Introduction to the HITSP

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Technical Committee Tiger Team Orientation June
9, 2009
Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSSVice
President, Informatics, HIMSS HITSP Standards
Implementation Technical Manager
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The Panels Purpose

• To harmonize and integrate diverse standards that
  will meet clinical and business needs for sharing
  information among organizations and systems.

• Establish HITSP Interoperability Specifications
  and promote their acceptance
  
• Support the deployment and implementation of
  HITSP Interoperability Specifications across the
  health care enterprise
  
• Facilitate the efforts of standards developing
  organizations to maintain, revise or develop new
  standards as required to support the HITSP
  Interoperability Specifications.

Harmonized standards promote interoperability,
enhance healthcare quality and contain costs
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HIT Standardization

• HITSP members agreed that a standard is a
  well-defined approach that supports a business
  process and . . .
  
• has been agreed upon by a group of experts
• has been publicly vetted
• provides rules, guidelines, or characteristics
• helps to ensure that materials, products,
  processes and services are fit for their
  intended purpose
  
• is available in an accessible format
• is subject to an ongoing review and revision
  process.

Standards Harmonization is required when a
proliferation of standards prevents progress
rather than enabling it.
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Standards Readiness CriteriaTier I

• The candidate standards required to support each
  Use Case are organized within an agreed upon
  standards taxonomy
  
• The candidate standards are examined using HITSP
  approved Harmonization Readiness Criteria

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Standards Readiness CriteriaTier II

• SuitabilityThe standard is named at a proper
  level of specificity and meets technical and
  business criteria of use case
  
• 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

• Preferred Standards CharacteristicApproved
  standards, widely used, readily available,
  technology neutral, supporting uniformity,
  demonstrating flexibility and international usage
  are preferred
• Standards Development Organization and
  ProcessMeet selected criteria including balance,
  transparency, developer due process, stewardship
  and others
• Total Costs and Ease of ImplementationDeferred
  to future work

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Standards Harmonization Goals

• To achieve interoperability, harmonization must
  be achieved in 5 areas
  
• Context/Information Model establishing a common
  reference information model to support clinical,
  public health, financial, and administrative
  healthcare functions
• Terminology/Content Definition establishing
  common reference terminology models and data
  content specifications that are integrated with
  the information model
• Privacy and Security establishing a common
  security framework
  
• Methodology establishing a common
  methodology/process that all standards
  organizations and code set maintainers will
  follow to achieve standards harmonization
• Information Exchange establishing a common
  information interchange format and
  standards-based application roles and
  interactions in a comprehensive dynamic model

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HITSP and Its Stakeholders - Harmonizing and
Integrating Standards To Meet Clinical and
Business Needs

• Patients
• Consumers
• Employers
• General Practitioners

Review Boards Practice Guidelines Residential C
are Providers
Specialists Payers Suppliers Hospitals
Outpatient Healthcare Providers
Government Agencies
HITSP - volunteer-driven, consensus-based
organization funded by the Department of Health
and Human Services.
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HITSP members are representatives of the broader
health IT community
Panel Members Board of Directors Technical
and Coordination Committees
and Tiger Teams
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HHS Secretary Kathleen Sebelius
Team
HHS ONC National HIT Coordinator, David
Blumenthal MD
Dr. John Halamka, HITSP Chair Panel, Committees,
and Tiger Teams

HHS ONCHIT1 PO, Carol Bean
Project Management Team Executive in Charge, F. S
chrotter, ANSI Program Manager, L. Jones GSI De
puty PM, J Corley, ATI Project Manager, Angela Pe
terson, Booz Allen
Standards Implementation Technical Manager
Joyce Sensmeier, HIMSS
Process Definition Technical Manager
Michelle Deane, ANSI
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For Immediate ReleaseOffice of the Press
SecretaryAugust 22, 2006 Executive Order Pr
omote Quality and Efficient Health Care in
Federal Government Administered or Sponsored
Health Care Programs Sec. 3. Agencies shall perf
orm the following functions Health Information
Technology - For Federal Agencies. As each ag
ency implements, acquires, or upgrades health
information technology systems used for the
direct exchange of health information between
agencies and with non-Federal entities, it shall
utilize, where available, health information
technology systems and products that meet
recognized interoperability standards.
HITSP- Harmonized standards promote
interoperability, enhance healthcare quality and
contain costs
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Federal Agencies must use the Recognized
Interoperability Standards that have been
harmonized by the Healthcare Information
Technology Standards Panel
HITSP is playing an integral role in the
development of a Nationwide Healthcare
Information Network (NHIN) for the United States
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2009 Obama vows to continue the HIT Plan begun
by President Bush

• President Barack Obama announces an audacious
  plan Computerize all health records within five
  years.
  
