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  • HL7 Personal Health Record System Functional Model and Standard

    Ambassador Briefing

    John Ritter


    An educational update to the HIMSS Enterprise Integration Task Force

    March 13, 2008

  • Slide 2

    About HL7 Ambassador Briefings

    This 30-minute briefing is being delivered by an HL7-authorized speaker.

    HL7 Ambassadors personally contribute to HL7 standards through participation in HL7 Technical Committees, Special Interest Groups, and/or other committees -- and can speak first-hand about standards and the standards development process.

  • Slide 3


    HL7’s Vision / MissionExecutive Summary of the standardWhy HL7 standards?Business Area (domain) of the standardOverview of the standardImplementation lessons learnedStatus of the standardBenefits of the standardNext steps / recommendationsSummaryAdditional information

  • Slide 4

    HL7’s Vision / Mission

    Health Level Seven (HL7) is an ANSI-accredited standards development organization that creates international electronic healthcare information standards

    (grab updated text from website)

  • Slide 5

    Executive Summary of the standard

    HL7 builds on its solid foundation of international healthcare information technology standards by offering the Personal Health Record System Functional Model (PHR-S FM) as a draft reference standard for Personal Health Record System functionality

  • Slide 6

    Executive Summary (con’t)

    The PHR-S FM:Is consumer-orientedLists the functions that PHR systems should or may performProvides a standard that certifying organizations can useServes as an anchor point for promoting system interoperability

  • Slide 7

    Business Area (domain) of the standard

    Envision interactions with healthcare providers, devices, and healthcare-device systemsEnvision use in the home and when travelingSupport consent-based Public Health Reporting requirementsSupport consumer’s option to provide Emergency Responder informationSupport Quality Improvement needs

  • Slide 8

    Overview of the standard

    Brief description of the standardBusiness Problem being addressedWho should use it?Examples of users (local and global)

  • Slide 9

    Overview of the standard

    Brief description of the standardA PHR-System is an electronic system that enables the collection of consumer-oriented, short-term and long-term health-related records and health-related goalsThe PHR-S FM is a consensus-based, well-defined list of all PHR-healthcare-related functions that may appear in a PHR system and that may serve as a “Universe Of Discourse” for all stakeholdersElectronic systems consists of data and purposes for usingthe dataThe PHR-S FM lists the set of all purposes (functions) related to PHR dataThus, the PHR-S FM is not a data standard, but a functional standard

  • Slide 10

    Overview of the standard

    Business Problem being addressedConsumers have difficulty remembering, organizing, coordinating, and re-using healthcare-related dataProviders have difficulty collecting healthcare-related information from consumersStakeholders (patients/consumer, providers, payers, etc.) have difficulty communicating and coordinating healthcare informationSystem designers have difficulty creating systems that address the various stakeholders’ needs (in an interoperable fashion)

  • Slide 11

    Overview of the standard

    Business Problem being addressedProvide a technology- and implementation-neutral standard that describes what PHR systems should or may doProvide a basis for building “roadmaps”Accommodate the present; look to the futurePromote interoperability between EHR systems and PHR systems

  • Slide 12

    Overview of the standard

    Business Problem being addressedAccommodate various business modelsPromote “trustworthiness and acceptance”of consumer-provided data towards providersPromote the use of Privacy, Security, and Confidentiality standards and policiesProvide clarity to the PHR market (nationally and internationally)Offer a basis for system certification

  • Slide 13

    Overview of the standard

    Business Problem being addressedServe as the cornerstone for describing:

    PHR Systems, thus:Enabling ModularityDefining FunctionalityScoping subsystems

    PHR System interoperability, thus:Clarifying InterfacesEnabling well-defined “Services”

  • Slide 14

    Overview of the standard

    Examples of (actual or potential) usersGovernments: Brazil – to set a national standardPayers: (Various) – to provide a value-added service to beneficiariesStandards Development Organizations: ISO – to evaluate the need for an international standardConsumers / Consumer Advocates: To analyze Privacy, Security, and Confidentiality expectations

  • Slide 15

    Overview of the standard

    Examples of usersVendors: (Various) to expand functionality suiteHealthcare Providers (primary and ancillary): (Various) – to provide a value-add to patientsQuality-Oversight / Accreditation organizations: (Various) – to prepare certification scripts

  • Slide 16

    Overview of the standard

    Origin of the work-effortThe Personal Health Record Working Group (PHR WG) is a subgroup under the HL7 EHR Technical CommitteePHR WG began work in early 2005Participants include an international collaboration of: vendors, payers, providers, informaticists, government

  • Slide 17

    Overview of the standard

    Personal Health

    PH.1 Account Holder Profile

    PH.2 Manage Historical Clinical Data And Current State Data

    PH.3 Wellness, Preventive Medicine, and Self Care

    PH.4 Manage Health Education

    PH.5 Account Holder Decision Support

    PH.6 Manage Encounters with Providers


    S.1 Provider Management

    S.2 Financial Management

    S.3 Administrative Management

    S.4 Other Resource Management


    IN.1 Health Record Information Management

    IN.2 Standards Based Interoperability

    IN.3 Security

    IN.4 Auditable Records

    Functions are categorized and listed hierarchically. (The highest level functions are shown.)

