Transcript EHR Functional Model

EHR Functional Model and Standard
Health Level Seven (HL7) EHR SIG
Gary Dickinson, Linda Fischetti, Sam Heard
SIG Co-Chairs
Outline
 History & Catalyst
 Functional Model
– EHR Functions
– Profiles
 Plan of attack!
© HL7 2003
Glossary
AHRQ
CMS
DHHS
EHR
EHRFM
EHR SIG
HIMSS
VA/VHA
Agency for Healthcare Research and
Quality (DHHS)
Centers for Medicare and Medicaid Services
(DHHS), formerly Health Care Financing
Administration (HCFA)
US Dept. of Health and Human Services
Electronic Health Record
EHR Functional Model
HL7 EHR Special Interest Group
Health Information Management Systems
Society
US Veterans Health Administration
© HL7 2003
Expert Panel
 Jeff Blair
– NCVHS, Medical Record Institute
 Diane Carr
– Queens Health Network
– 2002 Davies Recognition Award
 Simon Cohn, MD
– Kaiser Permanente, IOM
 Ed Hammond, PhD
– Duke University, IOM, HL7 BOD
© HL7 2003
Expert Panel, con’t
 Thomas Handler, MD
– Gartner, HIMSS EHR/Davies Criteria
 Dipak Kalra, MD
– NHS, UK
 Clem McDonald, MD
– Regenstrief Institute, University of Indiana
– LOINC
 Ron Parker
– Canadian Health Infoway
© HL7 2003
Expert Panel, con’t
 Paul Tang, MD
– Stanford University, IOM
 Charlene Underwood
– Siemens, HIMSS EHR/Davies Criteria
© HL7 2003
History & Catalyst
© HL7 2003
EHR SIG Co-Chairs
Linda Fischetti, RN MS
US Department of Veterans Affairs
Gary Dickinson
Per-Sé Technologies, Inc. US
Sam Heard, MD
OpenEHR, Australia
© HL7 2003
HL7 EHR SIG
Formed January, 2002
Establishes EHR related priorities for
HL7 Standardization
– Architectural issues – working with other
technical committees
– Functional specification
© HL7 2003
Original timeline
 Take 18 months to 2 years to write the
standard
 And then….. A customer arrived……
© HL7 2003
Dateline, Washington, DC
21st March 2003:
SCULLY URGES HOSPITALS TO HELP
DEVELOP STANDARDIZED HEALTH
RECORDS
“Tom Scully, Administrator of the federal
Centers for Medicare and Medicaid Services,
today urged hospital executives to work
with the government to develop
standardized electronic health records.”
© HL7 2003
Functional Model
© HL7 2003
Project Target
Initial Target
 EHR Functional Model and Standard– Draft Standard for Trial Use
Subsequently
 Full HL7 Standard
– Normative Document
© HL7 2003
Task
 Create a Functional Model
– Determine care delivery functions that are required across all
implementations
– Determine infrastructure functions supporting care delivery
– Determine care delivery functions that are required in
particular settings
– Allow for dynamic additions for innovation and elective
functions
 Ballot this model as a standardised description of EHR
functionality
© HL7 2003
EHR Functional Model
Functional
Profiles
Vary across
profiles
Care Delivery Functions
Infrastructure functions
© HL7 2003
Functional
Profiles
EHR Functions
© HL7 2003
Core functionality
Functional Profile
2
Functional Profile
1
Core specific
functions
Core specific functions
Essential
Essential
Core generic functions
<- Essential ->
Infrastructure functions
<- Essential ->
© HL7 2003
Core and Added Functionality
Profile 1
Profile 2
Added functions
Added functions
Desirable
Desirable
Core specific
functions
Core specific
functions
Essential
Essential
Added and innovative care delivery functions
Desirable
Core generic functions
Essential
Performance and reliability enhancement
Desirable
Infrastructure functions
Essential
© HL7 2003
Example functions
Inpatient
Functional Profiles
Medication
Administration Record
Bed
management
Drug-Drug Interactions Drug-Drug Interactions Drug-Drug Interactions.
Notes
Notes
Notes
Notes
Notes
Notes
Results Reporting
Results Reporting
Care delivery
functions
Results Reporting
Order Management
Event Capture
Order Management Order Management
Event Capture
Event Capture
Event Capture
Security Security Security Security Security Security Security Security
Management
InfrastructureDemographic
functions
Demographic Management
Standards Compliance
© HL7 2003
Standards Compliance
Increasing granularity
Care Delivery
Functions
Orders
Management
Recording
Functions
© HL7 2003
Workflow
Management
Increasing granularity
Care Delivery
Functions
Medication
Management
Laboratory
Management
Orders
Management
Imaging
Management
Recording
Functions
Referrals
Management
© HL7 2003
Workflow
Management
Functional domain hierarchies
Care Delivery Functions
ePrescribing
Medication orders
Administration recording
Warnings
Patient preferences
© HL7 2003
Functional dependencies
ePrescribing
Clinical workstation
Medication
knowledgebase
© HL7 2003
Prescription
printing
Adverse reaction
warnings
Functional dependencies
ePrescribing
Clinical workstation
Historical
recording
Problem
list
Demographic
service
Current
medication list
Past
medications
Medication
knowledgebase
User
authentication
Drug-drug
interactions
Therapeutic
precautions
Adverse
reactions
Allergies
Patient
preferences
© HL7 2003
Drug-disease
interactions
Prescription
printing
Indications
contraindications
Adverse reaction
warnings
EHR Function
Specification Triplet
For each functional element specified:
1) WHAT - Statement of function(ality)
2) WHY - Rationale (for inclusion)
3) Conformance Criteria
How = Implementation - OUT OF SCOPE
© HL7 2003
Functional profiles
© HL7 2003
What are functional profiles?
