Transcript Slide 1
Personal Health Records Portability April 11, 2008 Webinar Plan to Plan Data Transfer of PHR CCD Implementation Guide Ballot © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Introduction This webinar is being provided as an industry service Questions will be addressed in a Q&A period at the end of this ballot briefing © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Agenda 1. 2. 3. 4. 5. 6. 7. Overview of HL7, our current PHR & CCD initiatives Introduction of the session speakers Context and Background for the X12 & HL7 roles in the Plan to Plan Data Transfer for PHR Update and Overview on the X12 275 transaction CCD IG Overview • Background on CDA and CCD • High-level review of the CCD Implementation Guide Update and Expectations for the Ballot process Questions and Answers © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Health Level Seven (HL7) HL7 is a collaborative volunteer-driven organization with 2300 individual and corporate members HL7 members represent vendors, consultants, provider organizations, payers, government agencies and the regulated products industry. HL7 has developed and published more than 30 American National Standards HL7 has a worldwide presence with Affiliates in more than 30 countries around the globe HL7 is an ANSI accredited standards developer For more information visit www.HL7.org © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. HL7 Vision To create the best and most widely used standards in healthcare. © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. HL7 Mission HL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, the vendor community, fellow SDOs and patients. In all of our processes we exhibit timeliness, scientific rigor and technical expertise without compromising transparency, accountability, practicality, or our willingness to put the needs of our stakeholders first. © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. American National Standards Institute ANSI Accredits Standards Developing Organizations Approves all American National Standards Liaison to standards bodies in other countries Proponents of open consensus process © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Objectives of this Webinar Provide an overview of current PHR and CCD initiatives Ensure that the industry has an awareness and understanding of the opportunity for participation in April, May and June Provide for a forum for Q&A on this particular PHR portability effort © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Status of CDA Implementation Guides HL7-balloted Implementation Guides: Continuity of Care Document (CCD) History & Physical (H&P) Consult Note Healthcare Associated Infection Operative Note Diagnostic Imaging Reports Personal Health Monitor Report PHR2PHR Summary Quality Reporting Document Arch others in development: anesthesiology, anatomic pathology, w/ASTM CDA4CDT CDA4CDT CDC/NHSN CDA4CDT w/DICOM w/Continua w/AHIP/BCBSA w/QRDA complete complete* complete* complete* May ’08** May ’08** May ’08** May ’08** Sept ’08** lab, long term care, pediatrics * = will be published shortly ** = first ballot © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Status of PHR-S FM Draft Standard for Trial Use Ballot The PHR-System Functional Model: Balloted in November 2007 Reconciliation Complete in March 2008 Anticipate Publication in June 2008 Lists the functions that PHR systems should or may perform Provides support for a certification framework Serves as an anchor point for PHR system interoperability © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Speakers: Lenel James, Blue Cross and Blue Shield Association Co-lead of PHR-S Functional Model DSTU ballot BCBSA project team liaison Liora Alschuler, Alschuler Associates, LLC Co-Editor, CDA; Co-Chair, HL7 Structured Documents Work Group; Co-Editor, Plan-to-Plan PHR Data Transfer IG © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Agenda 1. 2. 3. 4. 5. 6. 7. Overview of HL7, our current PHR & CCD initiatives Introduction of the session speakers Context and Background for the X12 & HL7 roles in the Plan to Plan Data Transfer for PHR Update and Overview on the X12 275 transaction CCD IG Overview • Background on CDA and CCD • High level review of the CCD Implementation Guide Update and Expectations for the Ballot process Questions and Answers © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Health Plan Commitment to Advancing Health Information Exchange Health IT will help transform our industry and making PHRs available to consumers is a key building block of that vision Offering PHRs : a natural extension of what Plans do Information collection from full range of providers and settings Pre-populate and update PHRs PHR adoption promoted via well established relationships with consumers and providers Key Outcomes Affordable 1st steps Build toward interoperability Spur consumer uptake Immediate availability Increase provider adoption Empower consumers PHRs integrated with