1 enabling healthcare interoperability Webinar Series Sponsored by the HITSP Education, Communications and Outreach Committee Emergency Responder Electronic Health Record September 4, 2008 | 2:00 – 3:30 pm (Eastern) Presenter: HITSP Provider Perspective Technical Committee Stephen Hufnagel PhD, Co-chair Allen Hobbs PhD, Co-chair Michael Glickman, Facilitator
Emergency Responder Electronic Health Record. September 4, 2008 | 2:00 – 3:30 pm (Eastern) Presenter: HITSP Provider Perspective Technical Committee Stephen Hufnagel PhD, Co-chair Allen Hobbs PhD, Co-chair Michael Glickman, Facilitator. Learning Objectives. - PowerPoint PPT Presentation
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Introduction to the HITSPEmergency Responder
Presenter: HITSP Provider Perspective Technical Committee
Stephen Hufnagel PhD, Co-chair
Allen Hobbs PhD, Co-chair
HITSP – enabling healthcare interoperability
During this 90-minute webinar, participants will be introduced to
the emergency responder community stakeholder groups and gain a
basic understanding of their unique needs, including:
the Emergency Communication System (ECS) and the Emergency Contact
Registry (ECON)
Patient identification and information, including tracking data for
various types of vocabulary / terminology, messaging and document
sharing
Common approaches to delivering incident information and incident
types
Remote monitoring of ambulance or field-based devices
Situational Awareness Reporting
Learning Objectives
Slide *
Introduction to HITSP and HITSP Interoperability Specification 04
(IS 04),
Emergency Responder Electronic Health Record (ER-EHR)
Methodology and Technology used to transform an AHIC Use Case to
a
HITSP Interoperability Specification
AHIC Use-Case Stakeholders and Information Exchange
Requirements
HITSP Interoperability Specification’s Business and Technical
Actors
Emergency Responder’s HITSP Constructs
Emergency Responder Gap and Harmonization Projects
Questions and Answers / Open Dialogue
a webinar series on U.S. healthcare interoperability
Slide *
Introduction: Steve’s Story . . . part eight
Patient is a 26-year-old male coping with the long-term effects of
a brain tumor that was removed during his childhood
During a routine check-up at his local hospital in Las Vegas, Steve
sees a large number of emergency patients rushed in for CT scans to
check for smoke inhalation injury
Steve is troubled by the lack of accessible medical records,
especially for people visiting from out of town who may have
pre-existing conditions
Doctors and emergency responders need to know the whole story to
provide the best treatment
Slide *
In an interoperable world . . .
On-site emergency care professionals, medical examiner/fatality
managers and public health practitioners would have the access they
need to information regarding care, treatment, or investigation of
emergency incident victims
HITSP IS 04 covers the use of an ER-EHR from multiple
perspectives:
First responders (911 operators)
Dispatch care (Emergency Communications Systems or Systems)
On-site emergency care providers (EMS, Law Enforcement, Fire etc.)
and emergency care clinicians
Slide *
HITSP is a volunteer-driven, consensus-based organization that is
funded through a contract from the Department of Health and Human
Services.
The HITSP Panel brings together public and private-sector experts
from across the healthcare community to harmonize and recommend the
technical standards that are necessary to assure the
interoperability of electronic health records.
Overview
The HITSP Standards Harmonization Framework
Identify a pool of standards for an AHIC (American Health
Information Community) Use Case
Identify gaps and overlaps in the standards for this specific Use
Case
Make recommendations for resolution of gaps and overlaps
Select standards using HITSP-approved Readiness Criteria
Develop Interoperability Specifications (IS) that use the selected
standard(s) for the specific context
Test the IS
*
Each HITSP Interoperability Specification defines a set of
“constructs” that:
specify how to integrate and constrain selected standards to meet
the business needs of a Use Case; and
define a Roadmap to use emerging standards and to harmonize
overlapping standards when resolved.
In essence, a HITSP IS represents a suite of documents that
integrate and constrain existing standards to satisfy a Use
Case.
Deliverables and Mode of Operation
Slide *
Interoperability Specifications
Integration of all constructs used to meet the business needs of
a
Use Case
Transaction Packages
Transactions
Logical grouping of actions that use components and/or composite
standards to realize the actions
Components
Logical grouping of base standards that work together, such
as
messaging and terminology
Slide *
IS 02
IS 04
IS 05
IS 06
Version: 1.0 Accepted
(Secretary of HHS has accepted for a period of testing)
Version:1.1.1 Panel Review
Identify new stakeholders and their Information Exchange
Requirements (IERs)
HITSP ISs constrain IERs to their clinical care setting context and
map IERs to HITSP constructs
HITSP constructs map IERs to standards-based System Data Exchange
(SDE)
Emphasize re-use of existing HITSP IS and constructs
IERs, which do not have existing HITSP IS mappings require new or
repurposed
ISs and/or constructs
HITSP uses Sparx Enterprise Architect tool for Business Processing
Modeling Notation (BPMN) and UML modeling
Transforming an AHIC Use Case to a HITSP Interoperability
Specification
Emergency Responder Use Case
Emergency Responders’ Continuum of Care
Slide *
Local Response
Regional Response
incident type, size and needs.
