EHR SD RM           SAIF Alpha Project
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EHR SD RM SAIF Alpha Project “EHR System-Design Reference-Model”. Constructing a Future State EHR Reference Architecture EHR Way Ahead Business Architecture From HL7, HITSP and ARRA Artifacts For presentation at HL7 Sydney Workgroup Meeting, 11 Jan 2011

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Please send suggestions for improvement to nancy orvis tma osd mil govprojects

EHR SD RM SAIF Alpha Project

“EHR System-Design Reference-Model”

Constructing a Future State

EHR Reference Architecture

EHR Way Ahead Business Architecture

From HL7, HITSP and ARRA Artifacts

For presentation at HL7 Sydney Workgroup Meeting, 11 Jan 2011

Practical Guide:http://hssp.wikispaces.com/PracticalGuide

EHR SD RM info: http://hssp.wikispaces.com/Reference+Architecture

Please Send Suggestions for Improvement to

[email protected], GovProjects;

[email protected], EHR, SOA, ArB


Objective of this presentation is to discuss the following next step questions

Objective of this Presentation is toDiscuss the Following Next Step Questions …

  • How should the EHR-SD RM be represented?

    • Hypothesis: XML DB, DITTA documentation

  • Use cases for EHR-SD RM use?

    • Ad Hoc Reporting needs

    • Web based tools needs

    • Profile needs (e.g., domain adaption vs. local use adaption)

  • How to ballot the EHR-SD RM?

    • Part of EHR-S FM R2.1

    • Independent of EHR-S FM

  • Who will Participate?

    • Information Model sub-project

    • XML/XSL Technical expert

    • Subject Matter Experts (e.g., diabetes, Immunization, etc.)


Ehr sd rm milestones

EHR SD RM Milestones

2008

2009

2010

2011

Healthcare SOA Reference Architecture

(H-SOA-RA)

EHR SD RM Immunization & Response Management (IRM) Prototype

May

HSSP Practical Guide for SOA in Healthcare Volume II: Immunization Case Study

May

EHR-S FM R2.0

With

EHR SD RM Informative Reference

Sep

EHR SD RM Integrated into

EHR-S FM

R2.1

DSTU is Draft Standard for Trial Use (ANSI standards development)

EHR-S CI-IM is EHR System Computationally Independent Information Model

HF&EA is Harmonization Framework and Exchange Architecture


2008 healthcare soa framework based on hl7 ehr system functional model thomas erl s soa layers

2008 Healthcare SOA FrameworkBased on HL7 EHR System Functional Model & Thomas Erl’s SOA Layers

3


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HL7 EHR System Functional Model (EHR-S)> 160 System Functions in 4 level categorization(separate spreadsheet available for full enumeration)

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).

System Functions

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.


Anatomy of an ancillary system

ANATOMY OF AN ANCILLARY SYSTEM

Capabilities, which orchestrate Core Business Services

LABORATORY

RADIOLOGY

PHARMACY

CARDIOLOGY

OT/PT/SPEECH

IDENTITY

TERMINOLOGY

AUTHORIZATION

SCHEDULING

CORE BUSINESS SERVICES

SUPPLY CHAIN (ORDER/CHARGE)

DOCUMENT

RECORDS MANAGEMENT

s

DECISION SUPPORT

PERFORMANCE

DATA MANAGEMENT

5


Hl7 ehr s based functional architecture services analysis

HL7 EHR_S-Based Functional Architecture/Services Analysis

Primary Care

Critical/Emergency Care

Laboratory

Pharmacy

Dental

Non-Surgical Specialty Care

Nursing

Behavioral Health

ETC.

Population Health

ETC

Manage Business Rules

Infrastructure

Functions

Interoperability

  • Infrastructure

  • Services

  • Security

  • Policy

  • Records Management

  • Audit

  • Terminology

  • Registry

  • Workflow

  • Business Rules

  • etc

Terminology

Unique ID, Registry, and Director

Information and Records Management

Security

Lines of Business

Record Management

Manage Patient History

  • Core Clinical

  • Services

  • Entity Identification

  • Resource Location and

  • Updating Services

  • Decision Support

  • Orders Management

  • Scheduling

  • Image Management

  • Etc.

