“ Jericho / UT Austin Pilot”

1. “Jericho / UT Austin Pilot” Privacy with Dynamic Patient Review Presented by: David Staggs and Michael Dufel Jericho Systems Corporation

2. Agenda • Administrative issues • Pilot scope • Pilot data flow • Test scenarios • Transaction and Document tests • Discussion • Pilot Timeline • Plan of Action

3. Pilot Administrivia • This pilot is a community led pilot • Limited support provided by the ONC • JohnathanColeman (Security Risk Solutions) • Zachary May (ESAC) • Penelope Hughes (ONC) • LibbieBuchele (ONC Sponsor) • In conjunction with DS4P bi-weekly return of an All Hands meeting • Access to DS4P Wiki, teleconference, and calendar • Meeting times: Tuesdays 11AM (ET) • Dial In: +1-650-479-3208Access code: 662 197 169URL:https://siframework1.webex.com/siframework1/onstage/g.php?t=a&d=662197169

4. Scope of the Pilot • Define the exchange of HL7 CDA-compliant PCD between a data custodian and a PCD repository that includes a report on the outcome of the request to the healthcare consumer (subject). • Additional goal: use identifiers to identify the subject/ PCD repository for use in reporting the outcome of the “secondary user” request use case to subject by subsequent EHR custodians. • Stretch goal: mask and/or redact the clinical document based on data segmentation and PCD choices retrieved from the PCD repository.

5. Pilot Data Flow , = Clinical data A,B = PCD data = audit record  1st Requestor And Subsequent Custodian of Data being Provided at  B Custodian of Data being Provided at   PCD Repository 2nd Requestor Patient

6. Test Approach Sections included in each test scenario in the DS4P Pilot Execution Script: • Scenario • Actors • Preconditions • Test steps • Test results • Log Capture • Data Set Verification

7. Test Cases DS4P Pilot Execution Script: • Consent To Patient Discovery : No Consent • Consent To Patient Discovery : 1st Requestor (1st) • Consent To Patient Discovery : 2nd Requestor(2nd) • Consent To Document Query : No Consent • Consent To Document Query : 1st To PC - Allow • Consent To Document Query : 2ndTo PC - Deny • Consent To Document Query : 2ndto SC - Deny • Consent To Document Retrieve : No Consent • Consent To Document Retrieve : 1stto PC - Allow • Consent To Document Retrieve : 2ndTo PC - Deny • Consent To Document Retrieve : 2ndto SC - Deny • Consent To Document Retrieve : With Segmentation

8. Test Cases (Visual Representation) PC = Primary Custodian SC = Secondary Custodian

9. Original Query & Response Complete solution must retrieve PCD during ITI 55, ITI 38, ITI 39

10. J-UT Pilot Sequence Detail (A) Retrieving & applying PCD, reporting during patient discovery

11. J-UT Pilot Sequence Detail (B) Retrieving & applying PCD, reporting when returning document list

12. J-UT Pilot Sequence Diagram (C) Retrieving & applying PCD, reporting when returning a clinical document

13. Transaction Tests (Last Meeting) • NwHIN messages • Test messages must comply with NwHIN specification • Request for PCD from Document Custodian • ITI 55: Data Set A • ITI 38: Data Set B • ITI 39: Data Set C • ATNA audit record from Document Custodian • ITI 55: Audit data Set A • ITI 38: Audit data Set B • ITI 39: Audit data Set C

14. Document Tests • HL7 Documents • HL7 Documents must comply with HL7 specification • Clinical document from Document Custodian • Must include a reference to the patient consent repository • PCD document from PCD Repository • Must follow HL7 Privacy Consent Directive • Must include specific elements

15. Discussion • Review of J-UT DS4P Test Document Draft • Overview • Scenario Tests • Transaction Tests • Document Tests • Appendixes: Test Results

16. Pilot Timeline • General Timeline, conditioned on agreement of stakeholders

17. Plan of Action • Upon agreement of the participants the POA is: • Identify the elements available from previous DS4P pilots • Scope level of effort, decide on extended scenario • Determine first draft of functional requirements • Review standards available for returning information on requests • Determine any gaps or extensions required in standards • Stand up information holders and requestors • Create XDS.b repository holding PCD • Identify remaining pieces, create test procedures • Document and update IG with results of our experience

18. Backup Slides

19. DS4P Standards Material • Location of DS4P Standards Inventory: http://wiki.siframework.org/Data+Segmentation+-+Standards+Inventory • Location of DS4P Standards Mapping Issues: http://wiki.siframework.org/file/view/Copy%20of%20DataMappingsIssues%2005102012.xlsx/333681710/Copy%20of%20DataMappingsIssues%2005102012.xlsx • General Standards Source List: http://wiki.siframework.org/file/view/General%20SI%20Framework%20Standards%20Analysis.xlsx/297940330/General%20SI%20Framework%20Standards%20Analysis.xlsx • Standards Crosswalk Analysis http://wiki.siframework.org/Data+Segmentation+for+Privacy+Standards+and+Harmonization (at bottom of page, exportable) • Implementation Guidance http://wiki.siframework.org/file/view/Data%20Segmentation%20Implementation%20Guidance_consensus_v1_0_4.pdf/416474106/Data%20Segmentation%20Implementation%20Guidance_consensus_v1_0_4.pdf

20. DS4P References • Use Case: http://wiki.siframework.org/Data+Segmentation+for+Privacy+Use+Cases • Implementation Guide: http://wiki.siframework.org/Data+Segmentation+for+Privacy+IG+Consensus • Pilots Wiki Page: http://wiki.siframework.org/Data+Segmentation+for+Privacy+RI+and+Pilots+Sub-Workgroup

21. Pilot Data Flow , = Clinical data A,B = PCD data = audit record  1st Requestor And Subsequent Custodian of Data being Provided at  B Custodian of Data being Provided at   PCD Repository 2nd Requestor Patient

22. Pilot Data Flow Clinical exchange # , = Clinical data A,B = PCD data = audit record 1st Requestor And Subsequent Custodian of Data being Provided at  B Fetch PCD Fetch PCD Custodian of Data being Provided at  Clinical exchange #  Send audit Send audit PCD Repository 2nd Requestor Patient

23. Pilot Data Flow (1) , = Clinical data A,B = PCD data = audit record  1st Requestor Custodian of Data being Provided at  PCD Repository 2nd Requestor Patient

24. Pilot Data Flow (2) , = Clinical data A,B = PCD data = audit record  1st Requestor Custodian of Data being Provided at  PCD Repository 2nd Requestor Patient

25. Pilot Data Flow (3) , = Clinical data A,B = PCD data = audit record 1st Requestor And Subsequent Custodian of Data being Provided at  B Custodian of Data being Provided at   PCD Repository 2nd Requestor Patient

26. Pilot Data Flow (4) , = Clinical data A,B = PCD data = audit record 1st Requestor And Subsequent Custodian of Data being Provided at  Custodian of Data being Provided at   PCD Repository 2nd Requestor Patient

27. Pilot Data Flow (5) , = Clinical data A,B = PCD data = audit record 1st Requestor And Subsequent Custodian of Data being Provided at  Custodian of Data being Provided at  PCD Repository 2nd Requestor Patient

28. Pilot Data Flow (updated) , = Clinical data A,B = PCD data = audit record  1st Requestor And Subsequent Custodian of Data being Provided at  B Custodian of Data being Provided at   PCD Repository 2nd Requestor Patient