Slide *
Agency
Locator
Patient
Locator
Identity
Management/
Access
Control
HITSP specifies interoperability standards; not implementation
architectures.
*
AHIC Use-Case Stakeholders and Information Exchange
Requirements
Slide *
HITSP specifies interoperability standards; not implementation
architectures.
Slide *
Slide *
Patient ID Cross-Referencing Service (PIDs) / Emergency Contact
Registry (ECON)
On-Site Care Providers / Incident Commander
Public Health Agencies
Emergency Department Staff
Another Facility
on-site
DR20: CCD
Clinical Summary
Authorization Request
on-site
visual/clinical assessments
medications administered
procedures performed
02 Demographic Data
03 Allergy Data
Authorization Request
Health Plan eligibility, co-pay, deductibles, limits, and
exclusions
Administration of blood/blood products
DR 10: Treatment History
chief complaint
DR16: Vehicular
IER01-DR01
IER02-DR20
IER09-DR19
Scenario 1
On-Site Care
Slide *
AHIC Use Cases as BPMN Behavior-Models and UML Component
Structure-Models
Underlying Infrastructure Constructs are NOT shown (e.g., T15, T16,
T17, C19, TP20, TP30)
Information Exchange Requirement - Data Requirement
Component
Transaction
NA
NA
TP22
IER02-DR20
GAP PDF
T63, T64
Scenario 2
Emergency Care
Slide *
AHIC Use Cases as BPMN Behavior-Models and UML Component
Structure-Models
Underlying Infrastructure Constructs are NOT shown (e.g., T15, T16,
T17, C19, TP20, TP30)
Information Exchange Requirement - Data Requirement
Component
Transaction
NA
NA
TP22
IER02-DR20
NA
NA
NA
IER09-DR19
Scenario 3
Definitive Care
Slide *
AHIC Use Cases as BPMN Behavior-Models and UML Component
Structure-Models
Underlying Infrastructure Constructs are NOT shown (e.g., T15, T16,
T17, C19, TP20, TP30)
Information Exchange Requirement - Data Requirement
Component
Transaction
NA
NA
NA
IER02-DR20
NA
NA
NA
IER09-DR19
ER-EHR
CURRENT IS 04 Constructs
T 16
Consistent Time
T 17
T 64
T 68
T 79
T 86
Transaction Packages
TP 13
C 39
Encounter Message
C 48
C 62
ER-EHR Gaps and Overlaps Projects
In October 2007, the HITSP Care Delivery Technical Committee (CDTC)
formed an Emergency Medical Awareness and Response (EMAR)
tiger
team workgroup to address its IS04 ER-EHR identified standards
gaps
and overlaps
The work was planned to be completed in 2008, resulting in an
updated version of IS 04
National Emergency Medical Services Information System (NEMSIS)
assumed the leadership of the EMAR tiger team, which is addressing
or monitoring the ER-EHR related projects described on the
following pages
Slide *
Incident and Victim Identifiers
Develop a standard practice for the initial first responder
organization (normally government) to become aware of an
incident
assigns unique identifiers to an incident, any victims, and the
other actors
adopts those identifiers for all information exchanged about the
person or incident
associates person’s actual identity, when established, with the
unique identifiers (UIDs) noted above
links a person’s historical health information and new information
developed about the victim, patient, and or incident to the
UIDs
The UID for both victims and incidents is a temporary ID and is
used for the duration of the event by all involved
Slide *
Common Approaches to Delivering Incident Information
Exploring whether delivery of telematics data to the ECS and other
emergency responders can be generalized to other third party
incident information. This effort will consider, at a
minimum:
OASIS EDXL Distribution Element as the routing “header” for the
pre-hospital messaging, along with different payloads (VEDS, IEEE
1512)
The use of
core services to route data and provide security, including a
managed list of incident types
internet accessible electronic maps to share information before
interfaces to legacy systems are established
decision support tools in 9-1-1 and medical control to manage the
use of the new data
Slide *
Gap and Harmonization Project #3
Standardized List of Incident Types
Develop a consensus among leaders of the key emergency response
domains on incidents, names and types
NOTE: Though this is not a standards development process, it does
support the OASIS EDXL Distribution Element calls for a Managed
List
of Incident types
Situational Awareness Reporting
Utilize the OASIS EDXL DE and OASIS Resource Messages for
Situational Awareness Reporting
Other Situational Awareness Reporting messages are in early stages
of development by a Department of Homeland Security (DHS)-sponsored
process