Preferences, Directives, Consents, and Authorizations

Summary Lists

Management of Assessment

Cross-Cutting Direct Care/

Support Functions

Care Plans, Treatment Plans, Guidelines, and Protocols

Orders and Referral Management

Documentation of Care, Measurement, and Results

Record Patient Specific Instructions

Clinical Decision Support

Clinical Workflow Tasking

Support Clinical Communication

Support Knowledge Access

ETC

6


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EHR System Design Reference Model (EHR SD RM)

Supporting Requirements/ Architecture Development Cycle

PROCESS INPUTS

-Required Capabilities

-Environments

-Constraints

EHR

System Design

Reference Model

Capabilities, Functions,

Information and

Information Exchanges

Stakeholder

Requirements

Definition

Functions –

Dependencies

Conformance

Criteria

Conformanceis a recognition of formal testing, that prove that a system provides 100% support for a given standard.

Requirements

Loop

Interface

Specifications

Requirements

Analysis

Test

Specifications

Specifications

Loop

Architectural

Specifications

Verification & Validation

Loop

Test

Loop

PROCESS OUTPUTS

-System Architecture,

-Test Specifications

-Configuration Management Baselines

7


Ehr sd rm supporting requirements architecture development cycle

EHR SD RM Supporting Requirements/ Architecture Development Cycle

Stakeholder Requirements

Whatis the system supposed to do?

Under what conditions will the products be used?

Where will the products of the system be used?

How often? How long?

Who will use the products of the system?

Requirements Analysis (“HOW?” using “Action Verbs”)

Analyze functions and Services

Decompose higher level functions to lower level functions

Allocate performance requirements to the functions

Architecture Design (Whichhardware/ software elements)

Define the physical architecture

Each part must perform at least one function

Some parts may perform more than one function

Test Specifications

How Requirements-Specifications are validated

Requirements Loop

  • Ensure all requirements are covered by at least one function

  • Ensure all functions are justified by a valid requirement (no unnecessary duplication)

    Design Loop

  • Ensure all functions are covered by at least one hardware or software element

  • Ensure all elements of physical architecture are justified by a valid functional requirement (no unnecessary duplication)

    Verification & Validation (V&V) Loop

  • Each requirement must be verifiable that the solution meets requirements and validated that it meets the user’s needs and expectations.

  • V&V can be accomplished by: Inspection, Analysis, Demonstration, Test

    Test Loop

  • Ensure all information is covered by test specifications

  • Ensure all interfaces are covered by test specifications

8


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2010 SAIF Alpha ProjectThe Practical Guide For SOA in Healthcare Volume IIImmunization Management Case Study

The Practical Guide for SOA in Healthcare Volume II presents a case study, which adds an Immunization Management Capability (IMC) to Volume I’s SampleHealth’s Service Oriented Architecture (SOA). We used the TOGAF Architecture Development Method (ADM) and HL7 Service Aware Interoperability Framework (SAIF) Enterprise Conformance and Compliance Framework (ECCF). Volume II demonstrates the use of HL7’s EHR System Design Reference Model (EHR-SD RM) linked artifacts (e.g., EHR System Functional Model, FHIM, HITSP, HITEC, HSSP, IHE, NIEM, etc) to provide an initial architectural baseline suitable for an EHR related SOA acquisition, development or certification project. We conclude with lessons learned.

