the Lines of Business (LOBs). The three elements of data exchange that have been standardized include data description, data context, and data sharing. Establishing a common data model streamlines the information exchange process within and across the Federal Government and facilitates the ability to identify duplicative data resources. q Technical Reference Model - The Technical Reference Model (TRM) establishes a common technical framework for categorizing standards, specifications, and technologies that support and enable the delivery of services. This framework can be leveraged to support the development, delivery, and exchange of business and application components (Service Components) that RM - be leveraged in a Component-based. Reference Architecture EHR SD may EHR Way Forward … Future State or Service Oriented Architecture (SOA). Furthermore, it also Slide 12 serves as the foundation to advance the re-use of technology and best practices from each of the Service Components on

Architecture Functional Analysis Object Analysis Requirements Analysis EHR SD RM - EHR Way Forward Architecture Functional Analysis Object Analysis Requirements Analysis EHR SD RM - EHR Way Forward … Future State Reference Architecture Interface Design Service Analysis Slide 13

HL 7 EHR System Functional Model (EHR-S) > 160 System Functions in 4 level HL 7 EHR System Functional Model (EHR-S) > 160 System Functions in 4 level categorization (separate spreadsheet available for full enumeration) System Functions EHR-S FM functions can be grouped into Service Components … aka Capabilities (e. g. , Lab Order Capability, which does eligibility and authorization function as well as lab order function). O-1 Electronic Resource Planning (ERP) O-2 Finances O-3 Other EHR SD RM - EHR Way Forward … Future State Reference Architecture NOTE: “Other” Category - The EHR-S model does NOT include Electronic Resource Planning (ERP) / Logistics and Financial components, which are needed for completeness of a Health IT Enterprise. Slide 14

Healthcare SOA Framework Based on HL 7 EHR System Functional Model & Thomas Erl’s Healthcare SOA Framework Based on HL 7 EHR System Functional Model & Thomas Erl’s SOA Layers HL 7 System Functions Direct Care Supportive Information Infrastructure Other Business Process Value Chains Composite Services Federated Composition (e. g. , Choreograph or Orchestration) Within and Across Business Areas Core Business Services Functional Areas + Focal Classes Entity Services Information Management Information Reporting and Management C r o s s T e c h n I c a l “Common S e r v I c e s” (e. g. , Security, Privacy, Auditing, Logging…) Agnostic Services Application Services Ambulatory Care Systems, In Patient Care Systems Logistics Systems Financial Systems Decision Support Systems Data Marts Repositories Business Objects Integrated Healthcare Analysis Profiles Communications Implementation Profiles Enterprise (IHE) Profiles/Stacks Profiles EHR SD RM - EHR Way Forward … Future State Reference Architecture Slide 15 15 Implementation Profiles

HL 7 RIM (Reference Information Model) Six Core Classes Defining a Semantic Framework which HL 7 RIM (Reference Information Model) Six Core Classes Defining a Semantic Framework which Maintains Clinical Data Context ENTITY ROLE Participation ACT (aka ACTION) Role link Act relationship ACT – something that has happened or may The HL 7 RIM expresses the data content needed happen in a specific clinical or administrative context and Language / Entity – a person, animal, organization, or provides an explicit representation of the semantic and thing communication lexical connections that exist between the information Role – a responsibility of, or part played by, carried in the fields of HL 7 messages. an Entity The HL 7 RIM supports EHR interoperability; an EHR may needs additional foundation classes (e. g. , Participation – the involvement of a Role in Responsibility) an Act EHR SD RM - EHR Way Forward … Future State Reference Architecture Slide 16 Act Relationship – a relationship between

HITSP Harmonization Framework Addressing Business Needs Defining Information Content IS IS = Interoperability Specification HITSP Harmonization Framework Addressing Business Needs Defining Information Content IS IS = Interoperability Specification Capability Available for Independent Implementation Service Collaboration Transaction, Transaction Package Providing Infrastructure, Security, Privacy Components Data Architecture Base and Composite Standards EHR SD RM - EHR Way Forward … Future State Reference Architecture Slide 17

Agenda q Roll Call and Introductions min 3 q Overview Agenda min 2 q Agenda q Roll Call and Introductions min 3 q Overview Agenda min 2 q Overview of HSSP Practitioners Guide Volume I min 10 q Overview of Services Aware Interoperability Framework (SAIF) 10 min q Overview of EHR System Design Reference Model (EHR SD RM) 10 min q Candidate HSSP Services for use in HSSP Practitioners Guide Volume II q Overview of DRAFT Table of Contents for HSSP Practitioners Guide Volume II 13 min q Wrap Up EHR SD RM - EHR Way Forward … Future State Reference Architecture 2 min Slide 18

Candidate HSSP Services for use in HSSP Practitioners Guide Volume II q CTS 2 Candidate HSSP Services for use in HSSP Practitioners Guide Volume II q CTS 2 (Common Terminology Services 2) CTS 2 will be a commonly accepted standard for terminology services that enhances the capabilities of the initial CTS specification for sub-setting and mapping, and extends the specification into domains such as terminology distribution, versioning, and classification. q DSS (Decision Support Service) A commonly accepted standard for the DSS would make it more attractive for service consumers to invest in the infrastructure required for using the DSS to meet its patient evaluation needs, as they would be able to use the same interface to interact with multiple service vendors. q HCPDS (Healthcare Provider and Services Directory Service) HCPDS is required to provide an online facility that will enable Practitioners, via a set of parameters, to locate other practitioners, to assist in the continuum of care. q IXS (Identity Cross-Reference Service, formerly known as Entity Identification Service) Normative In balloting to become a full HL 7 standard. q PASS (Privacy, Access and Security Services) The goal of PASS is to define a suite of services that will provide a simple interface for all privacy, access control, consent, identity management and other security services that are needed in a service-oriented health information architecture. q RLUS (Retrieve, Locate and Update Service) and EIS (Entity Identification Service) The HL 7 SFM has been approved by the HL 7 Board as an official DSTU. EHR SD RM - EHR Way Forward … Future State Reference Architecture Slide 19

