Collaboration The Key to Interoperability Chuck Meyer Chair, HL7.

CollaborationThe Key to Interoperability

Chuck Meyer

Chair, HL7

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Interoperability Collaborative

The Interoperability Collaborative coordinates member activities to overcome obstacles in the progression towards global interoperability. It encompasses:

• Healthcare informatics standards (HL7)

• Standards adoption/implementation (IHE)

• Product delivery and tools for interoperability (EHRVA)

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HL7 = Standards Development

• Develops healthcare informatics standards for messaging and document exchange; key components of IHE integration profiles

• Meets national use cases

• Ensures international consensus

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IHE = Integration

• Identifies critical use cases

• Specifies integration profiles

• Publishes technical framework

• Tests implementation via Connectathons

• Engages vendors via product integration statements

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EHRVA = Advocacy and Tools

• Offers the Interoperability Roadmap

• Supports development of:– Standards– Integration Profiles

• Fosters member awareness and development of interoperable products

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The EHRVA Interoperability Roadmap

Internet

HIS toHIS toHISHIS

Document SharingDynamic Information

ManagementTransactions

Clinical Content

Resource LocatorServices

Security and Identity

Persistent InfoDocuments

DynamicInformation Access Workflow Quality

Patientand

ProviderID Mgmt

AccessControl

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Lab

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Radi

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Med

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Alle

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Notifications

(ePrescribing,Lab Ordering

etc.)

Quality &PublicHealth

Reporting

HIS toHIS toNHINNHIN

Scan

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Docu

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Clin

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HL7 Reference Information ModelHL7 Reference Information Model

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Linking the EHRVA Roadmap to Profiles and Standards

Internet

HIS toHIS toHISHIS



Clinical Content





Patientand

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AccessControl

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Lab

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Reporting


Scan

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IHE CT,ATNA, XUA

IHE PIX,PDQ

HL7 V2, V3Patient Admin

HL7 ConsentDocs

IHE AxsConsent

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Internet

HIS toHIS toHISHIS



Clinical Content





Patientand

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AccessControl

Med

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Lab

Resu

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Radi

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IHE CT,ATNA, XUA

IHE PIX,PDQ


HL7 ConsentDocs

IHE AxsConsent

IHE XDS

IHEXDS-MS

HL7 CDACRS, CCD

HL7 CDALab & Path

HL7 CDARad Report

HL7 CDA+PDF, TIFF

HL7 CDAAnest., Peds.

IHEXDS-I

IHEXDS-Sc

IHEXDS-zz

IHEXDS-Lab

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Internet

HIS toHIS toHISHIS



Clinical Content




DynamicInformation Access

Workflow Quality

Patientand

ProviderID Mgmt

AccessControl

Med

ical S

umm

arie

s

Lab

Resu

lts

Radi

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Med

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Alle

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Notifications


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Reporting


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IHE CT,ATNA, XUA

IHE PIX,PDQ


HL7 ConsentDocs

IHE AxsConsent

IHE XDS

IHEXDS-MS

HL7 CDACRS, CCD

HL7 CDALab & Path

HL7 CDARad Report

HL7 CDA+PDF, TIFF


IHEXDS-I

IHEXDS-Sc

IHEXDS-zz

IHEXDS-Lab

IHETransactions

HL7 V3Meds, Pt Care

IHE DynQMed-All-Pb

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Internet

HIS toHIS toHISHIS



Clinical Content




DynamicInformation Access Workflow

Quality

Patientand

ProviderID Mgmt

AccessControl

Med

ical S

umm

arie

s

Lab

Resu

lts

Radi

olog

y

Med

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ns

Alle

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s

Prob

lem

s

Notifications


etc.)


Reporting


Scan

ned

Docu

men

t

Clin

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pecia

lties


IHE CT,ATNA, XUA

IHE PIX,PDQ


HL7 ConsentDocs

IHE AxsConsent

IHE XDS

IHEXDS-MS

HL7 CDACRS, CCD

HL7 CDALab & Path

HL7 CDARad Report

HL7 CDA+PDF, TIFF


IHEXDS-I

IHEXDS-Sc

IHEXDS-zz

IHEXDS-Lab

IHETransactions

HL7 V3Meds, Pt Care

IHE DynQMed-All-Pb

HL7 V3 Meds,Orders, Lab

IHE LabRT WF

ePrescribeNPRM

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Internet

HIS toHIS toHISHIS



Clinical Content





Patientand

ProviderID Mgmt

AccessControl

Med

ical S

umm

arie

s

Lab

Resu

lts

Radi

olog

y

Med

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ns

Alle

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s

Prob

lem

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Notifications


etc.)


