Health eDecisions RI/ Pilots Sub-Workgroup June 24th, 2013 10/11/20111.

Health eDecisionsRI/ Pilots

Sub-Workgroup

June 24th, 2013

10/11/2011 1

Agenda

• Announcements • Review and Revisit of Goals• Review of RI/Pilot Sub-WG Timeline• Pilot Updates:

• Zynx/DesignClinicals – Order Sets• Continued Findings and Discussion

• AllScripts and NewMentor (Million Hearts – MU NQF 68)• VA and Wolters Kluwer - Demo• CDC and Allscripts

• Planning for the Open House• Review Implementation Guide• Review Action Items, Next Steps

Announcements

• We will be reviewing the IG in our next 2 workgroup Meetings• We need to plan an “Open House” to display our pilots work

• July 8th (during our regular Pilots call)

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Pilots

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Organization Pilot Lead Email Organization’s Role

Wolters Kluwer Health Sue Johnson/Steve Claypool/Howard Strasberg/Christy May

[email protected]@wolterskluwer.com [email protected] [email protected]

Service Supplier/Artifact Supplier

OpenCDS David Shields [email protected] Service Supplier

Zynx HealthClaude Nanjo (primary)Bernadette MintonVictor Lee

[email protected] (primary) [email protected]@zynx.com Service Supplier/Artifact Supplier

Medexter Healthcare Klaus-Peter AdlassnigKarsten Fehre

[email protected]@medexter.com Service Supplier

newMentor Julie SchererMatt Pfeffer

[email protected] [email protected] Service Supplier/Artifact Supplier

CDC Shu McGarveyLaura Conn

[email protected]@cdc.gov Government /Service Supplier/Artifact Supplier

NextGenDr. Sarah CorleyDr. Jeff FriedlinGary Wietecha

[email protected], [email protected],[email protected] EHR Vendor

Practice Fusion Lauren FifieldMichael Poremba

[email protected] [email protected] EHR Vendor

AllScripts Douglas GentileRobin Williams (primary)

[email protected] [email protected] (primary) EHR Vendor

Design Clinicals Dewy Howell [email protected] EHR Vendor

SuccessEHS Claude Ouimet [email protected] EHR Vendor

Applied Pathways Paul Arnone [email protected] Service Supplier

Support Team• Support Team:

• Pilots Lead: Jamie Parker: [email protected]• Support: Ali Khan: [email protected] • Subject Matter Expert: Aziz Boxwala: [email protected]• Subject Matter Expert: Bryn Rhodes: [email protected] • Use Case 1: Dave Shevlin: [email protected] • Implementation Guide: Lynette Elliot: [email protected] • SDO Support: Anna Langhans: [email protected]

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HeD Pilots Goal Goal

The goal of this initiative is to produce, consume and where feasible, execute implementable CDS interventions.1. Event Condition Action Rules (ECA Rules)2. Order Sets3. Documentation Templates

Pilot Scope4. Health eDecisions will apply defined aspects of the Implementation Guide in a

real-world setting.5. Modify the Implementation Guide to ensure it is usable6. Submission of explicit feedback to sub workgroups such as vMR and

vocabulary and terminology to close gaps7. The real-world pilots evaluate not only the technology, standards and model

(VMR), but also provide a test bed to evaluate the interaction of technology, implementation support, and operational infrastructure required to meet Health eDecisions use case 1 objectives at the stakeholder or organization levels.

8. Demonstrate intent of artifact (specifically structures and semantics) are communicated either by direct execution or by translation to native format

9. Ensure Completeness and consumability of artifact

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Timeline

10/11/2011

Goal & Activities EST. Time

Dates Deliverables

Kickoff /Establish Goals & Partnerships: - Review HeD Initiative Goals - Review Piloting Process & Resources - Define Value Statement - Define HeD Pilot Goals & Success Metrics - Establish & Approve Pilots - Develop Pilot Briefs

4 wks.(reality 5 weeks)

1/07-2/25 (we missed 2 meetings in January pushing our Dates back)

-Wiki Capturing Pilot Deliverables-Established Partnerships-Documented Value Statements and Success Metrics-Documented Pilot Briefs

Pilot Configuration: - Establish Pilot Test Environment & Resources - Establish Pilot Implementation & Testing Process - Develop & Review Pilot Configuration

2 wks.(reality- 4

weeks)

2/25-3/25

-Use Case is Updated with HL7 Comments (3/4)-Approved Pilot Briefs -Committed Pilot Resources-Documented & Reviewed Pilot Configuration Guide-Weekly Feedback on Use-Cases & IG Alignment