    Each function has an ID, Name, Statement, Description, Examples, and Conformance Criteria.

  • Slide 18

    Sample Function in the PHR-S FM

    PH.2.5.1 Manage Problem ListsStatement: Manage the account holder’s health problem list and provide the

    ability to manage the problem list over time.Description: Problems are a core feature of the medical record that provides

    structure and direct management. Problems may include diagnoses…Example: Problem list items may include: chronic conditions, diagnoses,

    allergies, or symptoms, both past and present, as well as …1. The system SHALL provide the ability to capture, display and report all

    problems associated with an account holder.2. The system SHALL capture, display and report a history of all problems

    associated with the account holder.3. The system SHALL provide the ability to capture the date the problem was

    documented.4. The system SHOULD provide the ability to capture the chronicity (chronic,

    acute/self-limiting, etc.) of a problem.(...)11. The system MAY provide the ability to consolidate or group multiple

    problems or related problems under a single problem.

  • Slide 19

    Implementation lessons learned

    The PHR-S FM is not an “implementablespecification” (as are other HL7 specifications); rather, the PHR-S FM aids systems requirements definitionThe PHR-S FM is new as of January 2008; industry feedback is expected over the two-year DSTU period

  • Slide 20

    Status of the standard

    Summer 2007: Public Comment reviewDecember 2007: Ballot passed as a “Draft Standard for Trial Use”2008 – 2010: DSTU-level improvementAfterwards: Full ANSI standard; promotion towards ISO standard

  • Slide 21

    Status of the standard

    Currently seeking feedback:Does the PHR-S FM include the breadth of functions that would be useful to a consumer in managing his or her healthcare?Should there be additional functionality?Are there industry trends that have not been accounted for – but should be?Are there areas for specific international scope that need to be broadened?Are the conformance criteria granular enough and comprehensive enough to support a given function?

  • Slide 22

    Status of the standard

    CurrentlyPreparing for profile developmentAnalyzing HITSP use-case alignment of EHR-S FM and PHR-S FMOffering HL7 PHR-S FM TutorialIs currently available in English

  • Slide 23

    Benefits of the standard

    Governments: Public Health data; Identify fraud and abuse; Quality Assurance; Compliance; Reduce costsPayers: Pay for performance; value-add services (e.g., Care Management); Reduce costsStandards Development organizations: reduce overlap and duplication; identify gapsConsumers: interface with provider, payer, pharmacy, Pharmacy Benefits Manager; reduce office waiting time; reduce paperwork; populate PHR’s; self-manage healthcare

  • Slide 24

    Benefits of the standard

    Vendors: System definition / scope / profiles; RFP’s; best-of-breed collaboration; certificationHealthcare Providers (primary and ancillary):modularization; apples-to-apples comparisons; simplify interfaces; purchasing incentives; access to best practices; access patient data; streamline workflowQuality-Oversight / Accreditation organizations:consent-based collection of raw data for analysis and reporting; identify providers that are outliers.

  • Slide 25

    Next steps / recommendations

    How to use / implement the standardGet the standard; review it; receive educationDevelop a “profile” (a subset) that describes your requirements

    How to influence your organizationEmphasize that the standards-based approach is cost-effective, wise, and difficult (but less difficult than NOT using standards)Note that interoperability is highly desirable for PHR’s

  • Slide 26


    HL7 develops electronic health information standardsHL7’s PHR-S FM serves as a cornerstone for defining Personal Health Record systems

  • Slide 27

    Additional information on HL7

    At the HL7 website:The standardsWorking Group MeetingsHL7 AffiliatesEducational tutorialsHL7 Ambassador speakers

  • Slide 28

    Additional information on this standard

    Visit the HL7 web site and download the PHR-S FM

    Subscribe to HL7 PHR list server

    Contact the co-facilitators:•




  • HL7 Personal Health Record System Functional Model and Standard


  • Slide 30

    Thank you!

    For more information, please contact HIMSS Staff Liaison

    JoAnn W. Klinedinst, CPHIMS, PMP, FHIMSS at

    HL7 Personal Health Record System Functional Model and StandardAbout HL7 Ambassador BriefingsTopicsHL7’s Vision / MissionExecutive Summary of the standardExecutive Summary (con’t)Business Area (domain) of the standardOverview of the standardOverview of the standardOverview of the standardOverview of the standardOverview of the standardOverview of the standardOverview of the standardOverview of the standardOverview of the standardOverview of the standardSample Function in the PHR-S FMImplementation lessons learnedStatus of the standardStatus of the standardStatus of the standardBenefits of the standardBenefits of the standardNext steps / recommendationsSummaryAdditional information on HL7Additional information on this standardHL7 Personal Health Record System Functional Model and StandardSlide Number 30

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