 Sets of functions
– Care setting specific
 Based on consensus
Standard
– Purpose specific
 Registered for specific use
 Not controlled through standards process
© HL7 2003
Registered
Care setting profiles
 Institute of Medicine
– Agree standard care settings
– Minimal functionality required
 Express in EHR Functional Model
– Review functions
– Ballot functions
© HL7 2003
Example functions
Inpatient
Outpatient
Profiles
Medication
Administration Record
Bed
management
Wellness Reminders
Home
Medication
Administration Record
Lifestyle
Wellness
Reminders
Drug-Drug Interactions Drug-Drug Interactions Drug-Drug Interactions.
Notes
Notes
Notes
Notes
Notes
Notes
Results Reporting
Results Reporting
Care delivery
functions
Results Reporting
Order Management
Event Capture
Order Management Order Management
Event Capture
Event Capture
Event Capture
Security Security Security Security Security Security Security Security
Management
InfrastructureDemographic
functions
Demographic Management
Standards Compliance
© HL7 2003
Standards Compliance
What are registered functional profiles?
 Sets of functions
–
–
–
–
–
Determined by users
Determined by authoritative bodies
Defined by quality or safety initiatives
Defined by regulation
Defined by payors
© HL7 2003
Profiles
Profiles
Use
Profiles
Care Setting
Profiles
Care Delivery Functions
Infrastructure functions
© HL7 2003
Profiles
Profiles
Care Setting
Profiles
Part of Standard
Provider Vendor
Profiles Profiles
Professional Regulation Accreditation
Profiles
Association
Profiles
Profiles
Registered – Not in standard
“How-to” is part of Standard
© HL7 2003
Use of Profiles
Profiles
Care Setting
Profiles
Provider
Profiles
Professional Regulation
Association
Profiles
Profiles
Vendor
Profiles
Outpatient
Oncologist
Product
X
Guideline
HIPAA
© HL7 2003
Use of the Model: Vendor
Application profile
Domains
Application
Profile 1
Laboratory result
management
Chronic disease
Prompts and recalls
ePrescribing
© HL7 2003
Application
Profile 1
Use of the Model: Provider
Domains
Laboratory result
management
Application
Profile 1
Chronic disease
Prompts and recalls
ePrescribing
© HL7 2003
Application
Profile 2
Provider
profile
EHR SIG Work Plan
Deliverables
 Top down functional decomposition
–
References and sources
 Standard care setting functional profiles
–
EHR SIG/IOM collaboration
 Functional profile “How-to”
–
–
Guidance: build, adapt, extend and integrate
profiles
Registry, conformance
© HL7 2003
Project Work & Timeline
© HL7 2003
Plan of Attack
EHR Functions
 HL7 EHR SIG
EHR Care Setting Profiles
 HL7 EHR SIG, IOM collaboration
 Profile per setting
– E.g. acute inpatient, ambulatory, long-term care, care in the
community, home health, Integrated Delivery Network
© HL7 2003
Plan of Attack (cont.)
EHR Registered Use Profile “How-to”





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Government: CMS, VA, FDA…
Accreditation
Providers, Practitioners
Vendors
Professional Societies
Patients, consumers?
© HL7 2003
Project Timeline…
21 July
 Ballot draft published - ready for meeting
23-24 July
 Open EHR SIG Meeting
End July
 Ballot draft revised - ready to ballot
1 August
 Ballot opens
1 September
 Ballot closes
© HL7 2003
Project Timeline…
8-12 September 2003
 HL7 Fall Working Group Meeting
 Memphis, Tennessee
9-11 September 2003
 EHR SIG Meeting
 Reconciliation of ballot comments
© HL7 2003
How to Participate
 Join HL7
 Subscribe to HL7 EHR SIG Listserver (HL7 members)
 Attend open public sessions (no HL7 membership
required)
 Join teleconference calls (HL7 members)
 Join ballot group (HL7 members)
 Review ballot draft (no HL7 membership required)
 Vote and submit pertinent comments (HL7 members)
© HL7 2003
Contacts
Linda Fischetti, RN
Veterans Health Administration
[email protected]
Gary Dickinson
Per-Sé Technologies, Inc.
[email protected]
Sam Heard, MD
OpenEHR, Australia
[email protected]
© HL7 2003
EHR SIG Work Plan
Functional Perspectives
 Front-end user functions
– Explicit functions
– Extrinsic - externally invoked process/action
 Embedded functions
– Implicit functions
– Intrinsic - bound to internal process
© HL7 2003
EHR SIG Work Plan
Functional Perspectives, con’t
 Service Oriented Architecture functions
 Communication functions
– Interface functions
– Multimedia functions
 Interface functions
– HL7 trigger events, messages, query/response
– In and outbound data streams
© HL7 2003
EHR SIG Work Plan
Functional Perspectives, con’t
 Reporting and notification functions
– Outbound data streams
© HL7 2003
Functional dependencies
ePrescribing
Clinical workstation
Historical
recording
Demographic
service
Medication
knowledgebase
User
authentication
Drug-drug
interactions
© HL7 2003
Drug-disease
interactions
Prescription
printing
Indications
contraindications
Adverse reaction
warnings