The DHS-Disaster Management PWG is developing potential
standards
Slide *
Emergency Contact Registry (ECON)
IHE is developing a standardized query for law enforcement on-site
access and exchange of patient-specific emergency contact
information from a nationwide database, “ECON”, based upon a unique
identified, such as a Vehicle Identification Number (VIN#)
On 12/3/07 the IHE ITI Technical Committee approved the ECON Query
Profile Proposal
The IHE PCC Technical Committee is reviewing a Pre-Hospital Patient
Care Report (PCR) Profile Proposal which will develop a standard
for on-site care provider electronic download and automated entry
patient-specific Emergency Contact Registry, Personal Health Record
(PHR), and/or EHR data into an on-site Pre-Hospital Patient Care
Report (PCR) system
Slide *
Patient Information and Tracking Data Vocabulary / Terminology
Harmonization
The project will identify current data and exchange standards
(e.g., DEEDS and NEMSIS harmonization) that are being used within
EMAR enterprise
and harmonize them
and Document Sharing
Standard methods to support system to system exchange and
notification of appropriate entities regarding all the information
related to emergency medical response
The resulting standards will be based upon HL7, HITSP constructs,
the NEMSIS standards or the harmonized data standards that are
established from Project #6
Slide *
Nursing Terminology Overlap
An overlap in standards has been identified by the ER-EHR Work
Group
in the Use Case scenario for Present Episode of Care
Many of the individual data elements may be captured by nursing and
dependent on nursing terminology
A work group of nurses with expertise in nursing terminologies and
emergency nursing is being convened to address this
overlap.
CONCLUSION
This IS will use SNOMED CT as a reference terminology with the
HITSP IS
pre-condition that the sending and using systems must use formal
coded nursing terminologies, such as the Clinical Care
Classification (CCC) System or the
Omaha System
Gap and Harmonization Project #9
Development of a new HITSP Construct to support EMS cross-domain
messaging
This project will compare and contrast the prevalent OASIS
pre-hospital and HL7 hospital transport protocols in order to
create a HITSP transport construct that is consistent with DOT,
DHS, HHS and other relevant non-healthcare
On-Site ER-EHR Use Case Perspective domains
Slide *
Remote Monitoring of Ambulance or Field-based Devices
*
Conclusion
Slide *
Use or specify HITSP Interoperability Specifications in your HIT
efforts
and in your Requests for Proposals (RFPs)
Ask for CCHIT certification
to make connections easier in the future
Ask . . . Is there a HITSP standard we could be using?
Get involved in HITSP . . . Help shape the standards
*
Webinar 1 Standardizing How We Share Information in Healthcare: An
Introduction to HITSP Thursday, June 5, 2008 — 2:00-3:30 pm
EDT
Webinar 6 Quality New date Thursday, October 2, 2008 — 2:00-3:30 pm
EDT
Webinar 2 HITSP Foundational Components Thursday, June 19, 2008 —
2:00-3:30 pm EDT
Webinar 7 Security, Privacy and Infrastructure Thursday, August 21,
2008 — 2:00-3:30 pm EDT
Webinar 3 Consumer Access to Clinical Information Thursday, June
26, 2008 — 2:00-3:30 pm EDT
Webinar 8 EHR and Emergency Response Thursday, September 4, 2008 —
2:00-3:30 pm EDT
Webinar 4 Biosurveillance Thursday, July 10, 2008 — 2:00-3:30 pm
EDT
Webinar 9 Medication Management Thursday, September 18, 2008 —
2:00-3:30 pm EDT
Webinar 5 Electronic Health Record (EHR) and Lab Reporting
Thursday, July 24, 2008 — 2:00-3:30 pm EDT
www.HITSP.org/webinars
Join HITSP in developing a safe and secure health information
network
for the United States.
Visit www.hitsp.org or contact . . .
Emergency Responder
EHR-Facility
IER02,DR20IER06
IER08,DR16
interface (e.g., closed "lolipop" icon) is
associated with the data's legal system-
of-record. This model does not show
intermediary dependencies (dashed
imply a preferred implementation
or several locations simultaneously or it
might go through intermediaries.
cmp ER-EHR Scenario 2: Emergency Care
Name:ER-EHR Scenario 2: Emergency CareAuthor:HITSP Provider
TCVersion:1.0Created:7/29/2008 7:57:23 PMUpdated:8/5/2008 8:22:34
PM
EHR-Facility
IER02,DR20IER06IER05IER16
cmp ER-EHR Scenario 3: Definitive Ca...
Name:ER-EHR Scenario 3: Definitive CareAuthor:HITSP Provider
TCVersion:1.0Created:7/30/2008 4:34:23 PMUpdated:8/5/2008 4:17:12
PM
EHR-Facility
IER02,DR20IER06
IER05,DR15IER09
IER04,DR15IER07IER10IER11IER02