hed uc2 finalized technical solution
DESCRIPTION
HeD UC2 Finalized Technical Solution. The revised solution approach still aligns with the long-term industry need, but has been limited to a more manageable and Use Case-appropriate scope:. Long-term Industry Need. HeD UC2 Scope. Potential future or parallel work. CDS Request. - PowerPoint PPT PresentationTRANSCRIPT
Long-term Industry Need
HeD UC2 Scope Potential future or parallel work
Updated vMR
Model
HeD UC2 Data
Requirements
QRDA Semantics
C-CDA Semantics
HeD UC2 Finalized Technical SolutionThe revised solution approach still aligns with the long-term industry need, but has been limited to a more manageable and Use Case-appropriate scope:
Foundational Model
(e.g. FHIM)Future
Standards?
QRDAC-CDA
Harmonized vMR/QDM
Model
Request Service: DSS Request ElementRequest Items Organizer/Container: vMR
Request Item Payload: vMR Clinical Statement
vMR Payload
This approach would support vMR as the payload standard with mappings to CCDA and QRDA
CDS Request
CDS Response
HeD Schema/vMR
Response Service: DSS Response ElementResponse Items Organizer/Container: Harmonized vMR/HeD Schema
Response Item Payload: vMR Clinical Statements
Appendix
4
Use Case 2: CDS Guidance Service Transactions - Standards per Transaction
# Transaction Service Organizer/Container Item PayloadsReference
Information Model
1CDS Request (patient data
and potentially context)
• Decision Support Service (DSS)
• Context Aware Retrieval Application (Infobutton)
• CDS Knowledge Artifact Implementation Guide (HeD UC1 IG)
• Consolidated CDA• Virtual Medical Record
(vMR)
• Context Aware Retrieval Application (Infobutton)
• Virtual Medical Record (vMR)• Consolidated CDA (hL7 Clinical
Statements)• HL7 Version 3 Standard: Order Set
Publication, Release 1
• Federal Health Information Model (FHIM)
• HL7 v2.x• HL7 v3
2 CDS Response (guidance
and/or other response elements)
• Decision Support Service (DSS)
• Context Aware Retrieval Application (Infobutton)
• CDS Knowledge Artifact Implementation Guide (HeD UC1 IG)
• HL7 Version 3 Standard: Order Set Publication, Release 1
• Consolidated CDA• Virtual Medical Record
(vMR)
• Context Aware Retrieval Application (Infobutton)
• Virtual Medical Record (vMR)• Consolidated CDA (HL7 Clinical
Statements)• HL7 Version 3 Standard: Order Set
Publication, Release 1
• Federal Health Information Model (FHIM)
• HL7 v2.x • HL7 v3
Use Case 2: CDS Guidance Service Transactions - Standards per Transaction
# Transaction Transport Authentication/Authorization Encryption Vocab & Code Set
1CDS Request (patient data
and potentially context)
• SOAP• REST
• SAML • TLS • LOINC• SNOMED CT• CVX• Manufacturers of Vaccines (MVX)• OID• RxNorm• ICD-9-CM and ICD-10-CM• HCPCS• C80 - Clinical Document and
Message Terminology Component • NQF Value Sets
• ICD-10-PCS• UCUM• CPT• C154• NDC• FDA Route Administration• HL7 Vocabulary• Diagnostic and Statistical Manual
of Mental Disorders, Fourth Edition (DSM-IV)
2 CDS Response (guidance
and/or other response elements)
• SOAP • REST
• SAML • TLS • LOINC• SNOMED CT• CVX• Manufacturers of Vaccines (MVX)• OID• RxNorm• ICD-9-CM and ICD-10-CM• HCPCS• C80 - Clinical Document and
Message Terminology Component • NQF Value Sets
• ICD-10-PCS• UCUM• CPT• C154• NDC• FDA Route Administration• HL7 Vocabulary• Diagnostic and Statistical Manual
of Mental Disorders, Fourth Edition (DSM-IV)
CDS Guidance Request Transaction: Service Standards RationaleStandard
Summary of Findings from UCR
CrosswalkKeep? Rationale
Decision Support Service (DSS)HITSC Rating:*M: 78.69A: 88.6SI: 33.33T: 72.71
(Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions
(P) Partially Fits: Response Metadata;
(N) Does not Fit:
Yes • One significant gap is DSS will tie to SOAP. There is significant industry movement towards REST.
• DSS has 2 levels, one is model of the service which is implementation agnostic. Could support standard with implementation based on REST, but it would have to be developed.
• DSS is designed to be able to support patient data, unlike Infobutton.
