Health eDecisions RI/ Pilots Sub-Workgroup

1. Health eDecisionsRI/ Pilots Sub-Workgroup June 10th, 2013

2. Agenda • Announcements • Review and Revisit of Goals • Review of RI/Pilot Sub-WG Timeline • Pilot Updates: • Zynx/DesignClinicals – Order Sets • Findings and Discussion • AllScripts and NewMentor (Million Hearts – MU NQF 68) • VA and Wolters Kluwer - Demo • CDC and Allscripts • Review of Use Case 2 Functional Interactions • Review Implementation Guide • Review Action Items, Next Steps

3. Announcements • We will be reviewing the IG in our next 2 workgroup Meetings • We need to plan an “Open House” to display our pilots work • July 8th?

4. Pilots

5. Support Team • Support Team: • Pilots Lead: Jamie Parker: jamie.parker@esacinc.com • Support: Ali Khan: Ali.Khan@esacinc.com • Subject Matter Expert: Aziz Boxwala: aziz.boxwala@meliorix.com • Subject Matter Expert: Bryn Rhodes: bryn@veracitysolutions.com • Use Case 1: Dave Shevlin: d.s.shevlin@accenturefederal.com • Implementation Guide: Lynette Elliot: lynettte.elliott@esacinc.com • SDO Support: Anna Langhans: anna.langhans@accenture.com

6. HeD Pilots Goal • Goal • The goal of this initiative is to produce, consume and where feasible, execute implementable CDS interventions. • Event Condition Action Rules (ECA Rules) • Order Sets • Documentation Templates • Pilot Scope • Health eDecisions will apply defined aspects of the Implementation Guide in a real-world setting. • Modify the Implementation Guide to ensure it is usable • Submission of explicit feedback to sub workgroups such as vMR and vocabulary and terminology to close gaps • The real-world pilots evaluate not only the technology, standards and model (VMR), but also provide a test bed to evaluate the interaction of technology, implementation support, and operational infrastructure required to meet Health eDecisions use case 1 objectives at the stakeholder or organization levels. • Demonstrate intent of artifact (specifically structures and semantics) are communicated either by direct execution or by translation to native format • Ensure Completeness and consumability of artifact

7. Timeline We are Here

8. Vendor Engagement Discussion

9. Pilot Updates: Zynx – DesignClinicals (Order Set- Heart Failure ) • Team: • Claude Nanjo and Victor Lee Zynx • Dewy Howell – DesignClinicals • Status • What we learned • How to capture that in the IG

10. Pilot Updates: NewMentor – AllScripts (ECA Rule Million Hearts –NQF 68) • Team: • Julie Scherer - NewMentor • Bryn Rhodes – Internal Support • Robin Williams – AllScripts • Team Meetings • Status: • Notes on the IG • Notes on the Vocab Work

11. Pilot Updates: Wolters Kluwer – VA (Documentation Template) • Team: • Christy May -Wolters Kluwer • ???? – Internal • Ken Kawamoto - VA • Robert – Lario - VA • Status: - DONE ….DEMO!!!! • Notes on the IG • Notes on the Vocab and Terminology Work • ENM Code issue (maybe include them in LOINC) • Follow up with Mark (examples are in the UTI template – send to LOINC folks) • Tracking sheet has been created to track these follow up issues through the vocab and term group

12. Pilot Update: CDC – AllScripts (ECA Rule) – 99% • TEAM: • Shu McGarvey - CDC • Aziz Boxwala – Internal Support • Bryn Rhodes- Internal Support • Manoj Sharma- AllScripts Technical guru • Status • Expected Completion Date • Shu to provide value sets for the Labs (general culture) • We are only piloting the Clinical Rule not the Lab Rule (for stand alone labs) • HL7 – act/relationship value sets (work with Terminology team to get this done - • Notes on the IG • Notes on the Vocab Work

13. Pilot Updates: Zynx – DesignClinicals (Order Set- Heart Failure ) • Team: • Claude Nanjo and Victor Lee Zynx • Dewy Howell – DesignClinicals • Status • Expected Completion Date? • Notes on the IG • Notes on the Vocab and Terminology Work

14. Working Session on the UC 1 IG: • http://wiki.siframework.org/HeD+Pilot+Tools

15. HeD UC2 Solution Plan • Create implementation guidance that leverages vMR as the base model but is aligned with C-CDA and QRDA (semantics, terminologies, and templates) to the highest extent possible. • Solution will be to update the vMR model to align with the semantics of C-CDA and QRDA to the extent possible and reasonable • vMR is a streamlined data model for CDS. This model is at a similar level of granularity to models such as Green CDA

16. HeD UC2 Solution Plan This approach supports vMR as the payload standard with mappings to CCDA and QRDA Request Service: DSS Request Element Request Items Organizer/Container: vMR CDS Request Request Item Payload: vMR Clinical Statement vMR Payload CDS Response Response Service: DSS Response Element HeD Schema/vMR Response Items Organizer/Container: Harmonized vMR/HeD Schema Response Item Payload: vMR Clinical Statements

