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Standards Analysis Summary. vMR Pros Designed for computability Compact Wire Format Aligned with HeD Efforts Cons Limited Vendor Adoption thus far Represents an additional required format for EHRs. Standards Analysis Summary (cont.). CDA (C-CDA & QRDA) Pros

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standards analysis summary
Standards Analysis Summary
  • vMR
    • Pros
      • Designed for computability
      • Compact Wire Format
      • Aligned with HeD Efforts
    • Cons
      • Limited Vendor Adoption thus far
      • Represents an additional required format for EHRs
standards analysis summary cont
Standards Analysis Summary (cont.)
  • CDA (C-CDA & QRDA)
    • Pros
      • Well specified for various use cases
      • Established Vendor Basis
      • Aligned with MU
    • Cons
      • Difficult for computability
      • Expensive wire format
standards analysis conclusion
Standards Analysis Conclusion
  • Conclusion
    • Not likely to be able to recommend a single format
    • Should provide a solution that allows flexibility in payload formats, but still enables interoperability
proposed ig outline
Proposed IG Outline
  • DSS Profile for CDS Request
  • DSS Profile for CDS Response
  • Container Profile for CDS Request
  • Container Profile for CDS Response
  • Payload Format Guidance
    • Data Requirements
    • Interaction Types
  • Modular Transport Options
dss profile
DSS Profile
  • DSS Profile for CDS Request
  • DSS Profile for CDS Response

For each, either a single, general profile or one profiled for each functional interaction type, if necessary

container profile
Container Profile
  • CDSInput
    • vMR Container
    • Extended w/ additional context as specified in UC2
    • Extended to allow multiple payload formats
  • CDSOutput
    • vMR Container
    • Extended to allow multiple payload formats

For each, either a single, general profile or one profiled for each functional interaction type, if necessary

payload formats
Payload Formats
  • This section would describe supported payload formats (vMR, CDA, QRDA)
  • For each format, describe generally how each type of clinical concept would map into the target format
    • This effort would leverage the Value Sets & Terminologies work, basically defining how to express each clinical concept in the terminology space in each format
data requirements
Data Requirements
  • Mapping between clinical concepts, data requirements, payload standards, and vocabulary/terminology bindings for all 225 data requirements specified in Use Case 2
  • This section would describe the formal mechanism for expressing data requirements for a particular exchange
  • Each exchange would be represented by a set of data requirements, where each data requirement includes:
    • Clinical Concept (Encounter, Problem, Procedure, etc.)
    • Value Set (A specific value set identifying codes)
    • Date Range (A date range, relative to the time of the request)
    • Number needed (e.g., collect X of most recent in timeframe)
interaction types
Interaction Types
  • A section for each functional interaction type, where each section includes:
    • Data Requirements, using the formal specification described above
    • Mapping for each of those requirements into a specific format for this functional interaction type.
      • This would involve selection of a specific C-CDA document type, QRDA CDA template, or vMR template, as well as potentially further constraints on those specifications as appropriate
interaction types cont
Interaction Types (cont.)
  • Proposal is to select the most broadly applicable functional interaction types, along with the most appropriate payload format for each type to use as examples, for example:
    • Disease Management – C-CDA, History & Physical
    • Quality Measurement – QRDA, specific template
    • Immunization – vMR, specific template
transport format
Transport Format
  • Recommend DSS Release 1
    • SOAP vs REST can be addressed as an additional profile for DSS
      • This effort may be part of DSS Release 2, or may be part of the HeD UC2 IG
cds request options for functional interaction types
CDS Request Options for Functional Interaction Types

Functional Interaction Type A: vMR

Request Service: DSS Request Element

Request Service: DSS Request Element

Request Service: DSS Request Element

Request Items Organizer/Container: vMR

Request Items Organizer/Container: vMR

Request Items Organizer/Container: vMR

Request Item Payload: vMR Clinical Statement

Request Item Payload: QRDA

Request Item Payload: CCDA

Functional Interaction Type B: QRDA

Functional Interaction Type C: CCDA

slide13

Overview of Process to Develop Specific Functional Interaction Type Guidance

Determine Functional Interaction Type

Determine Data Elements for Functional Interaction Type

Select Standard

(vMR,CCDA, QRDA)

Begin

Update/Constrain template

Select template(s) by leveraging mapped data elements

What is selected Standard?

Include Mapped Data Elements into Selected Standard

CCDA,QRDA

vMR

Select template(s) by leveraging mapped data elements

Create vMR data profile by leveraging mapped data elements

Document as Implementation Guide