1 / 42

EHR Systems Functional Model and Standard

EHR Systems Functional Model and Standard. • Triplets (what + why + criteria) • Hierarchies/Decompositions • Timelines • Open Process Screens • Ballot • Reconciliation 2 July 2003. Functional Decomposition. Functional decomposition Based on a functional hierarchy

sderby
Download Presentation

EHR Systems Functional Model and Standard

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. EHR Systems Functional Model and Standard • Triplets (what + why + criteria) • Hierarchies/Decompositions• Timelines • Open Process Screens • Ballot • Reconciliation 2 July 2003

  2. Functional Decomposition • Functional decomposition • Based on a functional hierarchy • Abstract to specific • EHR Function Specification Triplet • At arbitrary level of decomposition: 3+ (?) • Deemed useful for applicability across functional profiles or conformance measure

  3. EHR Function Specification Triplet • WHATStatement of Function, Functionality • WHYRationale, with references • Conformance Criteria • HOWOut of Scope

  4. Statement of Function - WHAT • Statement of EHR System function(ality) • Final Proposed Form [EHR Systems] “must/should/may” [verb-first function statement] • Considered per care setting • must/shall :: essential • should :: desirable • may :: optional

  5. Core v. profile specific • Core • Deemed essential in all care settings • Deemed desirable in all care settings • Functional Profile Specific • Deemed essential in one care setting and not in another • Deemed desirable in one care setting and not in another

  6. Statement of Function - WHATExample: Care delivery • Example hierarchy, decomposition • L1: Prescribing • L2: Prescription validation • L3: Drug-Disease interaction warnings

  7. Statement of Function - WHATExample: Care delivery (cont.) • Short statement, verb-first • “Warn of drug-disease interactions” • Full statement • “EHRS provide a synchronous warning if a clinician is about to order a medication when the patient has an entry in their problem list which is a contraindication to this medication”

  8. Rationale - WHY • Rationale for inclusion of function(ality) • Utility based – efficiency, workflow • Safety based – prevent medical errors • Outcome based – improved patient outcomes • Empowerment based – patient in a better position to manage their own care • References

  9. Rationale - WHYExample: Care delivery • Prescription validation • Safety • Proven reduction in medication errors • Reference… • Utility • Proven reduced requirement for medication review by other staff (including pharmacist. • Reference…

  10. Statement of Function - WHATExample: Infrastructure • Example hierarchy, decomposition • L1: Security • L2: Entity authentication • L3: User authentication

  11. Statement of Function - WHATExample: Infrastructure (cont.) • Short statement, verb-first • “Ensure user authentication” • Full statement • “EHRS must/should/may ensure user authentication: • at signon, at start of user session; and • throughout user session.”

  12. Rationale - WHYExample: Infrastructure (cont.) • User Authentication example • “To ensure… • “User identity is verified at signon; • “User identity is established for duration of user session; • “Accountable actions can be attributed (traced) to authenticated users, including acts of EHR authorship and amendment.”

  13. Rationale - WHYExample: Infrastructure (cont.) • User authentication references • HIPAA • JCAHO • IOM • ISO 18308, 18307, 21089, 17799 • ASTM E1462, E1467 • …

  14. Conformance Criteria • Method or basis for measuring conformance • Of EHR systems

  15. Conformance CriteriaExample: Infrastructure • User Authentication example • EHRS conforms if user identity • Is actively verified at each signon or session start • (and thus) is actively verified before EHR function(s) or content is accessed • Is maintained for duration of user session

  16. Contribution • Propose functional triplets • Process documents and derive functional triplets • Review functional triplets in an agreed manner and with agreed criteria • Review functional triplets from limited set from the perspective of a care setting

  17. Contribution (cont.) • Join the email lists • Join the Groove collaboration • Lead the Groove collaboration • Others…(Ken)

  18. Proposal for Initial Ballot • Functional Hierarchy and Decomposition (v1.0) • Infrastructure: 3-5 levels • Care delivery: 3 levels • Triplet • What, Why: v1.0 • Conformance Criteria: v1.1, v2…

  19. EHR Ballot Schedule 21 July Draft published: Co-Chairs and Staff 23-24 July EHR SIG Open Meeting Rockville, MD - AHRQ Conference Center Attendees must register, no meeting fee Draft reviewed and vetted

  20. EHR Ballot Schedule, con’t 1 Aug v1.0 ballot opens 1 September v1.0 ballot closes

  21. EHR Ballot Schedule, con’t 9-11 September Memphis, Tennessee Ballot reconciliation HL7 Fall Plenary and Working Group Open meeting Attendees must register w/HL7 and pay meeting fees Sept/Oct Next ballot draft and ballot round…

  22. EHR Roadmap • Now • v1.0 • Draft Standard for Trial Use • 60% consensus needed • Future • v1.1,, v2… • Progressive iterations, each with greater specificity

  23. EHR Roadmap (cont.)

  24. EHR Ballot, Part 1 (proposed)EHR Functional Model • Framework • Horizontal Axis - EHR Function • EHR Infrastructure Functions • EHR Care Delivery Functions • Vertical Axis - EHR Use • EHR Care Setting Profiles • EHR Use Profiles • Informative