health plan tools to improve care © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Developing Plan-to-Plan PHR Data Feed: CORE CONCEPTS Data follows the member Plan and Member data sources Enrollment-related data Claims-related data Member self-reported data Health plans are already implementing PHRs Longitudinal data also available for consumer wellness tools Emphasis on preserving the longitudinality of PHR data Not lost when member changes coverage from one health plan to another “Portability” not “interoperability:” Prior data incorporated with current data for new Plan’s Member view Data transfer is after-the-fact to change of health plan Data not used for rating/underwriting © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Participants Subscriber - an individual eligible for coverage because of their association with a sponsor. Owner of their PHR data. Also, known as the health care consumer. May include dependents of the subscriber. Sponsor - A sponsor is the party that ultimately pays for the coverage, benefit, or product. Can be an employer, union, government agency, association, or insurance agency. Health Insurance Plan - The product, coverage, and benefits provided to an enrolled individual. Predecessor is the sending health plan or current custodian of the PHR Successor is the receiving health plan or the new custodian of the PHR © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. AHIP/BCBSA Project Overview Developed prototype for PHR data and portability Created an initial implementation guide Developed operating rules Pilot-test of plan-to-plan transfer Hand-off to X12 and HL7 Draft X12 and HL7 standards, Spring 2008 Pilot test of clinical data transfer, Summer 2008 Finalize X12 and HL7 standard, Fall 2008 Operationalize plan-to-plan transfer, 2009? © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. AHIP/BCBSA Project Overview AHIP and BCBSA developed a payer-based Personal Health Record data transfer standard framework where the data follows the Member Deliverables 16 Standard PHR Data Domains: Patient Information, Encounters, Medications, more Map identifying the data source Data Dictionary Implementation Guide and Operating Rules Plan-to-Plan standard for transferring PHR information Portability standards in synch with AHIC/HITSP/HL7 and will impact standardization of PHR core data elements across vendors © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Core PHR data set was confirmed across constituents* Patient Patient Information Family History Physiological Information Encounter Medication Immunization Provider Facility Benefit Information Health Risk Factors ** ** ** ** ** ** ** ** ** ** Emergency Physician Primary Care Specialist *** ** *** ** *** * ** * *** ** ** ** ** ** ** ** * Relevance Scale * Low ** Medium *** High Provider surveys and interviews show: Different data are prioritized by context and specifics of ‘use case’ Physicians suggested pilot of confirm PHR standards and confirm value Physicians concerned about liability, roles and workflow disruption Largest incentive would be ease of use and transparency of value * Health insurance plans, providers, consumers, standards bodies and vendors ADOPTION “Give me one access point and give me only relevant data; I have 15 seconds to make a decision” – Emergency Department Physician Content and Data Stakeholder discussions have confirmed and prioritized data domains Self-Reported Data: Domain Domain Details Patient Information Demographic and personal information including advanced directives and living wills Family History Possible health threats based on familial risk assessment Physiological Information Health Risk Factors System Populated Data: Domain Encounter Data pertaining to individual encounters with the care continuum either in patient or outpatient including diagnoses, procedures, etc. [HIPAA, HL7, CCD, SNOMED, LOINC, DICOM, ICD9/10, APG, CPT4] Medication Medication history such as medication name, dosage, etc. Provider Information regarding clinicians who have provided services to the individual (ties to encounters) Facility Information regarding facilities where individual has received services (ties to encounters) Benefit Information Basic benefits information such as eligibility, copays and deductibles Immunization Information regarding immunizations such as vaccine name, vaccination date, etc. Physiological characteristics such as allergies, blood type, height, weight, etc. Patient’s habits, such as smoking, alcohol consumption, substance abuse, etc. * Benefit information will be populated by each plan; portability of this information is not currently being addressed by PHR specifications. Domain Details Standard PHR Data Domains Domain Domain Summary Patient Information Demographic and personal information, emergency contacts, PCP, etc. Family History Possible health threats based on familial risk assessment Physiological Info. Physiological characteristics such as blood type, height, weight, etc. Encounter