• Has broader scope than Infobutton•
* M: Maturity A: Adoptability SI: S&I Specific T: Total
Context Aware Retrieval Application (Infobutton)
HITSC Rating*M: 90.08A: 92.11SI: 47.62T: 82.07
(Y) Fits: Context; Supporting Evidence; Supporting Resource
(P) Partially Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response
(N) Does not Fit: Clinical; Actions; Attribute Value List; Response Meta Data
No
• Can send some patient data, but not designed to support rich patient data payload like DSS
CDS Guidance Response Transaction: Service Standards RationaleStandard
Summary of Findings from UCR
CrosswalkKeep? Rationale
Decision Support Service (DSS)HITSC Rating:*M: 78.69A: 88.6SI: 33.33T: 72.71
(Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions
(P) Partially Fits: Response Metadata;
(N) Does not Fit:
Yes • One significant gap is DSS will tie to SOAP. There is significant industry movement towards REST.
• DSS has 2 levels, one is model of the service which is implementation agnostic. Could support standard with implementation based on REST, but it would have to be developed.
• DSS is designed to be able to support patient data, unlike Infobutton.
• Has broader scope than Infobutton
* M: Maturity A: Adoptability SI: S&I Specific T: Total
Context Aware Retrieval Application (Infobutton)
HITSC Rating:*M: 90.08A: 92.11SI: 47.62T: 82.07
(Y) Fits: Context; Supporting Evidence; Supporting Resource
(P) Partially Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response
(N) Does not Fit: Clinical; Actions; Attribute Value List; Response Meta Data
No
• Can send some patient data, but no designed to support rich patient data payload like DSS
CDS Guidance Request Transaction: Organizer/Container RationaleStandard
Summary of Findings from UCR
CrosswalkKeep? Rationale
CDS Knowledge Artifact Implementation Guide (HeD UC1 IG)HITSC Rating:*M: 61.39A: 86.84SI: 35.71T: 64.62
(Y) Fits: (Sender) CDS Response; (Receiver) CDS Response; Clinical; Supporting Evidence; Supporting Resource; Actions; Attribute Value List;
(P) Partially Fits: Context; Response Metadata
(N) Does not Fit: Exceptions
No • UC1 is not designed to carry patient data
• If CCDA is chosen, would probably have to use related HL7 Clinical statements for the Item Payload bucket.
• If vMR is chosen, would probably have to use the vMR Clinical Statements for the Item Payload bucket
• External options may exist for transforming CCDA request into a vMR component
• Develop options for both CCDA and vMR
* M: Maturity A: Adoptability SI: S&I Specific T: Total
Consolidated CDAHITSC Rating:*M: 53.59A: 80.70SI: 33.33T: 58.48
(Y) Fits: Clinical;
(P) Partially Fits:
(N) Does not Fit: Context, Supporting Evidence; Supporting Resource; Actions; Attribute Value List; Response Metadata; Exceptions
Yes • Can transform CCDA request into a vMR component from the execution system
• Not everything from CCDA goes easily into vMR, but vMR is designed to easily accept CCDA components
CDS Guidance Request Transaction: Organizer/Container Rationale (continued…)Standard
Summary of Findings from UCR
CrosswalkKeep? Rationale
Virtual Medical Record (vMR)HITSC Rating:*M: 78.06A: 81.58SI: 33.33T: 70.08
(Y) Fits: Clinical; Attribute Value List
(P) Partially Fits: CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Context; Supporting Evidence; Supporting Resource; Actions;
(N) Does not Fit: Response Metadata; Exceptions
Yes • Lighter weight than the other options• Developed specifically for clinical decision
support computability• Intended to be used for this initiative, and
has recently been enhanced in this respect
* M: Maturity A: Adoptability SI: S&I Specific T: Total
CDS Guidance Response Transaction: Organizer/Container RationaleStandard
Summary of Findings from UCR
CrosswalkKeep? Rationale
CDS Knowledge Artifact Implementation Guide (HeD UC1 IG)HITSC Rating:*M: 61.39A: 86.84SI: 35.71T: 64.62
(Y) Fits: (Sender) CDS Response; (Receiver) CDS Response; Clinical; Supporting Evidence; Supporting Resource; Actions; Attribute Value List;
(P) Partially Fits: Context; Response Metadata
(N) Does not Fit: Exceptions
Yes • Fits Clinical; Supporting Evidence; Supporting Resource; Actions data requirements
• Attribute value list is not supported in UC1 schema, however the schema does allow extensions using XSD
• Would use subset of HeD UC1 schema that may require further modifications
* M: Maturity A: Adoptability SI: S&I Specific T: Total
Consolidated CDAHITSC Rating:*M: 53.59A: 80.70SI: 33.33T: 58.48