Pilot Development : - Setup & Develop Pilot Prototypes - Review prototypes

6 wks. or less

depending on Pilot activity

3/25 – 5/20

-Use Case is Updated with HL7 Comments (3/4)-Weekly Pilot Development Status Updates-Weekly Feedback on Use-Cases & IG Alignment-Updates to Pilot Configuration Guides

Pilot Testing & Showcase : - Complete Testing - Prepare Solution Showcase

2wks 5/20 -6/04 -Weekly Pilot Testing Updates & KPIs-Showcase-Prepare for HL7

Pilot Wrap-up : - Develop Lessons Learned an ONC Feedback - Review Initiative Goal Alignment - Establish Next-Steps

2 wks. 6/4 – 6/18 -Documented ONC Feedback- Next Steps Action Plan

We are Here

Vendor Engagement Discussion

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EHR Area of Interest Potential Match

Design Clinicals Order Sets Zynx

AllScripts ECA Rules –NQMF Rule (for Ambulatory Setting)

NewMentor (have catalog for rules in ambulatory setting)

Allscripts San Diego Pertussis ECA rule CDC

VA Documentation Template Wolters Kluwer

Pilot Updates: Zynx – DesignClinicals (Order Set- Heart Failure )• Team:

• Claude Nanjo and Victor Lee Zynx• Dewy Howell – DesignClinicals

• Status• Expected Completion Date?

• Notes on the IG

• Notes on the Vocab and Terminology Work

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Pilot Updates: NewMentor – AllScripts (ECA Rule Million Hearts –NQF 68)

Team:• Julie Scherer - NewMentor• Bryn Rhodes – Internal Support • Robin Williams – AllScripts

Team Meetings

Status:• Notes on the IG• Notes on the Vocab Work

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Pilot Updates: Wolters Kluwer – VA (Documentation Template)• Team:

• Christy May -Wolters Kluwer• ???? – Internal • Ken Kawamoto - VA• Robert – Lario - VA

• Status: - DONE ….DEMO!!!!• Notes on the IG• Notes on the Vocab and Terminology Work

• E&M Code issue (maybe include them in LOINC)• Follow up with Mark (examples are in the UTI template – send to

LOINC folks)• Tracking sheet has been created to track these follow up issues through

the vocab and term group

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Pilot Update: CDC – AllScripts (ECA Rule) – Complete• TEAM:

• Shu McGarvey - CDC• Aziz Boxwala – Internal Support• Bryn Rhodes- Internal Support• Manoj Sharma- AllScripts Technical guru

• Status• Expected Completion Date

• Shu to provide value sets for the Labs (general culture)• We are only piloting the Clinical Rule not the Lab Rule (for stand alone

labs)• HL7 – act/relationship value sets (work with Terminology team to get

this done -

• Notes on the IG• Notes on the Vocab Work

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Open House Plan

• Working on outreach plan – are there any particular groups/individuals you all would like to have attend the “open house”

• Each Group will have 15 minutes to discuss pilot• What did you all pilot• Members of the Team• How you did it• Findings• Lesson Learned• Going forward = what can we do to make it better• How can someone consume/consider doing this work

• Feedback: Question: What would a vendor want to know?• Response: If I hadn’t done the pilot – I would want to have an idea of the tasks or

analysis needed for creating the transformation for each of the artifact types.  As a vendor, unless I can ‘resource’ that activity and have it repeatable, I will not be able to use content ‘off the shelf’.

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Working Session on the UC 1 IG:

http://wiki.siframework.org/HeD+Pilot+Tools

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Pilot Support Tools and Feedback channels Discussion Board: • http://

wiki.siframework.org/HeD+Pilot+Activities#HeD_Pilot_Discussion

Vocabulary and Terminology Feedback:• http://

wiki.siframework.org/HeD+Pilot+Tools

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Action Items & Next Steps

• Continue to work on the IG• Begin to step through the UC 1 IG based on Pilot activities• As needed and necessary we will be discussing issues and

challenges during the pilot activities• Update the IG• Update the Vocabulary and Terminology work• Identify additional support resources if necessary

• Prepare for our HeD Pilots “open house”• July 8th

Meeting Reminder

• Pilots Work stream meets (next meeting: July 1st, 2013) • Every Monday• 1-2:30 pm EDT See Wiki homepage for meeting details: http://

wiki.siframework.org/Health+eDecisions+Homepage

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Appendix A: Success Criteria

NOTE: This is a work –in-progress we will need to re-evaluate this after Pilot Project Plans• Discuss Pilot Success Criteria:

• Individual Criteria• Initiative Criteria

• EHR Involvement - DONE• Production (at least one of each artifact and consumption of those artifacts)