• - January 12, 2009

• February 17, 2009 the American Reinvestment and
  Recovery Act (ARRA) is signed into law
  
• HITECH Act component of ARRA provides a 19
  billion program to stimulate the adoption and use
  of HIT, with a focus on meaningful use of
  certified EHR systems

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HITSP Standards Harmonization

• Identify a pool of standards for a general
  breakthrough area
  
• Identify gaps and overlaps for specific context
• Make recommendations for resolution of gaps and
  overlaps
  
• Develop Interoperability Specifications for using
  the selected standard(s) for a specific context
  
• Test the instruction for using the standard

Open Inclusive Collaborative Use Case Driven
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Provider Perspective and Domain Technical
Committees Collaborate on Standards Harmonization

• Provider Perspective

Population Perspective
Consumer Perspective

• Care Management and Health Records Domain
  Committee

Security, Privacy and Infrastructure Domain
Committee
Administrative and Financial Domain Committee
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• Population Perspective
• IS 02 - Biosurveillance
• IS 06 - Quality
• IS 10 - Immunizations and Response Management
• IS 11 - Public Health Case Reporting

• Provider Perspective
• IS 01 - Electronic Health Record (EHR) Laboratory
  Results Reporting
  
• IS 04 - Emergency Responder Electronic Health
  Record (ER-EHR)
  
• IS 08 - Personalized Healthcare
• IS 09 - Consultations and Transfers of Care

• Consumer Perspective
• IS 03 - Consumer Empowerment
• IS 05 - Consumer Empowerment and Access to
  Clinical Information via Media
  
• IS 07 - Medication Management
• IS 12 - Patient Provider Secure Messaging
• IS 77 - Remote Monitoring

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HITSP Priorities and Use Case Roadmap
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Extensions/Gaps/Use Cases 2009
Consumer
Population
Provider
General Lab Orders Order Sets Long Term Ca
re Assessment
Newborn Screening Maternal Child Health Co
nsumer Adverse Event Reporting

Quality Measures Clinical Research
Common Device Connectivity Medical Home Co-mor
bidity and Registries
Medication Gaps
Admin/Finance
Scheduling Prior-Authorization in Support of Tr
eatment, Payment, Operations
Care Management/ Health Records
Consumer Preferences Common Data Transport
Clinical Note Details
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Steps in the HITSP Harmonization Process
HITSP Program Management
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Harmonization Framework
Use Case Identifies interoperability business nee
ds

• Interoperability Specification
• Identifies what HITSP lower-level constructs are
  used to meet business needs
  
• Defines Requirements, Context and Constraints
  for those constructs
  
• Addresses multi-year roadmap as needed

SDO
Composite Standard 1
Composite Standard 4
Base Standard 2
Base Standard 3
Base Standard 5
Base Standard n
Base Standard n
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Definitions and Rules
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Definitions and Rules (cont.)
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Current Activities

• President Barack Obama vowed in his inauguration
  speech to restore science to its rightful place,
  and wield technology's wonders to raise health
  care's quality and lower its cost. Healthcare
  IT continues to evolve and expand with ongoing
  activity in the nations capitol and throughout
  the country.
• American Recovery and Reinvestment Act (ARRA)
  Economic Stimulus for Health IT
  
• It includes over 20 billion to aid in the
  development of a robust IT infrastructure for
  healthcare and to assist providers and other
  entities in adopting and using health IT 3
  billion for ONC (http//www.himss.org/content/file
  s/HIMSSSummaryOfARRA.pdf)
• HITSP is working with the Office of the National
  Coordinator to ensure maximum support for
  standards required by ARRA
  

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ARRA Requirements Eight areas for standards

• Technology to protect privacy and security
• A nationwide health information infrastructure
  that supports exchange of health information
  
• The use of certified health record for each
  person in the U.S. by 2014
  
• Technologies to account for disclosures of health
  information
  
• The use of certified electronic health records to
  improve the quality of healthcare, such as by
  promoting the coordination of healthcare and
  improving continuity of healthcare among
  healthcare providers, by reducing medical errors,
  by improving population health, by reducing
  health disparities, by reducing chronic disease,
  and by advancing research and education.

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ARRA Requirements Eight areas for standards

• Technologies that allow individually identifiable
  health information to be rendered unusable,
  unreadable, or indecipherable to unauthorized
  individuals
• The use of electronic systems to ensure the
  comprehensive collection of patient demographic
  data
  
• Technologies that address the needs of children
  and other vulnerable populations

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The Vision

• In order to meet the ARRA statutory requirements,
  HITSP must focus all the energies of its
  volunteers, staff, and leadership on supporting
  this effort for the next 90 days. The use of
  electronic systems to ensure the comprehensive
  collection of patient demographic data
• HITSP's recognized and accepted products to
  date will be leveraged to create new streamlined
  electronically published standards guides
  organized around the ARRA EHR interoperability
  requirements instead of Use Cases
• End result much more compact, easy to implement,
  and flexible implementation guidance that
  supports meaningful use of EHRs and protection of
  privacy

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Tiger Teams were formed to focus on ARRA and
Clinical Research
Tiger Teams

• EHR-Centric IS

Data Architecture
Security, Privacy, and Infrastructure
Quality Measures
Exchange Architecture and Harmonization Framework
Clinical Research
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Tiger Team Leadership

• EHR Centric Interoperability Specification 127
  members
  
• Manick Rajendran, eZe Care LLC
• Corey Spears, McKesson Health Solutions
• Mike Nusbaum, Staff Co-chair
• Harmonization Framework and Information Exchange
  Architecture 97 members
  