  25. EHR Ballot, Part 2 (proposed)Functional Hierarchy/Decomposition • Framework • Hierarchical framework • Establishes functional groupings and relationships • Identifies functional inter-dependencies and redundancies • Supports Functional Decomposition • Informative • Does not dictate implementation

  26. EHR Ballot, Part 3 (proposed)EHR Function Specification Triplets • One per EHR function(ality) proposed for inclusion • Placed at parent or leaf nodes in Functional Hierarchy • Where applicability/conformance metric is deemed useful

  27. EHR Ballot, Part 3 (proposed, con’t)EHR Function Specification Triplets • Now • v1.0 • Informative (as DTSU) • What + Why • Next • v1.1, v2… • Normative • What + Why + Conformance Criteria

  28. Function Specification TripletBasis for Inclusion, 1st Screen • SIG Co-Chairs and Staff • Applicability: Within EHR scope? • Does function(ality) apply to at least one EHR system in one EHR use setting? • Identify applicable use settings • Now or Next Iteration: Within EHR v1.0 scope? • Is function(ality) within decomposition scope for v1.0?

  29. Function Specification TripletBasis for Inclusion, 1st Screen, con’t • Position triplet within Functional Hierarchy and Decomposition • First pre-ballot draft - target 21 July 2003

  30. Function Specification TripletBasis for Inclusion,2nd Screen • Review in open session • EHR SIG Open Meeting, 23-24 July • HL7 membership not required • Consensus of attendees • Per triplet: • Applicability? • Now or next iteration? • Typical Use Setting(s)

  31. Function Specification TripletBasis for Inclusion,2nd Screen, con’t • Post meeting revisions • Final ballot draftTarget: End July 2003

  32. Function Specification TripletBasis for Inclusion, 3rd Screen • Ballot Opens/Closes: 1 Aug to 1 Sep • Ballot options • Add new function(ality), including proposed: • Function Specification Triplet • Placement within Functional Hierarchy and Decomposition • Urgency: now or future iteration • Exclude proposed function(ality) • Reason for exclusion • OK in future iteration?

  33. Function Specification TripletBasis for Inclusion, 3rd Screen, con’t • Ballot options, con’t • Add/delete proposed EHR use setting • Revise Statement of Function(ality) - WHAT • Revise Rationale - WHY

  34. Function Specification TripletBasis for Inclusion, 4th Screen • Review in open session • EHR SIG Meeting, 9-11 September • In conjunction with HL7 Annual Plenary, Memphis • HL7 membership not required but meeting fee is • Consensus of attendees • Ballot submitters are encouraged to attend while their comments are discussed and resolution sought!!

  35. Function Specification TripletBasis for Inclusion, 4th Screen, con’t Ballot Resolution Options • Accept vote to add function(ality) • Establish Statement of Function(ality) - WHAT • Establish Rationale - WHY • Within v1.0 scope? • Place in Functional Hierarchy and Decomposition • Beyond v1.0 scope? • Log for future consideration, inclusion • Establish related EHR Use Setting(s) • Revise ballot draft • Request submitter to withdraw negative (if any)

  36. Function Specification TripletBasis for Inclusion, 4th Screen, con’t Ballot Resolution Options, con’t • Decline vote to add function(ality) • State reason: e.g., out of scope • Offer compromise to submitter: e.g., future consideration • Notify submitter, request withdrawal of negative (if any) • Votes to include or exclude care settings • Consensus of committee • No committee response to individual submitter

  37. Function Specification TripletBasis for Inclusion, 4th Screen, con’t Ballot Resolution Options, con’t • Accept vote to exclude function(ality) • State reason: e.g., out of scope • Offer compromise to submitter: e.g., future consideration • Revise ballot draft • Notify submitter, request withdrawal of negative (if any) • Decline vote to exclude function(ality) • State reason • Notify submitter, request withdrawal of negative (if any)

  38. Function Specification TripletBasis for Inclusion, 4th Screen, con’t Ballot Resolution Options, con’t • Accept revision to Statement of Function(ality) or Rationale • Revise draft • Notify submitter, request withdrawal of negative (if any) • Decline revision toStatement of Function(ality) or Rationale • State reason or suggest compromise • Notify submitter, request withdrawal of negative (if any)

  39. Function Specification TripletBasis for Inclusion, 5th+ Screens Sep/Oct • Next ballot round • Repeat Screens 3&4 until consensus is achieved…

  40. Accepted SubmissionsEHR Functional Hierarchies • Proposed EHR functional hierarchies and decompositions, as scoped for v1.0: • EHR Infrastructure Functions • Decomposition - target 5 levels • EHR Care Delivery Functions • Decomposition - target 3 levels

  41. Accepted SubmissionsEHR Specification Triplets • Proposed EHR Specification Triplets • 1) What 2) Why 3) Conformance Criteria • Proposed in context of: • Applicable use setting(s) • Placement within Functional Hierarchy and Decomposition

  42. Contacts Linda Fischetti, RNVeterans Health AdministrationLinda.Fischetti@med.va.gov Gary DickinsonPer-Sé Technologies, Inc.gary.dickinson@per-se.com Sam Heard, MDOpenEHR, Australiasam.heard@bigpond.com

More Related