– Addressed as part of the Pilot Project Plans (who will be doing which artifacts)• Successful implementation of artifacts

– EHR involvement» Validate artifact – perhaps Pilots focuses on this ?» Execute the artifact

• Cross initiative function» Potential Alignment with eDOC and esMD » SDC

• Alignment with MU 3 objective» 10% knowledge based engine (align 402b)» ACTION ITEM: Review MU3 Criteria» Determine the delivery model we want to pilot

• External (i.e. cloud service)• Assets are portable (can be run locally)

• Discuss this with the group10/11/2011 18

Appendix B

In Scope/Out of Scope

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Scope of Use Case 1

• This Use Case defines the requirements to build a standard for the contents of CDS Knowledge artifacts.  The use case focuses on the following artifact types: Event Condition Action (ECA) Rules, Order Sets, and Documentation Templates. To support this purpose the Use Case has one scenario:  A CDS Knowledge Artifact Supplier makes computable CDS Knowledge Artifact available to CDS Artifact Integrator (From HeD Use Case: CDS Artifact Sharing)

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In Scope

• Standards to structure medical knowledge in a shareable and executable format for use in CDS

• In Scope Artifact Types (definitions for these artifact types can be found in Appendix A)

– Event Condition Action Rules– Order Sets – Documentation Templates

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Out of Scope• Tools:

– Authoring tools, source “content” management.– Terminology server and mapping tools including management of concept coordination.– Semantic processing of text, including structured string processing and natural language processing.

• System Functions– Messaging Layer– Means of sharing– Security

• Authoring, creation and maintenance of clinical decision support knowledge• Knowledge Repository Design• Search and query mechanisms• Implementation in systems• User presentation, Transport layers• Market factors: regulatory incentive/mandate, liability shield, IP shield (patent/licensing litigation),

certification body, marketplace design, test procedures, FDA rules• Clinical Decision Support Services (this will be covered in Use Case 2 CDS Guidance Services)• CDS Content Development Activities, including the distribution and sharing of artifacts• Context-Aware information retrieval (HL7 Information Button) – This will be covered in UC 2 (CDS

Guidance)

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Pre and Post Conditions• Pre-Conditions

– CDS Artifact Supplier makes CDS artifacts available for search and consumption by CDS Artifact Integrators _ ACTION ITEMS (Clarify this –what is a precondition for this to be useful)

– CDS Artifact integrator has the means to obtain the knowledge artifact from a CDS Repository (e.g. they have either browsed or queried the CDS Repository for available artifacts)

– CDS Artifact Integrator Selects Artifacts of Interest to Use in their CDS System

• Post Conditions– The CDS Knowledge Artifact Supplier has sent the CDS Knowledge Artifact to the

requesting CDS Artifact Integrator– CDS Artifact has been received by CDS Integrator and is available for processing– CDS Artifact is available for mapping, structural transformations and local adaptation– Strategy

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Decision: In the pilot activities we will not directly address these as part of our pilot. We will focus the pilot activities on those tasks which occur between the pre and post condition

Appendix C: UC 2 Approach

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HeD UC2 Solution Plan

Create implementation guidance that leverages vMR as the base model but is aligned with C-CDA and QRDA (semantics, terminologies, and templates) to the highest extent possible.– Solution will be to update the vMR model to align with the

semantics of C-CDA and QRDA to the extent possible and reasonable

– vMR is a streamlined data model for CDS. This model is at a similar level of granularity to models such as Green CDA

Request Service: DSS Request Element

Request Items Organizer/Container: vMRRequest Item Payload: vMR Clinical Statement

vMR Payload

This approach supports vMR as the payload standard with mappings to CCDA and QRDA

HeD UC2 Solution Plan

HeD Schema/vMR

Response Service: DSS Response ElementResponse Items Organizer/Container: Harmonized vMR/HeD Schema

Response Item Payload: vMR Clinical Statements

CDS Response

CDS Request

HeD UC2 Solution Plan

We will utilize templates to guide the IG development and Functional Interaction Types as examples– vMR templates will be used as building blocks of data that are

coordinated to meet template requirements– The Functional Interaction Types will be the examples that use

the building blocks– Leverage pilots from UC1 for functional interaction types

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Potential Functional Interaction Types1. Disease Management

2. Drug Dosing Calculation

3. Immunization Forecasting

4. Quality Measure Evaluation

5. Transition of Care Support

6. Prediction Rule Evaluation – APACHE score, AHRQ Pneumonia Severity Index, etc.

7. Severity of Illness Assessment – Charlson index, etc.

Which functional interaction types best align with current pilot efforts?

Which types would be the most straight forward to test?

Which types would best validate the HeD UC2 solution, or be the most widely used in the industry?