Encounter data in inpatient or outpatient settings for diagnoses, procedures, etc. Medication Medication history such as medication name, prescription date, dosage, etc. Immunization Information regarding immunizations such as vaccine name, vaccination date, etc. Provider Information regarding clinicians who have provided services to the individual Facility Information regarding facilities where individual has received services Health Risk Factors Patient’s habits, such as smoking, alcohol consumption, substance abuse, etc. Advance Directives Advance directives documented for the patient for intubation, resuscitation, IV fluid, etc. Alerts Patient’s allergy and adverse reaction information Health Plan Info. Used for plan to plan PHR transfer. Information about the sender and recipient plans; the originator of the PHR for the consumer download of PHR. Plan of Care Any reminder, order, and prescription, etc. recommended by the care management and disease management for the patient. White Rows are Self-Reported Information Yellow Rows are Systems-Populated Information Operating Rules Framework PHR Operating Rules Framework Access: Defines access to data, information inclusion, delegation Control Interoperability Presentation Portability Control: Defines controls over PHR and usage Privacy / Security Legislative / Regulatory Access Standards Adherence Presentation: Defines requirements for data presentation consistency across specified media Interoperability: Defines data, technical and business process requirements to enable transfer of data between systems Portability: Defines requirements that enable data to be extracted from the PHR and transported by specified media Standards Adherence: Defines which standards the PHR leverages The PHR Consensus Group must define rules for each of the operational domains of a PHR standard Legislative / Regulatory: Defines federal, state, local, regulatory compliance Privacy / Security: Defines organizational and regulatory compliance rules Agenda 1. 2. 3. 4. 5. 6. 7. Overview of HL7, our current PHR & CCD initiatives Introduction of the session speakers Context and Background for the X12 & HL7 roles in the Plan to Plan Data Transfer for PHR Update and Overview on the X12 275 transaction CCD IG Overview • Background on CDA and CCD • High level review of the CCD Implementation Guide Update and Expectations for the Ballot process Questions and Answers © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Business Use • Support Health IT: help consumers to document and manage their health events and improve communication with health care stakeholders to improve patient safety, health care outcomes and quality care: – By providing a standardized specification for one health insurance plan to electronically send PHR data to another health insurance plan: • X12 275 (X274)Transaction • HL7 Clinical Document Architecture (CDA) Release 2 (R2) based upon CCD – Include claim data, medications, administrative data, information about providers and facilities, self reported data, and other relevant clinical information ASC X12 275 (X274) Standard Transaction • Plan to Plan PHR Data transfers – Maximize usage of existing HIPAA transaction infrastructure; – Supports both bulk (employer group) and individual transmission; – Practical transfer of PHR data for large number of subscribers to single destination; – Allows for future EHR data from providers into PHRs hosted at health plans; – Supports use of XML for PHR encoding, as used in CCD. 275 for Transfer of PHR Data Milestones to Publish the X12 Implementation Guide • Version 5050 published in the third quarter 2008 – 3/17 Get a complete, clean copy of version 5050 – 3/24 Obtain TG4/TG8 Approval by 4/15 – 4/15 Post the draft for Public Comment Period for 30 days – 5/19 Reconcile and post comments – 6/03 Informational Forum at X12 meeting (6/01/08 – 6/07/08) – 6/05 Approved vote to publish – 9/30 WPC publishes 275 X274 version 5050 TR3 Webinar April 24, 2008 @ 2pm ET Agenda 1. 2. 3. 4. 5. 6. 7. Overview of HL7, our current PHR & CCD initiatives Introduction of the session speakers Context and Background for the X12 & HL7 roles in the Plan to Plan Data Transfer for PHR Update and Overview on the X12 275 transaction CCD IG Overview • Background on CDA and CCD • High level review of the CCD Implementation Guide Update and Expectations for the Ballot process Questions and Answers © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. HL7 V3:CDA:CCD:P2P How do they all relate? Worldwide agreement at the most abstract, general level HL7 V3 RIM, data types are ISO standards CDA is in use worldwide Community of interest agreement at the most specific level CCD represents exchange requirements in the US P2P represents exchange requirements for Plans © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. HL7 V3:CDA:CCD:P2P Common foundation at highest level of common implementation data types, model in use globally specific data elements