• Steve Hufnagel, PhD, DoD/Medical Health System
  (MHS)
  
• Ed Larsen, Staff Co-chair

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Tiger Team Leadership

• Quality Measures - 110 members
• Floyd Eisenberg, MD, MPH, National Quality Forum
• Eileen Koski, M. Phil
• Lori Reed-Fourquet, Staff Co-chair
• Data Architecture (Element, Template and Value
  Set) 133 members
  
• Keith Boone, GE Healthcare
• Don Bechtel, Siemens Medical Solutions
• Don Van Syckle, Staff Co-chair

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Tiger Team Leadership

• Security, Privacy Infrastructure - 119 members
• Glen Marshall, Grok-A-Lot, LLC
• John Moehrke, GE Healthcare
• Johnathan Coleman, Staff Co-chair
• Clinical Research - 95 members
• Walter Suarez, MD, Institute for HIPAA/HIT
  Education and Research
  
• Gene Ginther, Staff Co-chair
• Landen Bain, Technical Writer
• Total Tiger Team Membership 299 individuals

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Starting Point ARRA Requirements and Tiger Teams
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Early View of EHR-Centric IS use of SPI Service
Collaborations
IS documents/Workflows
?????
?????
EHR Centric IS
All other ISxxx
Service Collaboration Suites
Query forExisting Data
Healthcare Document Mgt
Healthcare Images
TransactionPackages (e.g. TP30)
Patient Identity Management
Knowledge and Vocabulary
Documents
Transactions (e.g. T29)
Other Service Collaboration
Component(e.g. C26)
Constructs Specified in Service Collaboration
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Service Collaboration Suite
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June 4, 2009
HITSP 2009 Timeline Overview
2/9 HITSP Board Teleconf
6/1 HITSP Board Teleconf
2/16 HITSP TCL DC Area
11/2 HITSP TCL possibly Phoenix
8/24 HITSP TCL, Chicago
12/1 HITSP Board
8/25-8/27 TC F2F, Chicago
6/8 HITSP TCL F2F, DC Area
2/17-2/19 TC F2F DC Area
4/14 - 4/16 Cross-Communication Telecons
9/8 HITSP Board
6/9 6/11 TC F2F, DC Area
11/3 11/5 TC F2F possibly Phoenix
MAR
APR
JAN
JUNE
AUG
SEPT
OCT
NOV
JULY
FEB
DEC
MAY
July 15, 2009 ARRA Work Due
7/8 HITSP Panel DC Area
2/20 HITSP Panel DC Area
12/15 HITSP Panel
9/15 HITSP Panel
EHR-Centric Lightweight IS
Legend
Holidays
Full TC/Tiger Team Meetings
Security, Privacy, and Infrastructure Service
(Suite)
Requirements and Design
Complete Deliverable
Exchange Architecture and Harmonization Framework
Data Architecture
Editorial Review and Quality Review
IRT Content Review
Harmonization Framework and Draft TN
Review Copy for Panel Approval
IS/Construct Cleanup
Other NHIN Collaboration, CCHIT Collaboration,
Test Collaborative, Concept Paper on Meaningful
Use, Quality Measures, Clinical Research, Content
Publication and Management Infrastructure
2009 ONC Use Case, Gaps Extensions
Comment Resolution IS, Gaps Ext Doc Creation
Comment
3 weeks
Planning
Detailed Analysis, Draft IS, Gaps Extensions
Documents Creation

2 weeks
Receive Gaps/Extensions from ONC
WE ARE HERE
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• Joint Working Group
• Healthcare Information Technology Standards Panel
  (HITSP)
  
• and the
• Certification Commission for Healthcare
  Information Technology (CCHIT)

Between the federal implications and the
certification efforts of CCHIT, stakeholders
will be motivated to adopt a standard way of
sharing data throughout the Nationwide
HealthInformation Network, leading to better
healthcare for us all.
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NHIN Joint Working Group
HITSP worked closely with these contractors
during implementation.

• CareSparkTri-Cities region of Eastern Tennessee
  and Southwestern Virginia
  
• Delaware Health Information NetworkDelaware
• Indiana UniversityIndianapolis Metroplex
• Long Beach Network for HealthLong Beach and Los
  Angeles, California
  
• Lovelace Clinic FoundationNew Mexico

• MedVirginiaCentral Virginia
• New York eHealth CollaborativeNew York
• North Carolina Healthcare Information and
  Communications Alliance, Inc.North Carolina
  
• West Virginia Health Information NetworkWest
  Virginia
  
• Federal Health ConsortiumFederal health agencies

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Join HITSP in developing a safe and secure health
information network for the United States.

Learn more at www.hitsp.org or contact . . .
Michelle Deane, ANSI mmaasdeane_at_ansi.org Re
HITSP, its Board and Coordinating Committees
Allyn Clemons, HIMSS Theresa Wisdom, HIMSS
aclemons_at_himss.org twisdom_at_himss.org

Re HITSP Technical Committees
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