Transcript 20070622 - hitsp ce is03 final

Healthcare Information
Technology Standards Panel
Consumer Empowerment – Registration and
Medication History
June 22, 2007
Consumer Empowerment Registration and
Medication History
Scope
– Deploy to targeted populations a pre-populated, consumer-directed and
secure electronic registration summary. Deploy a widely available prepopulated medication history linked to the registration summary
Addresses core consumer empowerment enabling “connected PHRs”
Now recognized to be also applicable to EHR-to-EHR information
exchange for interoperable patient charts with meds, allergies,
problems, registration info.
A successful collaboration between HITSP and several HITSP
member organizations developing base standards and
implementation guides/profiles: ASTM, CAQH, CDC, FMT, HL7, IHE,
NCPDP, X12, SNOMED
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Consumer Empowerment Registration and
Medication History
class CE Interoperability Specification
«interoperability specification»
Consumer Empow erment
+
docId = IS03
contains
+
«transaction package»
Manage Sharing of
Documents
«component»
Registration and Med History
Document Content
docId = TP13
+
constrains
«composite standard»
IHE XDS
+
+
+
+
contains
contains
Provide & Register Document Set: ITI-15
Query Registry: ITI-16
Register Document Set: ITI-14
Retrieve Document: ITI-17
«transaction package»
Patient ID CrossReferencing
docId = C32
constrains
+
«base stand...
LOINC
«composite stand...
IHE PIX
constrains
«composite standard»
Federal Medication
Terminologies
constrains
-
«base stand...
X12N 270/271
docId = T23
constrains
«composite stand...
IHE PDQ
PIX Query: ITI-9
«base standard»
NCPDP SCRIPT
constrains
constrains
references
«transaction»
Patient Demographics
Query
+
constrains
implements
«base standard»
ISO 15000 ebRS
docId = TP22
constrains constrains
«composite stand...
CAQH CORE
contains
constrains
«base standard»
HL7 V2.5 Message
«base stand...
ASTM/HL7 CCD
uses
«base standard»
NDC RxNorm SPL
constrains
«base stand...
HL7 CDA R2
Healthcare Information Technology Standards Panel
«base standard»
ASTM E2369
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IS03
Consumer Empowerment Registration and Medication History
Developed in support of Harmonized Use Case for Consumer Empowerment
(Registration and Medication History), March 19, 2006
– Consumer creates account to host registration summary & medication history
– Consumer visits Healthcare Provider and provides registration summary
information
– Authorized Healthcare Provider reviews medication history
Key Requirements/Functionality Enabled by the IS
– Querying other organizations for data and matching to the consumer
– Accessing, viewing, and sharing registration summaries and medication
histories
– Note: Security and privacy in the process of being addressed.
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IS03 Consumer Empowerment Registration and Medication History
Set of Constructs
Document
Document Description
HITSP/TP13
HITSP Manage Sharing of Documents Transaction Package
– facilitates the registration, distribution and access of patient
electronic health records across health enterprises
– uses the Cross-Enterprise Document Sharing (XDS) Integrating
the Healthcare Enterprise (IHE) Integration Profile
– Based on ISO 15000
HITSP/TP22
HITSP Patient ID Cross-Referencing Transaction Package
– deals with identifying and cross-referencing different patient
attributes for the same patient.
– leverages the IHE IT Infrastructure (ITI) Technical Framework
(TF), Volume 2 (ITI TF-2) for Patient ID Feeds and Patient ID
Cross-referencing (PIX).
– Based on HL7 V2.5
HITSP/T23
HITSP Patient Demographics Query Transaction
– provide a ‘list patients and their demographics’ query / ‘patient(s)
and their demographics identified’ response message pair
– Leverages the IHE IT Infrastructure Technical Framework,
Volume 2 (ITI TF-2) for Patient Demographics Query (PDQ)
– Based on HL7 V2.5
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IS03 Set of Constructs (cont’d)
Document
HITSP/C32
Document Description
HITSP Registration and Medication History Document Content
Component
– describes the document content that summarizes a consumer’s
registration and medication data information for the purpose of
information exchange
– the registration summary is restricted to the information
consumers generally need to provide when visiting a physician,
hospital, or pharmacy, such as:
1. Demographic information sufficient to help identify the
consumer
2. Financial information sufficient for insurance eligibility
checking and claims submission
3. Basic clinical information including allergies
– the medication history (i.e., prescriptions and over-the-counter
products) is the first clinical data section and includes a core
medication summary that answers the question of “what
medications are you currently taking” and provides a path to
more complete medication history data exchange to support full
medication management
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Transaction Package TP-13 – Manage Sharing of Documents
pkg TP 13
«transaction package»
Manage Sharing of Documents
+
docId = TP13
constrains
«composite standard»
IHE XDS
+
+
+
+
 Defines the methodology and metadata
requirements for the registration, storage and
retrieval of documents across repositories
within an affinity domain
Provide & Register Document Set: ITI-15
Registry Stored Query: ITI-18
Register Document Set: ITI-14
Retrieve Document: ITI-17
 Calls out a subset of transactions defined in
the IHE XDS Cross Document Sharing
Specification, Dec 2006
– ITI 14 Register Document Set
– ITI 15 Provide and Register Document Set
– ITI 18 Registry Stored Query
– ITI 17 Retrieve Document
implements
«base standard»
ISO 15000 ebRS
 Key Concepts: Sharing of source attested
documents, document content neutral,
document registry, document repositories
distributed or centralized.