defined for this application How is this expressed? each specification is a set of constraints on the more general standard CDA constrains the RIM CCD constrains CDA P2P PHR constrains CCD © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. HL7 V3:CDA:CCD:P2P Pluses & Minuses of this approach Pluses: highly interoperable across domains locally customizable efficient specification of each layer of constraint Minuses each layer specifies only the constraint, so, is not a full recipe for implementation © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Clinical Document Architecture Clinical Document Architecture (CDA) is a Version 3 specification ANSI / HL7 CDA R1 1.0 - 2000 ANSI / HL7 CDA R 2.0 - 2005 CDA is a specification for a document exchange using Extensible Markup Language (XML) The HL7 Reference Information Model (RIM) Version 3 methodology Vocabulary - SNOMED, ICD, local... © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Clinical Document Architecture CDA Release 2, section 2.1: A clinical document …has the following characteristics: Persistence Stewardship Potential for authentication Context Wholeness Human readability CDA = Header + Body © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Clinical Document Architecture CDA Header Metadata required for document discovery, management, retrieval CDA Body: Human Readable Clinical Report Discharge Summary Care Record Summary Progress Note H&P Public health report Any content that carries a signature © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Sample CDA Header Body Readable: required Computable: optional © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. CDA: Incremental Semantic Interoperability Standard HL7 metadata Simple XML for point of care human readability RIM semantics for reusable computability (“semantic interoperability”) © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Relationship to HL7 messages CDA complements HL7 messaging specs A CDA document is a defined and complete information object that can exist outside of a messaging context A CDA document can be a MIMEencoded payload within an HL7 message © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Relationship to HL7 messages CDA documents are encapsulated as MIME packages within HL7 messages HL7 V3 <someMessage> <Act.Code code="11488-4“ codeSystem="2.16.840.1.113883..." displayName="Consultation note"/> <Act.text type="multipart/related"> MIME-Version: 1.0 Content-Type: multipart/related; boundary="HL7-CDAboundary"; type="text/xml"; start="10.12.45567.43" Content-Transfer-Encoding: BASE64 --HL7-CDA-boundary Content-Type: text/xml; charset="US-ASCII“ Content-ID: <10.12.45567.43> ... Base 64 of base CDA document, which contains ... <observationMedia classCode="OBS" moodcode="EVN"> <id root="10.23.4567.345"/> <value mediaType="image/jpeg"> <reference value="left_hand_image.jpeg"/> </value> </observationMedia> ... --HL7-CDA-boundary Content-ID: <10.23.4567.345> Content-Location: canned_left_hand_image.jpeg Content-Type: image/JPEG ... Base64 image ... --HL7-CDA-boundary-</Act.text> © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. </someMessage> HL7 V2.x MSH|... EVN|... PID|... PV1|... TXA|... OBX|1|ED|... |... General Relationship to Messaging CDA can be the payload in any kind of message V2 X12 V3 XDS And can be passed from one kind to another © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Primary Use Cases access/portability/exchange integration query/locate by patient, provider, practitioner, setting, encounter, date access distributed information through common metadata document management transcription systems EHR records re-use/derivative data summaries, reports decision support © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. CDA for Information Exchange in the US Recommended by Health Information Technology Standards Panel (HITSP) work groups CMS Notice of Proposed Rule Making Claims attachments using CDA + X12 First pilot concluded, others underway Widespread vendor adoption: Integrating the Healthcare Enterprise CDA4CDT Other © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. CDA Implementation Guides The CDA itself is generic To define specific requirements, CDA is constrained through Implementation Guides (IGs) Specific use case, audience, application Balloted Implementation Guides: Continuity of Care, transfer of care H&P, US realm, history-taking Consult Report, US realm, consultations Healthcare Associated Infection Reports, US CDC, National Healthcare Safety Network © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Conformance to template ID DOCUMENT LEVEL: <ClinicalDocument xmlns='urn:hl7-org:v3'> <typeId extension='POCD_HD000040' root='2.16.840.1.113883.1.3'/> <templateId root='2.16.840.1.113883.10.20.1'/> … </ClinicalDocument> PATTERN LEVEL: <Section> <templateId root='2.16.840.1.113883.10.20.1.14'/> … <Observation classCode=”OBS” moodCode=”EVN”> <templateId