Reporting


Scan

ned

Docu

men

t

Clin

ical S

pecia

lties


IHE CT,ATNA, XUA

IHE PIX,PDQ


HL7 ConsentDocs

IHE AxsConsent

IHE XDS

IHEXDS-MS

HL7 CDACRS, CCD

HL7 CDALab & Path

HL7 CDARad Report

HL7 CDA+PDF, TIFF


IHEXDS-I

IHEXDS-Sc

IHEXDS-zz

IHEXDS-Lab

IHETransactions

HL7 V3Meds, Pt Care

IHE DynQMed-All-Pb

HL7 V3 Meds,Orders, Lab

IHE LabRT WF

ePrescribeNPRM

HL7 V2, V3Pub. Health Rep.

CDCImp

Guide

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Credit Where Credit Is Due

My thanks to

Charles Parisot [GE, IHE] and

Liora Alschuler [Alschuler Associates, HL7]

for their work developing the slide mapping profiles and standards to the EHRVAInteroperability Roadmap.

HL7 and ASTM Collaboration The Continuity of Care Document

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HL7 CDA

• Clinical Document Architecture– ANSI/HL7 R1-2000, R2-2005

• eDocuments for Interoperability– Key component for local, regional, national

electronic health records– Gentle on-ramp to information exchange

• Everyone uses documents• EMR compatible, no EMR required• All types of clinical documents

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ASTM CCRA core data set ofthe most relevant administrative, demographic, andclinical informationfacts about a patient’s healthcare, coveringone or more healthcare encounters.

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CCR vs. CDA

• Conflicting?

• Overlapping?

• Could we have both?– CCR data elements– CDA common exchange framework

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CCR + CDA = CCD

• CDA designed to support professional society recommendations, national clinical practice guidelines, standardized data sets, etc.

• From the CDA perspective, CCR represents a standardized data set providing constraints for specific summary document.

• The resulting specification, designated the Continuity of Care Document (CCD), will be the result of a collaborative effort between ASTM and HL7.

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Continuity of Care Document

• There is a history of collaboration– Presentation on CDA for continuity of care at ASTM,

2003– Memorandum of Understanding, 2004– Acapulco demo: CDA for CCR, October, 2004– Initial HL7 Care Record Summary ballot, April, 2005:– As a result of HL7 ballot, Spring 2005: CCR

incorporated changes required for bi-directional exchange and semantic interoperability

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• Current activities– Meeting ~ weekly by webinar, teleconference– Sample lab section developed as pattern– Participation by:

• ASTM E31.28• HL7 Structured Documents TC • HL7 domain experts (patient care, lab, ED...)• Clinical societies: ACP, AAFP, ACR...

– Interest in international harmonization• CDA summary documents in use around the world

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Will CCD be adopted?• Role of IHE

– 2005: Cross-enterprise document sharing (XDS) with both CDA and CCR

– 2006: XDS for Patient Care Coordination domain Medical Summaries

• CDA Care Record Summary• Extend with coded content for three required

sections

– 2007: likely adoption of CCD

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• Timeline– February – March: Meet by web/telconference

• Individuals developing:– Header– List of sections– Lab– Allergies/adverse reactions– Problems/conditions– Medications

– April – May • Initial ballot: header, list of sections, detailed sections• Ballot reconciliation: Spring HL7 Working Group Meeting

– June – July • Develop complete draft for second ballot

– August – September • Second ballot• Ballot reconciliation: Fall HL7 Working Group Meeting

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• Benefits– Industry consensus on summary document

contents and requirements through ASTM ballots (2004, 2005)

– Industry consensus on document exchange framework through HL7 ballots (1999-2005)

– Summaries for continuity of care • Interoperable with full range of document types• Interoperable with HL7 V3 messages, all RIM-

based specifications (public health reporting, clinical trials, structured product labels and more)

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Thank you for your time and attention.

QUESTIONS?

Collaboration The Key to Interoperability Chuck Meyer Chair, HL7.

Documents

hl7 slide

hl7 v2

xua ihe pix

tiff hl7 cda anest

interoperability ehrva

lab ordering

standards internet

standards integration