17. HeD UC2 Solution Plan • We will utilize templates to guide the IG development and Functional Interaction Types as examples • vMR templates will be used as building blocks of data that are coordinated to meet template requirements • The Functional Interaction Types will be the examples that use the building blocks • Leverage pilots from UC1 for functional interaction types

18. Potential Functional Interaction Types • Disease Management • Drug Dosing Calculation • Immunization Forecasting • Quality Measure Evaluation • Transition of Care Support • Prediction Rule Evaluation – APACHE score, AHRQ Pneumonia Severity Index, etc. • Severity of Illness Assessment – Charlson index, etc. • Which functional interaction types best align with current pilot efforts? • Which types would be the most straight forward to test? • Which types would best validate the HeD UC2 solution, or be the most widely used in the industry?

19. Pilot Support Tools and Feedback channels • Discussion Board: • http://wiki.siframework.org/HeD+Pilot+Activities#HeD_Pilot_Discussion • Vocabulary and Terminology Feedback: • http://wiki.siframework.org/HeD+Pilot+Tools

20. Action Items & Next Steps • Continue to work on the IG • Begin to step through the UC 1 IG based on Pilot activities • As needed and necessary we will be discussing issues and challenges during the pilot activities • Update the IG • Update the Vocabulary and Terminology work • Identify additional support resources if necessary • Prepare for our HeD Pilots “open house” • July 8th???

21. Meeting Reminder • Pilots Work stream meets (next meeting: June 24th, 2013) • Every Monday • 1-2:30 pm EDT See Wiki homepage for meeting details: http://wiki.siframework.org/Health+eDecisions+Homepage

22. Appendix A: Success Criteria • NOTE: This is a work –in-progress we will need to re-evaluate this after Pilot Project Plans • Discuss Pilot Success Criteria: • Individual Criteria • Initiative Criteria • EHR Involvement - DONE • Production (at least one of each artifact and consumption of those artifacts) • Addressed as part of the Pilot Project Plans (who will be doing which artifacts) • Successful implementation of artifacts • EHR involvement • Validate artifact – perhaps Pilots focuses on this ? • Execute the artifact • Cross initiative function • Potential Alignment with eDOC and esMD • SDC • Alignment with MU 3 objective • 10% knowledge based engine (align 402b) • ACTION ITEM: Review MU3 Criteria • Determine the delivery model we want to pilot • External (i.e. cloud service) • Assets are portable (can be run locally) • Discuss this with the group

23. Appendix B • In Scope/Out of Scope

24. Scope of Use Case 1 • This Use Case defines the requirements to build a standard for the contents of CDS Knowledge artifacts.  The use case focuses on the following artifact types: Event Condition Action (ECA) Rules, Order Sets, and Documentation Templates. To support this purpose the Use Case has one scenario:  A CDS Knowledge Artifact Supplier makes computable CDS Knowledge Artifact available to CDS Artifact Integrator (From HeD Use Case: CDS Artifact Sharing)

25. In Scope • Standards to structure medical knowledge in a shareable and executable format for use in CDS • In Scope Artifact Types (definitions for these artifact types can be found in Appendix A) • Event Condition Action Rules • Order Sets • Documentation Templates

26. Out of Scope • Tools: • Authoring tools, source “content” management. • Terminology server and mapping tools including management of concept coordination. • Semantic processing of text, including structured string processing and natural language processing. • System Functions • Messaging Layer • Means of sharing • Security • Authoring, creation and maintenance of clinical decision support knowledge • Knowledge Repository Design • Search and query mechanisms • Implementation in systems • User presentation, Transport layers • Market factors: regulatory incentive/mandate, liability shield, IP shield (patent/licensing litigation), certification body, marketplace design, test procedures, FDA rules • Clinical Decision Support Services (this will be covered in Use Case 2 CDS Guidance Services) • CDS Content Development Activities, including the distribution and sharing of artifacts • Context-Aware information retrieval (HL7 Information Button) – This will be covered in UC 2 (CDS Guidance)

27. Pre and Post Conditions • Pre-Conditions • CDS Artifact Supplier makes CDS artifacts available for search and consumption by CDS Artifact Integrators _ ACTION ITEMS (Clarify this –what is a precondition for this to be useful) • CDS Artifact integrator has the means to obtain the knowledge artifact from a CDS Repository (e.g. they have either browsed or queried the CDS Repository for available artifacts) • CDS Artifact Integrator Selects Artifacts of Interest to Use in their CDS System • Post Conditions • The CDS Knowledge Artifact Supplier has sent the CDS Knowledge Artifact to the requesting CDS Artifact Integrator • CDS Artifact has been received by CDS Integrator and is available for processing • CDS Artifact is available for mapping, structural transformations and local adaptation • Strategy Decision: In the pilot activities we will not directly address these as part of our pilot. We will focus the pilot activities on those tasks which occur between the pre and post condition