root='2.16.840.1.113883.10.20.1.32'/> … </Observation> </Section> © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Validation All instances are valid CDA maintain and validate multiple document types using single generic schema single stylesheet rendering Schematron/XPath statements validate constraints that can’t be specified in W3C schema language validate constraints specific to IG © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. HL7/ASTM Continuity of Care Document (CCD) A CDA Implementation Guide, issued April, 2007 Constrains CDA to represent the data elements of the ASTM Continuity of Care Record (CCD) © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. ASTM CCR+HL7 CDA = CCD CCR Primary use case CDA snapshot in time summary of the pertinent clinical, demographic, and administrative data for a specific patient supports professional society recommendations, national clinical practice guidelines, standardized data sets, etc... ASTM CCR is a standardized data set that can be used to constrain CDA specifically for summary documents Result: The Continuity of Care Document (CCD). © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Continuity of Care Document CCD maps the CCR elements into a CDA representation. CCR data element CDA R2 correspondence Results Section Result Observation DateTime Observation / effectiveTime IDs Observation / id Description Observation / code Status Observation / statusCode © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Continuity of Care Document CCD maps the CCR elements into a CDA representation. <section> <Results> <Result> <code code="30954-2“ <CCRDataObjectID> codeSystem="2.16.840.1.113883.6.1" 2.16.840.1.113883.19.1 codeSystemName="LOINC"/> </CCRDataObjectID> <title>Laboratory results</title> <DateTime> <text> <Type> CBC (04/07/2000): HGB 13.2; WBC 6.7; PLT 123* <Text>Assessment Time</Text> </text> </Type> <entry> <ExactDateTime> <observation classCode="OBS" moodCode="EVN"> 200004071430 <id root="2.16.840.1.113883.19" extension=" </ExactDateTime> <code code="43789009" </DateTime> codeSystem="2.16.840.1.113883.6.96" <Type> codeSystemName="SNOMED CT" <Text>Hematology</Text> displayName="CBC WO DIFFERENTIAL"/> </Type> <statusCode code="completed"/> <Description> <effectiveTime value="200004071430"/> <Text>CBC WO DIFFERENTIAL</Text> <Code> <Value>43789009</Value> <CodingSystem>SNOMED CT</CodingSystem> </Code> </Description> <Status><Text>Final Results</Text></Status> © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. CDA beyond CCD How do other exchange requirements relate to CCD? Not everything we want to exchange is a summary or the same kind of summary Some implementation guides re-use CCD templates H&P, Consult... Other implementation guides are strict constraints on CCD P2P PHR © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. CDA for Common Document Types Project initiated in January, 2007 M*Modal AHDI(was AAMT)/MTIA AHIMA Strong support from dictation / transcription and document management industries Cooperation/coordination with HL7, IHE, EHR vendors and providers Developed and brought to ballot: History & Physical Consult Report Operative Note Diagnostic Imaging Reports (with DICOM) © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Other current projects Pilots: Healthcare Associated Infection Reports Cancer Abstract submission with Centers for Disease Control and Prevention CDA R2 reporting to the National Health Safety Network North American Association of Central Cancer Registries Evaluation: Long Term Care documentation Quality reporting Many domain-specific reports © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Other CDA Implementation Guides IHE 2006: 1 content type built on HL7 CRS 2007: 7 content types, some constrain CRS, others new HITSP: included in all use cases – adopting pre-defined profiles, so far... Providers: MHS, VA, Mayo, UPMC, NY Presbyterian, BIDMC, others Internationally: sets of IGs in Germany, Finland, Greece, Canada, Japan, Korea, UK, France, Italy © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. HL7 Plan to Plan PHR Implementation Guide © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. P2P PHR IG Structure Formal specification: A set of constraints on the CCD Illustration of how to use CDA, CCD to convey information between Plans Full sample instance © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Here’s a look at a sample of the P2P PHR Display is HTML Underneath is XML Basic sample document is from CCD ballot Customized for P2P exchange conforms to further constraints of the IG illustrates the full range of data envisionned © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. P2P PHR sample © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Structure of the IG Introduction Purpose, audience, approach Use of templates, conventions Scope P2P constraints on the CCD header P2P constraints on the CCD body References and appendices © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. P2P Introduction: Scope “The goal of the