IHE's contribution to standards harmonization for the NHIN

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IHE's contribution to standards harmonization for
the NHIN
Joyce Sensmeier MS, RN, BC, CPHIMS, FHIMSS Vice
President, Informatics, HIMSS Didi
Davis Director, IHE, HIMSS
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U.S. Efforts Supporting the NHIN

• There are many industry-wide efforts supporting
  the future viability and success of the NHIN
• AHIC Public-Private Effort coordinating
  interoperability framework
• HITSP Release of 30 standards in 3
  Interoperability Specifications
• HISPC State-level Security and Privacy
  Harmonization
• CCHIT EHR and NHIN Infrastructure Certification
• NCVHS Consolidated Minimum Functional NHIN
  Requirements
• IHE Global initiative creating a framework for
  exchanging health information seamlessly
• State Health Alliance for eHealth
• Other standards body organizations work efforts
• ..All to be accomplished in a phased
  approached

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The Community is the hub that drives
opportunities for increasing nation wide health
information interoperability

• AHIC, chaired by HHS Secretary is the strategic
  coordination
• CCHIT focuses on developing a mechanism for
  certification of health care IT products
• HITSP brings together all relevant stakeholders
  to identify appropriate IT standards
• HISPC addresses variations in business policy and
  state law that affect privacy and security
• NHIN is focused on interoperability pilots

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First Round of Standards Harmonization

• AHIC breakthroughs
• Use cases
• Context
• Processes
• Data
• HITSP
• Harmonization of standards
• Gaps and needs
• Specificity as to how to use the standard in
  implementation level guidance Interoperability
  Specifications

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Standards Harmonization

• Develop, prototype, and evaluate a harmonization
  process for achieving a widely accepted and
  useful set of standards targeted specifically to
  enable and support widespread interoperability
  among health care software applications,
  particularly EHRs.

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HITSP Framework Basis for Interoperability
Specification Development

• HITSP receives Use Cases and Harmonization
  Requests from external sources, such as AHIC and
  ONC.
• The Use Case or Request defines scenarios,
  business actors, and business and
  functional/interoperability requirements.
• HITSP develops Interoperability Specifications
  supporting the UseCases technical actors,
  transactions, content and terminology.
• HITSP identifies constructs which are logical
  groupings of base standards that work together,
  such as message and terminology.
• These constructs can be reused like building
  blocks.
• While reuse is a HITSP goal, it is established in
  the context of a use case and its
  functional/interoperability requirements.
• HITSP constructs are version controlled and, if
  reused, will be uniquely identified.

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The HITSP process results in creation of
Interoperability Specifications used to promote
nationwide interoperable health information
exchange
Impact
ReceiveRequest
I Harmonization Request
II RequirementsAnalysis
III Identificationof CandidateStandards
IV Gaps,Duplicationsand Overlaps Resolution
V Standards Selection
VI ConstructionofInteroperabilitySpecification
VII InspectionTest
VIIIInteroperabilitySpecificationReleaseandD
issemination
IX Program Management
BeginSupport
Harmonization Process Steps
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Breakthrough Areas
HITSP Focus

• 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 and anonymized format to authorized
  public health agencies with less than one day lag
  time.
• Consumer Empowerment -- Deploy to targeted
  populations a pre-populated, consumer-directed
  and secure electronic registration summary.
  Deploy a widely available pre-populated
  medication history linked to the registration
  summary.
• Electronic Health Records -- Deploy
  standardized, widely available, secure solutions
  for accessing laboratory results and
  interpretations in a patient-centric manner for
  clinical care by authorized parties.
• Chronic Care Ensure that widespread use of
  secure messaging, as appropriate, is fostered as
  a means of communication between clinicians and
  patients about care delivery

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The three HITSP Technical Committees have
published Interoperability Specifications in
October 2006
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HITSP Recommended Standards