(Y) Fits: Clinical;
(P) Partially Fits:
(N) Does not Fit: Context, Supporting Evidence; Supporting Resource; Actions; Attribute Value List; Response Metadata; Exceptions
Probably No
• There is a profile in IHE that uses DSS and returns IHE as an output. But hasn’t been finalized within IHE
• Lacks the ability to group and organize things the way that UC1 does
• Do not anticipate using, unless modification or subset of UC1 approach does not work
CDS Guidance Response Transaction: Organizer/Container Rationale (continued…)
StandardSummary of
Findings from UCR Crosswalk
Keep? Rationale
Virtual Medical Record (vMR)HITSC Rating:*M: 78.06A: 81.58SI: 33.33T: 70.08
(Y) Fits: Clinical; Attribute Value List
(P) Partially Fits: CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Context; Supporting Evidence; Supporting Resource; Actions;
(N) Does not Fit: Response Metadata; Exceptions
No(Probably)
• Does fit this situation, however CDS Knowledge artifact may be the better option
• UC1 action would need to be modified to represent payload for UC2 regarding vMR
• May need a model agnostic response • Do not anticipate using, unless
modification or subset of UC1 approach does not work
* M: Maturity A: Adoptability SI: S&I Specific T: Total
HL7 Version 3 Standard: Order Set Publication, Release 1HITSC Rating:*M: 46.20A: 75.44SI: 33.33T: 53.31
(Y) Fits: Supporting Evidence; Supporting Resource; Response Metadata
(P) Partially Fits: Clinical; Context; Actions
(N) Does not Fit: Attribute Value List; Exceptions
No(Probably)
• Some vendors may want to support this as an option, however CDS Knowledge Artifact is the better option
• Adoption of this standard is low, so there is not a driving reason to extend support to it
CDS Guidance Request Transaction: Item Payloads Rationale Standard
Summary of Findings from UCR
CrosswalkKeep? Rationale
Context Aware Retrieval Application (Infobutton)HITSC RatingM: 90.08A: 92.11SI: 47.62T: 82.07
(Y) Fits: Context; Supporting Evidence; Supporting Resource
(P) Partially Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response
(N) Does not Fit: Clinical; Actions; Attribute Value List; Response Meta Data
No • The information that is contained in infobutton is already represented in vMR, or if not can be
• Can use infobutton as a reference to modify vMR or CCDA
* M: Maturity A: Adoptability SI: S&I Specific T: Total
Virtual Medical Record (vMR)HITSC Rating:*M: 78.06A: 81.58SI: 33.33T: 70.08
(Y) Fits: Clinical; Attribute Value List
(P) Partially Fits: CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Context; Supporting Evidence; Supporting Resource; Actions;
(N) Does not Fit: Response Metadata; Exceptions
Yes • The vMR has relevant information in a reasonable format
• The contents and scope of the vMR are aligned with the requirements of the Use Case
• Maintained by CDS WG• As a reference model, part of its purpose
is to provide exchangeable representation clinical information
CDS Guidance Request Transaction: Item Payloads Rationale (Continued…)Standard
Summary of Findings from UCR
CrosswalkKeep? Rationale
Consolidated CDAHITSC Rating:*M: 53.59A: 80.70SI: 33.33T: 58.48
(Y) Fits: Clinical;
(P) Partially Fits:
(N) Does not Fit: Context, Supporting Evidence; Supporting Resource; Actions; Attribute Value List; Response Metadata; Exceptions
Yes • Several stake holders have a business need to have this supported
• A methodology is needed to be able to reflect changes, which currently does not exist
* M: Maturity A: Adoptability SI: S&I Specific T: Total
HL7 Version 3 Standard: Order Set Publication, Release 1HITSC Rating:*M: 46.20A: 75.44SI: 33.33T: 53.31
(Y) Fits: Supporting Evidence; Supporting Resource; Response Metadata
(P) Partially Fits: Clinical; Context; Actions
(N) Does not Fit: Attribute Value List; Exceptions
No • Order Set does not hold patient data, not suitable for request transaction
CDS Guidance Response Transaction: Item Payloads Rationale Standard
Summary of Findings from UCR
CrosswalkKeep? Rationale
Context Aware Retrieval Application (Infobutton)
HITSC Rating:*M: 90.08A: 92.11SI: 47.62T: 82.07
(Y) Fits: Context; Supporting Evidence; Supporting Resource
(P) Partially Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response
(N) Does not Fit: Clinical; Actions; Attribute Value List; Response Meta Data
No • The information that is contained in infobutton is already represented in vMR, or if not can be
• Can use infobutton as a reference to modify vMR or CCDA