Plan-to-Plan Personal Health Record (P2PPHR) Data Transfer Project is to create an HL7 implementation guide that will provide for PHR portability between Health Plans.” US Realm, may be expanded later Constraints on CDA Assumes highly coded content incorporates CCD templates defines additional templates specific to this IG does not allow non-XML document body HITSP C32 compatible C32 is narrower in scope © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. P2P: Header Constraints inherited from the CCD Must carry document-level template IDs A templateId element SHALL be present representing conformance to the Continuity of Care Document (CCD) (templateId 2.16.840.1.113883.10.20.1). A templateId element SHALL be present representing conformance to the constraints of this guide (templateId 2.16.840.1.113883.10.20.8). © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. P2P Header: Participants Not constrained beyond CCD IG illustrates how to indicate that parts of the document have different authors in header sections/entries Patient as author, informant author if they originate the data informant if they are entering data from another source © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. P2P Body: Sections All sections optional Must have at least one Sections must have text, may have entries Sections can be in any order Sections can nest Additional sections, not defined here, can be included © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. P2P Body: Social History 3.2.1 Social History 29762-2 “29762-2” is the LOINC code for Social History According to CCD, section contains “data defining the patient’s occupational, personal (e.g. lifestyle), ...” P2P also constrains vocabulary for spoken language of the patient lists data elements that are “required if known” illustrates use of CCD template to indicate patient citizenship © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. P2P Body: Social History Vocabulary constraint The patient's spoken language, if known, shall be recorded as a Social History Observation (CCD templateId 2.16.840.1.113883.10.20.1.33) where observation/code is 61909002 from code system 2.16.840.1.113883.6.96 SNOMED CT STATIC and observation/value is selected from code system 2.16.840.1.113883.6.121 RFC3066 STATIC. Means: use CCD template and use RFC-3066 for the value (language code) © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. P2P Body: Social History Required if known © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. P2P Body: Social History © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. P2P Body: Social History © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. P2P Body: Social History Entries for language, citizenship © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. P2P Body: Sections 3.2.1 Social History 29762-2 15 3.2.2 Family History 10157-6 19 3.2.3 Advance Directives 42348-3 24 3.2.4 Problems 11450-4 26 3.2.5 Alerts (Allergies) 48765-2 29 3.2.6 Medications 10160-0 30 3.2.7 Immunizations 11369-6 37 3.2.8 Results 30954-2 38 3.2.9 Encounters 46240-8 43 3.2.10 Plan of Care 18776-5 45 3.2.11 Vital Signs 46 3.2.12 Payers 8716-3 48768-6 49 © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. P2P: Appendices References: to cited specifications Appendix A: templates defined in this IG Appendix B: Value sets referenced in the IG (only 2 defined in this IG) Appendix C: Vocabularies refenced in the IG © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Agenda 1. 2. 3. 4. 5. 6. 7. Overview of HL7, our current PHR & CCD initiatives Introduction of the session speakers Context and Background for the X12 & HL7 roles in the Plan to Plan Data Transfer for PHR Update and Overview on the X12 275 transaction CCD IG Overview • Background on CDA and CCD • High level review of the CCD Implementation Guide Update and Expectations for the Ballot process Questions and Answers © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. The HL7 Ballot Process Join the ballot pool 1. Provide your contact information Identify the constituency to which you belong Can register up to two weeks before the ballot closes 2. Download and review the draft document 3. Submit your vote © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. The HL7 Ballot Process Votes Can Take One of Three Forms: Affirmative – can include comments Negative – MUST include rationale and, we hope, suggestions for improving Abstain – Better than not voting © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. The HL7 Ballot Process See link for how to join the pool as a nonmember http://www.hl7.org/ctl.cfm?action=ballots.n onmemberjoin&ballot_cycle_id=514 P2P PHR Ballot closing date is April 28, 2008 (Monday, April 14th final day to join) Ballot comment discussions at May 4 – 9 Workgroup Meeting, Phoenix, in Structured Document Technical Committee © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office. Questions? © 2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Office.