• Biosurveillance
• ICD-9CM International Classification of
  Diseases v. 9 Clinical Modifications
• ICD-10 CM Diagnoses and Procedures
• IHE-XDS Integrating the Healthcare Enterprise
  (IHE) Cross-Enterprise Document Sharing
• IHE-XDS Lab IHE Laboratory Report Document
  Sharing
• IHE-RFD IHE Retrieve Form for Data Capture
• IHE-PIX IHE Patient Identification
  Cross-Referencing
• IHE-RAD XDS-I IHE Cross-Enterprise Sharing of
  Images
• IHE-NAV IHE Notification of Document
  Availability
• IHE-XDS-MS IHE Medical Summary Document Sharing
• ISO/TC215 -DTS 25237 - Health Informatics
  Pseudonymisation
• LOINC Logical Observation Identifiers Names and
  Codes
• NCCLS National Committee for Clinical
  Laboratory Standards
• RxNorm National Library of Medicine RxNorm

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HITSP Recommended Standards

• Consumer Empowerment
• IHE-XDS Integrating the Healthcare Enterprise
  (IHE) Cross-Enterprise Document Sharing
• IHE-PIX IHE Patient Identification
  Cross-Referencing
• IHE-PDQ IHE Patient Demographics Query
• Health Level Seven (HL7) CDA R2 HL7 Clinical
  Document Architecture Release 2
• HL7 CCD HL7 Clinical Document Architecture
  Release 2 and ASTM E 2369-05 Standard
  Specification for Continuity of Care Record (CCR)
• HL7 v. 2.5
• HL7 EHR Systems Functional Model Draft Standard
  for Trial Use (DSTU)
• Logical Observation Identifiers Names and Codes
  (LOINC)

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HITSP Recommended Standards

• Electronic Health Record Exchange
• IHE-XDS Lab IHE Laboratory Report Document
  Sharing
• IHE-PIX IHE Patient Identification
  Cross-Referencing
• IHE-PDQ IHE Patient Demographics Query
• Health Level Seven (HL7) CDA R2 HL7 Clinical
  Document Architecture Release 2
• HL7 v. 2.5
• Clinical Laboratory Improvement Amendments (CLIA)
• Logical Observation Identifiers Names and Codes
  (LOINC)
• Health Insurance Portability and Accountability
  Act (HIPAA)
• Systematized Nomenclature of Medicine Clinical
  Terms (SNOMED CT)
• Unified Code for Units of Measure (UCUM)

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Compliance with US National Health Info
NetHITSP Interoperability Specs and CCHIT Roadmap
Clinical and PHR Content
Security
Patient ID Mgmt
Emergency Referrals
PHR Extracts/Updates
Format of the Document Content and associated
coded vocabulary
Basic Patients Privacy Consents
Patient Demographics Query
ECG Report Document
Format of the Document Content and associated
coded vocabulary
Lab Results Document Content
Establish Consents Enable Access Control
Format of the Document Content and associated
coded vocabulary
Scanned Documents
Patient Identifier Cross-referencing
Format of the Document Content and associated
coded vocabulary
Imaging Information
Format of the Document Content
Medical Summary (Meds, Allergies, Pbs)
Format of the Document Content and associated
coded vocabulary
Map patient identifiers across independent
identification domains
Document Digital Signature
Format of the Document Content and associated
coded vocabulary
Attesting true-copy and origin
Health Data Exchange
Audit Trail Node Authentication
Cross-Enterprise Document Sharing
Centralized privacy audit trail and node to node
authentication to create a secured domain.
Registration, distribution and access across
health enterprises of clinical documents forming
a patient electronic health record
Consistent Time
Cross-Enterprise Document Media Interchange
Coordinate time across networked systems
Cross-Enterprise Document Reliable Interchange
Accepted by HITSPCCHIT in 2006
Candidates for HITSPCCHIT in 2007
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Emergency Responder Use Case

• Under the leadership of the Office of the
  National Coordinator for Health Information
  Technology, an Emergency Responder Use Case has
  been developed and prioritized for the attention
  of the HITSP and the other ONC initiatives.
• The Use Case describes the role that an Emergency
  Responder Electronic Health Record, comprising at
  a minimum demographic, medication, allergy and
  problem list information, that can be used to
  support emergency and routine health care
  activities.