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Transaction Package TP-13 Manage Sharing of Documents
Document
Registry
Registry Stored Query
[ITI-18] 
Document
Consumer
 Register
Document Set[ITI-14]
Document Source
Provide&Register
Document Set[ITI-15] 
Document
Repository
Retrieve Document
[ITI-17] 
 Four Technical Actors, 4 Transactions:
– A Document Source that publishes a document to a repository (architecture neutral: local, shared
or central)
– A Document Repository that stores the document and forwards high-level meta-data to Document
Registry
– A Document Registry that tracks meta-data about documents
– A Document Consumer that queries the Document Registry, selects document of potential interest
and retrieves one or more from the referenced Document Repositories.
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TP22 – Patient Identity Cross-Referencing
pkg TP22
«transaction package»
Patient ID Cross-Referencing
+
docId = TP22
constrains
 Defines the methodology for identifying
and cross-referencing different patient
attributes for the same patient.
 Underlying source material is from the
IHE IT Infrastructure (ITI) Technical
Framework (TF), Volume 2 (ITI TF-2),
specifically:
–ITI-8: Patient Identity Feed [§3.8.1]
«composite standard»
IHE PIX
-
–ITI-9: Pix Query [§3.9.1]
PIX Query: ITI-9
Patient Id Feed: ITI-8
used by any system capable of
performing real-time HL7 query and
response and/or unsolicited patient
demographic feed transactions.
constrains
«base standard»
HL7 V2.5 Message
 Key Concepts
–Patient Identity Demographics, HL7
Query/Response
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Transaction Package TP22: Patient ID Cross-Referencing
Patient Identity Source
Patient Identity Feed [ITI-8]
Patient Identifier
Cross-reference
Consumer
 PIX Query [ITI-9]
Patient Identifier Crossreference Manager
 Three Technical Actors and Two Transactions
– The Patient Identity Source which creates, updates or merges Identities and
communicates them with the Patient Id Cross-Reference Manager
– The Patient Id Cross-Reference Manager that manages those identities and links
them across identification domains (Process and Algorithm are not specified by
HITSP as they are an application function within the Technical Actor).
– The Patient Id Cross-Reference Consumer which queries to link on Id in one
identification domain to Ids in one or more other identification domains.
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T23 – Patient Demographics Query
pkg T23
«transaction»
Patient Demographics Query
+
 Defines the methodology for obtaining a
patient identity (or list of patient
identities) that match a provided set of
patient demographics
docId = T23
constrains
 From the IHE IT Infrastructure (ITI)
Technical Framework (TF), Volume 2 (ITI
TF-2), specifically:
– ITI-21: Patient Demographics Query
[§3.21.1]
used by any system capable of
performing real-time HL7 query and
response and/or unsolicited patient
demographic feed transactions
«composite standard»
IHE PDQ
constrains
«base standard»
HL7 V2.5 Message
 Key Concepts
– Patient Identity Demographics, HL7
Query/Response
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TransactionT23 Patient Demographics Query
Patient Demographics
Supplier
 Two Technical Actors, One Transaction
Patient
Demographics
Query [ITI-21]
– The Patient Demographic Supplier which
manages the demographics traits of
persons.
– The Patient Demographics Consumer which
issues a Patient Demographics Query to the
Patient Demographics Supplier with some
person traits, and receives in response one
or more matching persons with those
respective traits.
Patient Demographics
Consumer
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C32 – Registration and Medication History Document Content
«component»
Registration and Med History
Document Content
+ docId = C32
maps to
constrains
 Describes the document content that
summarizes a consumer’s registration
and medication data information for the
purpose of information exchange with a
Personal Health Record (PHR)
constrains constrains
«composite stand...