Healthcare Services Specification Project (HSSP) Practical Guide:

  • http://hssp.wikispaces.com/PracticalGuide


Saif eccf examples

SAIF ECCF examples


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Example of SAIF Traceability

Using HL7 EHR-S FM

Business Viewpoints

Conceptual Independent Model

Platform Independent Model

Platform Specific Model

Information Viewpoints

Conceptual Independent Model

Platform Independent Model

Platform Specific Model

FMIDs

FMIDs

Engineering/Technical

Viewpoints

Conceptual Independent Model

Platform Independent Model

Platform Specific Model

Behavioral

Viewpoints

Conceptual Independent Model

Platform Independent Model

Platform Specific Model

FMIDs

FMIDs

EHR-S FM

FMIDs

Investment Portfolio

Line Items

Planning budget for new, improved or sunset capabilities

Product Line Inventory

Inventory of systems and their capabilities and Functions

FMIDs

Key to Traceability

Traceability is achieved by using Functional Model Identifiers (FMIDs) as attributes to all SAIF artifacts.

This is analogous to a library system, which uses Dewey decimal numbers as book identifiers.


Immunization management eccf specification stack

Immunization Management ECCF Specification Stack

12


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Implement

& Test

Initiation

SAIF ECCF -

Services Aware Interoperability Architecture -

Enterprise Compliance and Conformance Framework

EHR-S FM &

EHR-S CI-IM

EHR System Function Model & EHR System Computationally-Independent Information-Model

V&V

Checkpoint

Peer

Review

“Ballot”

Analysis

V&V

Checkpoint

V&V

Checkpoint

HL7 Development Framework (HDF)

DSTU - Draft Standard for Trial Use “Prototype”

Draft Working Document; Not for Public Distribution

  • Specifications for

  • Business Objects

  • Components

  • Capabilities

  • Applications

  • Systems

DAM Domain Analysis Models

CDA Clinical Document Architecture

CMET Common Model Element Types

D-MIM Domain Message Information Model

Design

  • Interoperability Specifications for

    • Messages and/or

    • Documents and/or

    • Services

V&V Checkpoint

14

V&V is Verification and Validation


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Interoperability

Specification

ECCF

SAIF ECCF

Viewpoints

CIM

PSM

CIM is Computationally Independent Model

PIM is Platform Independent Model

PSM is Platform Specific Model

Draft Working Document; Not for Public Distribution

PIM

15


Ehr s ci im started jun 2010 ehr system computationally independent information model

EHR-S CI-IM (Started Jun 2010)EHR System Computationally-Independent Information-Model

This project will produce a set of Constrained Information Models called EHR-S “data profiles”. Each EHR-S data profile corresponds directly with an EHR-S function profile and each EHR-S data profile will include one-or-more Reference Information Model classes. Pairs of EHR-S function profiles and data profiles can be used to define business objects, which can be composed into software components, capabilities, applications, systems and their message exchanges and/or document exchanges and/or services. The superset of EHR-S data profiles is called the EHR-S Computationally-Independent Information-Model, which supports the HL7 Development Process and Service Aware Interoperability Framework. The project will include the development and execution of a communication strategy to ensure that all affected stakeholders are engaged.


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HL7 RIM (Reference Information Model)Six Core Classes Defining a Semantic Framework whichMaintains Clinical Data Context

ACT (aka ACTION)

ENTITY

ROLE

Participation

Role link

Act relationship

ACT – something that has happened or may happen

Entity – a person, animal, organization, or thing

Role – a responsibility of, or part played by, an Entity

Participation – the involvement of a Role in an Act

Act Relationship – a relationship between two Acts

Role Link – a relationship between two Roles.

The HL7 RIM expresses the data content needed in a specific clinical or administrative context and provides an explicit representation of the semantic and lexical connections that exist between the information carried in the fields of HL7 messages.

Language /

communication

The HL7 RIM supports EHR interoperability; an EHR may needs additional foundation classes (e.g., Responsibility)


Federal health information model fhim person model harmonized with rim hipaa hitsp

Federal Health Information Model (FHIM) Person Model (Harmonized with RIM, HIPAA & HITSP)


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HL7 EHR System Computationally-Independent Information-Model

(EHR-S CI-IM) Project

Draft Working Document; Not for Public Distribution

EHR-S CI-IM

RIM Classes

Entity a.b.c

EHR-S Data Modules

EHR-S FM

Entity d.e.f

1:1

Relationship between

Function Profiles

and

Data Profiles

For each EHR-S Function, its Data Profile = Set of RIM Classes and their EHR-S Data Modules