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HITSP GOALS and IHE

• HITSP goals with respect to testing activities
• Ensure 'fitness for use' of HITSP
  Interoperability Specifications
• Has relationship with IHE that developed/maintain
  standards/profiles used in HITSP Interoperability
  Specifications to help overall collaborative
  testing activities
• HITSP collaboration with IHE
• 8 IHE Profiles are contained in HITSP
  Interoperability Specs.
• IHE Connectathon/HIMSS Showcase provide
  opportunity for collaboration to meet mutual
  goals
• HIMSS07 Interoperability Showcase Demonstration
• To access HITSP Interoperability Specifications
• www.hitsp.org

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IHE and HITSP

• HITSP has specified interoperability standards
  for three use cases - 8 IHE profiles used.
• EHR-Access to Lab results
• Historical Results XDS NAV XDS-Lab PIX
  PDQ
• Lab to Ordering Provider HL7 V2.5 msg with some
  differences with Lab-3 transaction from LSWF.
• Consumer Empowerment
• Doc Sharing XDS PIX PDQ
• Reg/Med History Not finalized but will be
  CDA/CCD. XPHR-TI version to be aligned on CCD
  when final is on the HITSP path.
• BIO Surveillance
• Doc Sharing track XDS, XDS-Lab, XDS-I, XDS-MS
• Anonymization PIX PDQ (with extensions)
• Capture RFD
• Message track, no use of IHE profiles

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HHS Health IT Strategy
American Health Information CommunityLed by
SecHHS Mike Leavitt
Office of the National CoordinatorProject
Officers
StandardsHarmonizationContractor
ComplianceCertificationContractor
Privacy/SecuritySolutionsContractor
NHINPrototypeContractors
Continuous Interaction with Multiple Public and
Private Stakeholders
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Third Nationwide Health Information Network
ForumJanuary 25 26, 2007

• The NHIN is an integral part of the National
  Health IT Agenda
• The NHIN will use the Internet to connect
  providers, consumers and other stakeholders
• It will need to connect states, regions and non
  geographical health exchanges
• RHIOs and HIEs will need to identify their set
  of services which may be cheaper to buy than
  build
• This is a developing market for service providers
  (Health Information Service Providers)
• ..All to be accomplished in a phased
  approached

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Third Nationwide Health Information Network
Forum Four NHIN Prototypes Demonstration

• The Players
• Accenture
• Computer Sciences Corporation
• IBM
• Northrop Grumman
• And a Consortia of healthcare providers,
  technology vendors and other stakeholders
  supporting these four companies with prototype
  development
• The Prototypes
• Developed under an 18.6 million HHS grant

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Third Nationwide Health Information Network
Forum Four NHIN Prototypes Demonstration

• Prototype Goals
• Develop an architecture and a prototype network
  for secure information sharing among hospitals,
  laboratories, pharmacies, physicians and other
  stakeholders in the participating markets.
• Work to ensure information can move seamlessly
  between each of the four prototype networks, thus
  establishing a single infrastructure among all
  the consortia for the sharing of electronic
  health information.
• Test patient identification, information locator
  services, user authentication, access control,
  other security protections and specialized
  network functions. Test the feasibility of
  large-scale deployment.
• Demonstrate 3 use cases

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Future Steps

• Future steps with the progression of building the
  NHIN will be based on the 3rd Forum demonstration
  results, other third resources and reports such
  as the anticipated Gartner report. Current plans
  include
• Validation of the 4 prototype architectures
  across the NHIN
• Release of Requests For Proposals (RFP) by HHS to
  develop state and regional trial implementations
  in March or April
• Awards to be announced in June or July timeframe
• Opportunities for all stakeholders to join or add
  on to existing prototype development
• Success will be achieved when we engage
  providers, involve consumers, security,
  government, and provide a sustainable funding
  model that establishes trust and provides capable
  business services

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Thank you! Questions? Comments!