CAQH CORE
«base stand...
LOINC
«composite standard»
maps to
«composite standard»
Federal Medication
Terminologies
constrains
«base stand...
X12N 270/271
IHE IT Infrastructure
«base standard»
NCPDP SCRIPT
constrains
references
«base stand...
ASTM/HL7 CCD
 Uses document content description for
the required data elements provided in:
– HL7 Implementation Guide: CDA
Release 2 – Continuity of Care
Document (CCD), Release 1.0, April
01, 2007
with additional clarifications and
specifications as appropriate
maps to
«base standard»
NDC RxNorm SPL
constrains
«base stand...
HL7 CDA R2
«base standard»
ASTM E2369
 Key Concepts
– HL7 Clinical Document Architecture
Release2, HL7 V3 Reference
Information Model (RIM), Continuity of
Care Medical Summary,
Implementation Guide, Object
Identifier (OID)
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IS03 Use of C32 Registration and Medication History
Document Content
Specific content modules each with multiple data elements include:
– Personal Information -- Languages Spoken
– Support
-- Healthcare Provider
– Insurance Provider
-- Allergies and Drug Sensitivity
– Condition
-- Medications – Prescription and Non-Prescription
– Pregnancy
-- Advance Directives
– Comments
-- Information Source
The Reg/Med document, as a whole, contains a designated author that is
the consumer and/or their designated agent, such as the parent of a minor
child
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Data Element
Free Text Sig
Indicate Medication
Stopped
Use of Component C32 :
Medications – Prescription and NonPrescription Module
Administration Timing
Frequency
Interval
Duration
Route
Dose
Key Specifications that extend CCD for medications:
 Route of Administration: Value drawn from FDA route of
administration
 Dose: Unit attribute, if present, coded using Unified Code for Units of
Measures (UCUM).
Site
Dose Restriction
Product Form
Delivery Method
Coded Product Name
Coded Brand Name
Free Text Product Name
Free Text Brand Name
Drug Manufacturer
Product Concentration
Type of Medication
 Site: a value descending from the SNOMED CT Anatomical Structure
(91723000) hierarchy.
 Product Form: from dosage form - FDA dosage form – source NCI
Thesaurus.
 Product name or brand name coded using RxNorm, or NDC. When
only the class of the drug is known, it shall be coded using NDF-RT.
FDA Unique Ingredient Identifier codes (UNII) codes may be used
when there are no suitable codes in the other vocabularies to identify
the medication.
 Indication coded using the VA/KP Problem List Subset of SNOMED
CT (terms descending from clinical finding (404684003) concept.
Status of Medication
Indication
Patient Instructions
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Data Element
Adverse Event Date
Adverse Event Type
Product Free-Text
Use of Component C32 :
Allergies and Drug Sensitivities Module
Key Specifications that extend CCD for allergies and drug
sensitivities:
 Adverse Event Type: see below. Support tiered level of specifics.
Product Coded
 Severity: see below
Reaction Free-Text
Reaction Coded
 Product causing the adverse event coded to UNII for Food and
substance allergies, or RxNorm when to medications, or NDF-RT
when to classes of medications.
Severity Free-Text
Severity Coded
 Reaction coded using the VA/KP Problem List Subset of SNOMED
CT (terms descending from clinical finding (404684003) concept.
SNOMED CT Preferred Terms for Adverse
Event Type
SNOMED CT
Preferred Terms
for Severity
SNOMED
CT Code
propensity to adverse reactions
SNOMED
CT Code
Usage
420134006
Used to record an adverse reaction.
418038007
Used to record an adverse reaction to an environmental agent.
propensity to adverse reactions to drug
419511003
Used to record an adverse reaction to a drug.
propensity to adverse reactions to food
418471000
Used to record an adverse reaction to a food.
allergy to substance
419199007
Used to record an allergy to an environmental agent.
propensity to adverse reactions to substance
mild
255604002
mild to moderate
371923003
moderate
6736007
drug allergy
416098002
Used to record an allergy to a drug.
moderate to severe
371924009
food allergy
414285001
Used to record an allergy to a food.
severe
24484000
drug intolerance
59037007
Used to record intolerance to a drug.
fatal
399166001
food intolerance
235719002
Used to record intolerance to a food.