Agenda q Roll Call and Introductions min 3 q Overview Agenda min 2 q Agenda q Roll Call and Introductions min 3 q Overview Agenda min 2 q Overview of HSSP Practitioners Guide Volume I min 10 q Overview of Services Aware Interoperability Framework (SAIF) 10 min q Overview of EHR System Design Reference Model (EHR SD RM) 10 min q Overview of candidate HSSP Services for use in HSSP Practitioners Guide Volume II 10 min q DRAFT Table of Contents for HSSP Practitioners Guide Volume II q Wrap Up EHR SD RM - EHR Way Forward … Future State Reference Architecture 2 min Slide 20

DRAFT Table of Contents for HSSP Practitioners Guide Volume II q See “HSSP Practitioners DRAFT Table of Contents for HSSP Practitioners Guide Volume II q See “HSSP Practitioners Guide Volume II May 2010 – DRAFT-A. Docx” – Note that the version will change each week … A, B, C D, … till HL 7 Rio q Versions available at www. HSSP. wikispaces. com/Reference+Architecture – Weekly Agenda/Minutes – Weekly Read Ahead Slides – Weekly updated “HSSP Practitioners Guide Volume II May 2010 DRAFTA. Docx” EHR SD RM - EHR Way Forward … Future State Reference Architecture Slide 21

Call for Participation – HL 7 in Rio We are inviting all interested to Call for Participation – HL 7 in Rio We are inviting all interested to participate in the 11 th International HL 7 Interoperability Conference (IHIC-2010), to be held in Rio de Janeiro, Brazil on May 2010. This time will be the first for IHIC in South America. Following the success of previous IHIC venues in Kyoto(2009), Crete (2008), New Zealand (2007), Germany (2006), Taiwan (2005), Mexico (2004), IHIC 2010 aims to serve as a meeting place for more than 30 HL 7 affiliates around the world as well as individuals interested in interoperability and standards, to share their HL 7 implementation experience and strengthen their shared vision. The paper submissions are invited to show to the international community successful experiences using HL 7 V 3 and CDA R 2 interoperability between informatics applications using standards. Also, results and experiences from the collaborative use of standards are most welcome, especially if they are related to HL 7 standards. Topics of interest include but are not limited to the following: This year, along with the successful “Show me your CDA!” track, IHIC will also incorporate the "Send me your CDA!" HL 7 CDA Interoperability Showcase to display basic interoperability of applications using a HL 7 V 3 and HL 7 CDA R 2 standards. All submitted papers will be reviewed based on their technical quality and merit by the technical committee and reviewers. Papers that describe research and experimentation are encouraged. All paper submissions will be handled electronically using IEEE format, and detailed instructions on submission procedure will be available on IHIC 2010 web pages (http: //www. ihic 2010. hl 7. org. ar/). Accepted papers will be published online. For other information, please contact IHIC 2010, ([email protected] com) • HL 7 implementation experience from regional, trans-regional, or national implementation: Important Dates: • HL 7 v 2. x and 3. 0 messages • Call For papers : November 2, 2009 • Clinical Document Architecture (CDA) • Deadline for submissions extended to February 15, • Imaging Diagnostics and DICOM Standard 2010 • Use of HL 7 in IHE profiles • Evaluation and notification, March 15, 2010 • Terminologies, Ontologies and Coding Systems: use of local and • Camera-papers ready due : April 15, 2010 international standards • Use of other standards in combination with HL 7 standards: ASTM, ISO, CEN, etc. Business Models, regional & large scale deployment: • Electronic Healthcare Record: from strategy to implementation • Legal and regulatory issues. • Epidemiology, disease surveillance and control Future State Reference Architecture EHR SD RM - EHR Way Forward … Slide 22

Agenda q Roll Call and Introductions min 3 q Overview Agenda min 2 q Agenda q Roll Call and Introductions min 3 q Overview Agenda min 2 q Overview of HSSP Practitioners Guide Volume I min 10 q Overview of Services Aware Interoperability Framework (SAIF) 10 min q Overview of EHR System Design Reference Model (EHR SD RM) 10 min q Overview of candidate HSSP Services for use in HSSP Practitioners Guide Volume II 10 min q Overview of DRAFT Table of Contents for HSSP Practitioners Guide Volume II 13 min q Wrap Up EHR SD RM - EHR Way Forward … Future State Reference Architecture 2 min Slide 23

Wrap Up q Any new attendees? q Agenda Time Metrics q Volunteers to help Wrap Up q Any new attendees? q Agenda Time Metrics q Volunteers to help prepare for next week’s meeting? – Do we need one-on-one working meetings? q Suggestions for Improvement q Next Meeting March 26, 2010 at 12: 30 Eastern Time – PHONE: +1 770 -657 -9270 Pass code 071582# – WEB: http: //my. dimdim. com/hssp EHR SD RM - EHR Way Forward … Future State Reference Architecture Slide 24