1:N

Relationship among

Data Profiles

and

RIM

Classes

Role a.b.c

EHR-S Data Modules

DC x.y.z EHR-S Function Profile

Role d.e.f

Act a.b.c

EHR-S Data Modules

Act d.e.f

SC x.y.z EHR-S Function Profile

Act Relationship a.b.c

EHR-S Data Modules

Act Relationship d.e.f

IN x.y.z EHR-S Function Profile

Role Link d.e.f

Role Link a.b.c

EHR-S Data Modules

Participation d.e.f

DC is Direct Care

SC is Supportive Care

IN is Infrastructure

Participation a.b.c

EHR-S Data Modules


Ehr sd rm status oct 2010

EHR SD RM Status (Oct 2010)

  • Supporting EHR System Functional Model R2

    • EHR SD RM foundation (linked XML version) Spring 2011 ballot

    • HITSP (2010 completion)

    • ARRA Meaningful Use Objectives/ Criteria (Jun 2010 Final Rule)

  • Sub Projects

    • EHR Computationally Independent Information Model

    • Harmonization Framework and Exchange Architecture

      • SAIF Executive Summary and Implementation Guide

      • http://hssp.wikispaces.com/PracticalGuide


Prototype demonstration of browser version xml with xsl xslt html style sheet

Prototype Demonstration of Browser-Version XML with XSL & XSLT  HTML Style Sheet

  • EHR-S FM R1.1 linked to

    • US Meaningful Use Objectives and Criteria

    • US Mandated Standards

    • Information Model (TBD)


Ehr sd rm issue questions

EHR SD RM Issue/Questions

  • 2011 Planned Representation (Better Options?)

    • Linked XML (most flexible for documentation, current preference)

      • EHR–S FM (R2) and it’s profiles (2011)

        • ISSUE: Managing Profiles

        • ISSUE: Tracking Changes / Comments

        • ISSUE: Managing HL7 Domain Analysis Models (DAMS)? and

        • ISSUE: Managing Detailed Clinical Models (DCMs)?

        • ISSUE: DITTA Publishing? (Resources needed)

        • ISSUE: Data Base / Web version? (Resources Needed)

      • EHR CI-IM - Computationally Independent Information Model

        • ISSUE: RIM/RIMBA expertise needed

      • US HITSP (2010)  Health & Human Services Selected Standards

      • US ARRA MU Meaningful Use Objectives & Criteria (2010)


Call for participation

Call for Participation

  • XSL style sheet expert for

    • EHR-S FM R2

    • EHR-S FM R2 with EHR SD RM additions

    • Profiles

    • Comment/Change tracking

  • EHR Computationally Independent Information Model

    • Decomposed by EHR-S FM

    • Traceable to RIM


Contact information

Contact Information

Nancy Orvis

Chief Integration Architect

Information Management

DoD Military Health System

Email: [email protected]

Steve Hufnagel

Enterprise Architect, TIAG contract support

Information Management

DoD Military Health System

Email: [email protected]

HOW TO PARTICIPATE:

Coordinate with [email protected], 703-575-7912-cell.

We have a weekly telecom each Friday 1230-1330 Eastern

PHONE: +1 770-657-9270, CODE: 071582#WEB LINK: http://my.dimdim.com/hssp

PROJECT WIKI: http://hssp.wikispaces.com/Reference+Architecture

Backup Slides Available at Web Site

24


Immunization management case study questions

Immunization Management Case StudyQuestions?

[email protected]

[email protected]

[email protected]

[email protected]

HOW TO PARTICIPATE:

Coordinate with [email protected], 703-681-3929 or 703-575-7912-cell.

We have a weekly telecom each Friday 1230-1330 Eastern

PHONE: +1 770-657-9270, CODE: 071582#WEB LINK: http://my.dimdim.com/hssp

PROJECT WIKI: http://hssp.wikispaces.com/Reference+Architecture


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