* M: Maturity A: Adoptability SI: S&I Specific T: Total
Virtual Medical Record (vMR)HITSC Rating:*M: 78.06A: 81.58SI: 33.33T: 70.08
(Y) Fits: Clinical; Attribute Value List
(P) Partially Fits: CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Context; Supporting Evidence; Supporting Resource; Actions;
(N) Does not Fit: Response Metadata; Exceptions
Yes • The vMR has relevant information in a reasonable format
• The contents and scope of the vMR are aligned with the requirements of the Use Case
• Maintained by CDS WG• As a reference model, part of its purpose
is to provide exchangeable representation clinical information
CDS Guidance Response Transaction: Item Payloads Rationale (Continued…)Standard
Summary of Findings from UCR
CrosswalkKeep? Rationale
Consolidated CDA
HITSC Rating:*M: 53.59A: 80.70SI: 33.33T: 58.48
(Y) Fits: Clinical;
(P) Partially Fits:
(N) Does not Fit: Context, Supporting Evidence; Supporting Resource; Actions; Attribute Value List; Response Metadata; Exceptions
Yes • Several stake holders have a business need to have this supported
• A methodology is needed to be able to reflect changes, which currently does not exist
* M: Maturity A: Adoptability SI: S&I Specific T: Total
HL7 Version 3 Standard: Order Set Publication, Release 1HITSC Rating:*M: 46.20A: 75.44SI: 33.33T: 53.31
(Y) Fits: Supporting Evidence; Supporting Resource; Response Metadata
(P) Partially Fits: Clinical; Context; Actions
(N) Does not Fit: Attribute Value List; Exceptions
Yes • Order set model contains recommendations for clinical actions, which is applicable to the types of outputs relevant in the Use Case
CDS Guidance Request Transaction: Transport RationaleStandard
Summary of Findings from UCR
CrosswalkKeep? Rationale
SOAP
HITSC Rating:*M: 100.00A: 100.00SI: 100.00T: 100.00
(Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions
(P) Partially Fits:
(N) Does not Fit:
Yes • There is currently implementation guidance on DSS to be used with SOAP, not REST
• Has the capabilities and functions needed for this initiative
* M: Maturity A: Adoptability SI: S&I Specific T: Total
RESTHITSC Rating:*M: 100.00A: 100.00SI: 42.86T: 88.30
(Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions
(P) Partially Fits:
(N) Does not Fit:
Yes • Industry is moving towards using REST• Guidance could be written for DSS to work
with REST
CDS Guidance Response Transaction: Transport RationaleStandard
Summary of Findings from UCR
CrosswalkKeep? Rationale
SOAP
HITSC Rating:*M: 100.00A: 100.00SI: 100.00T: 100.00
(Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions
(P) Partially Fits:
(N) Does not Fit:
Yes • There is currently implementation guidance on DSS to be used with SOAP, not REST
• Has the capabilities and functions needed for this initiative
* M: Maturity A: Adoptability SI: S&I Specific T: Total
RESTHITSC Rating:M: 100.00A: 100.00SI: 42.86T: 88.30
(Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions
(P) Partially Fits:
(N) Does not Fit:
Yes • Industry is moving towards using REST• Guidance could be written for DSS to work
with REST
CDS Guidance Request Transaction: Authentication/Authorization RationaleStandard
Summary of Findings from UCR
CrosswalkKeep? Rationale
SAMLHITSC Rating:*M: 100.00A: 100.00SI: 100.00T: 100.00
(Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions
(P) Partially Fits:
(N) Does not Fit:* M: Maturity A: Adoptability SI: S&I Specific T: Total
CDS Guidance Response Transaction: Authentication/Authorization RationaleStandard
Summary of Findings from UCR
CrosswalkKeep? Rationale
SAMLHITSC Rating:*M: 100.00A: 100.00SI: 100.00T: 100.00
(Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions
(P) Partially Fits:
(N) Does not Fit:* M: Maturity A: Adoptability SI: S&I Specific T: Total
CDS Guidance Request Transaction: Encryption
StandardSummary of
Findings from UCR Crosswalk
Keep? Rationale
TLSHITSC Rating:*M: 100.00A: 100.00SI: 42.86T: 88.30
(Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions
(P) Partially Fits:
(N) Does not Fit:* M: Maturity A: Adoptability SI: S&I Specific T: Total
CDS Guidance Response Transaction: Encryption
StandardSummary of
Findings from UCR Crosswalk
Keep? Rationale
TLSHITSC Rating:*M: 100.00A: 100.00SI: 42.86T: 88.30
(Y) Fits: (Sender) CDS Request; (Receiver) CDS Request; (Sender) CDS Response; (Receiver) CDS Response; Exceptions
(P) Partially Fits:
(N) Does not Fit: * M: Maturity A: Adoptability SI: S&I Specific T: Total