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PHR
Service Provider
Consumer
EHR
System
RHIO
Health Plan /
Intermediaries
PBM /
Pharmacies
Logon to PHR
a
b
PIX
Consumer
PIX Query
c
e
Document
Consumer
PIX
Mgr
Query Documents d
Retrieve Docs
(Reg/Med Doc)
f
g
Retrieve Docs
(Reg/Med Doc)
g
h
h
Document
Repository/
Registry
i
PIX
Consumer
j
PIX Query
X12 270/271 Core
X12 270/271 Core
Document
Repository/
Registry
PIX
Mgr
Provide & Register
k
(Reg./Med. Doc) l
m
o
Document
Source
PIX Query
PIX
Consumer
n
p
Provide & Register
q
r
PIX Query
s
NCPDP SCRIPT 8.1
Document
Source
PIX
Consumer
t
Provide & Register
v
u
PIX
Consumer
PIX Query
w
y
Document
Consumer
Document
Source
A
C
Query Documents x
Retrieve Docs
(Reg/Med Doc)
Retrieve Docs
(Reg/Med Doc)
PIX
Mgr
INTEROPERABILITY SEQUENCE DIAGRAM
Z
B
D
Document
Repository/
Registry
Healthcare Information Technology Standards Panel
CE – Scenario #2 – Customer Visits
Health Care Provider and Provides
Registration Summary Information
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EHR
System
RHIO
Document
Repository/
Registry
i
PBM /
Pharmacies
Health Plan /
Intermediaries
PIX
Consumer
PIX Query
j
X12 270/271 Core
X12 270/271 Core
Provide & Register
k
(Reg./Med. Doc) l
m
o
PIX
Mgr
q
s
PIX Query
Document
Source
PIX
Consumer
n
p
Provide & Register
r
PIX Query
Provide & Register
u
NCPDP SCRIPT 8.1
Document
Source
PIX
Consumer
t
v
Document Source
Populating the RHIO with a Consumers Registration and Medication Information
• Uses PIX Query (TP13) to Correctly Identify the Consumer [i-j, m-n, q-t]
• Physicians Provide & Register a Registration and Medication Document
(C32) with Information Available in EHR System (self-generated or
received from other sources) [k-l]
• Health Plans & PBMs/Pharmacies Provide & Register C32 Document
Directly to RHIO [ o-p, s-v] or via the EHR-System (using X12 or NCPDP
transactions)
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Consumer
EHR Sys, or
payer, or
health plan
PHR Service Provider
RHIO
Document
Repository/
Registry
Select PHR
Consumer Consent
PIX
Consumer
PIX Identity Feed
& Query
Document
Source
Provide & Register
(Reg./Med. Doc)
View Reg/Med
Modify Reg/Med
EHR
PIX
Mgr
PIX Query
Query Documents
Retrieve Docs
(Reg/Med Doc)
Retrieve Docs
(Reg/Med Doc)
PIX
Consumer
Document
Consumer
INTEROPERABILITY SEQUENCE DIAGRAM
CE – Implementation/Architecture Variant A – No RHIO is
present – RHIO functions are assumed by PHR Service provider
Healthcare Information Technology Standards Panel
View and Integrate
Registration Data
into EHR
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Consumer
EHR Sys, or
payer, or
health plan
PHR Service Provider
RHIO
Document
Repository/
Registry
Select PHR
Consumer Consent
PIX
Consumer
PIX Identity Feed
& Query
Document
Source
Provide & Register
(Reg./Med. Doc)
View Reg/Med
Modify Reg/Med
EHR
PIX
Mgr
PIX Query
Query Documents
Retrieve Docs
(Reg/Med Doc)
Retrieve Docs
(Reg/Med Doc)
EHR to EHR communication – Care Delivery Level Information
Healthcare Information Technology Standards Panel
PIX
Consumer
Document
Consumer
View and Integrate
Registration Data
into EHR
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Strength of IS-03: synergy between its four constructs
 Effective interoperability:
– Independent conforming implementations will interoperate (all dimensions of
interoperability covered, including sharing/selective access, transport and identity mgt).
– Semantic Interoperability with core clinical content:med, allergies, problems/conditions,
and real-world clipboard information.
– Designed to empower equally the consumers and their providers (PHR-PHR, PHR-EHR,
EHR-EHR) with the same level of robustness.
 Practical interoperability:
– Standards that already have “implementation feasibility” validated (IHE Connectathon,
HIMSS Interoperability Demonstration) with a significant number of implementations
(prototype and commercial).
 Flexible interoperability:
– Designed to allow “receivers of information” to operate at various level of richness:
display (browser+any CDA style sheet)
Import the “entire document”
Import discrete coded data
 Secured and Private interoperability:
– 6 Security Constructs in development by HITSP (October 2007) to support IS-03.
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