HSPC and CIIC September 13, 2018 1 Agenda Why semantic - - PowerPoint PPT Presentation
HSPC and CIIC September 13, 2018 1 Agenda Why semantic interoperability? What would the architecture of an interoperable system look like? Background and history of HSPC and CIIC The merger of HSPC and CIIC Current activities
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Patient
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James # 6
Neal G. Reducing risks in the practice of hospital general medicine. In Clinical Risk Management, 2nd edition. British Medical Journal, 2001. Chantler, Cyril. The role and education of doctors in the delivery of health care. Lancet 1999; 353:1178-81.
Heterogeneous Systems
Others…
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FHIR Profiles from CIMI detailed clinical models
Real Impact
Real Impact
Semantically Interoperable Healthcare focused Apps
Healthcare App Store
Repository of Shared Models in an approved Formalism Model Review
SOLOR
SNOMED CT LOINC RxNorm Core Reference Model
Standards Infusion Model Dissemination
Translators HL7 FHIR Profiles
Practicing Clinical Subject Matter Experts
ACOG – OPA modeling FPAR Application Development
FPAR Application
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HL7 Version 2 Compliance HL7 FHIR Compliance Argonaut Compliance HSPC Compliance
Structure, No terminology Constraints Structure(s), Generic LOINC
Common resources, extensions and some specific LOINC and SNOMED
1 Preferred structure, standard extensions, explicit LOINC and SNOMED, units, magnitude, …
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2014
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Improve health by creating a vibrant, open ecosystem of interoperable applications, content, and services. Be a provider‐led organization that accelerates the delivery of innovative healthcare applications that improve health and healthcare.
HSPC Mission HSPC Vision
Organizational Guiding Principles
(HL7 hosted first meeting in 2009)
across the breadth of medicine for:
NCI, AHRQ, NIAID, DoD, VA, PCPI, AMIA, SPM, HIMSS and many other
continue
and post coordination)
infarction, heart failure, chronic renal failure, etc.
Argonauts create
trust agreements, and data exchange infrastructure
that are essential for interoperability
models
VSAC
CIMI models
Interoperability, AMA Integrated Health Model Initiative, CDEs, openEHR, OMOP (OHDSI)
groups with whom we have overlapping interests
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and knowledge sharing (as represented by HSPC)
and make faster progress
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Intermountain
Intermountain
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Board Technical Steering Committee Nominates Candidates to Board Executive Leadership
and values of the organization are carried out
community
not the stakeholder group that they come from Clinical Steering Committee Specialty Societies Provider Organization Nominates Candidates to Board
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Surgeons
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ecosystem
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James E. Tcheng, MD Rebecca Wilgus, RN, MSN Grant support provided by the Pew Charitable Trusts
Convening the Registry Community
recommendations (for db developers)
Steve Hasley, ACOG CMIO
7.2 million encounters annually 4.1 million clients 4,127 Service delivery sites 1,134 Sub recipients 50+ States & territories funded by 94 Grantees monitored by 20 Regional OPA FTEs supported by 10 Regional Health Administrators 5 National Training Centers 1 OPA HQ
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Source: Family Planning Annual Report: 2014 (Aug 2015)
The 10 HHS Federal Regions
Converge: Draft 2.0 Data Elements
status
entry & exit or Reason for no method
test
Chlamydia, Gonorrhea, and HIV
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FPAR2.0@hhs.gov
7.2 million encounters annually 4.1 million clients 4,127 Service delivery sites 1,134 Sub recipients 50+ States & territories funded by 94 Grantees monitored by 20 Regional OPA FTEs supported by 10 Regional Health Administrators 5 National Training Centers 1 OPA HQ
Source: Family Planning Annual Report: 2014 (Aug 2015)
The 10 HHS Federal Regions
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Approved for Public Release; Distribution Unlimited. Case Number 16-1988
Cancer Data Interoperability Project Every patient’s journey improves all future care
Steve Bratt
Leader, Health Standards and Interoperability Group The MITRE Corporation sbratt@mitre.org Presented at the 17th General Meeting of HSPC Joint with CIIC / Bethesda, MD / 31 July 2018
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Approved for Public Release; Distribution Unlimited. Case Number 16-1988
Cancer Data Interoperability Project
[integrating the MITRE-funded Standard Health Record (SHR) for Oncology initiative]
Flux Notes
Capture: Collect and Visualize
Goal: Demonstrate low burden, incentivized collection of high-quality, standardized treatment data at point of care
ICAREdata Study
Use: Validate Approach
Goal: At cancer centers, demonstrate that collection of real-world data (RWD) can be as complete and accurate as clinical trials data
Oncology Spec
Breast Cancer
Define: Right Data in Standard Format
Goal: Advance detailed clinical model and FHIR IG for breast cancer as HL7 standard (CIC, CIMI)
Objective
high-quality complete, accurate and computable as clinical trials data
http://hspconsortium.org
https://healthservices.atlassian.net/wiki/display/HSPC/ Healthcare+Services+Platform+Consortium
http://www.developers.hspconsortium.org/
https://sandbox.hspconsortium.org
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www.DirectTrust.org 1629 K Street NW, Suite 300, Washington, DC 20006
President and CEO, DirectTrust
www.DirectTrust.org 1629 K Street NW, Suite 300, Washington, DC 20006
– 1.7 Million individual accounts, nearly 250,000 consumer accounts – Over 120,000 provider organizations – Over 400 EHRs (any CEHRT) can send and receive direct messages – 200 million direct messages sent annually, 431 million sent to date
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www.DirectTrust.org 1629 K Street NW, Suite 300, Washington, DC 20006
exchange
– Network Rules of the road – Technical Public Key infrastructure for:
– Accreditation of organizations that operate on the network
– (HISPs operate like an ISP on the open internet)
Registration Authorities (for digital certificates and identity proofing)
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www.DirectTrust.org 1629 K Street NW, Suite 300, Washington, DC 20006
– 120 members including HIT companies, provider organizations, governmental agencies and others – Some members operate or support the network
– Others want to help shape the direction of the trust framework
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www.DirectTrust.org 1629 K Street NW, Suite 300, Washington, DC 20006
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1.7 Million Addresses! 200 Million Messages a Year!
www.DirectTrust.org 1629 K Street NW, Suite 300, Washington, DC 20006
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CMS Administrator Seema Verma calls for an end to physician fax machines by 2020 "If I could challenge developers on a mission, it's to help make doctors' offices a fax free zone by 2020," Verma said to applause.
www.DirectTrust.org 1629 K Street NW, Suite 300, Washington, DC 20006
Workflows
– Some companies implemented only what was necessary for Meaningful use – need support for clinical messaging – An ability to send and receive both patient specific and general messages including all attachment types – Send documents as attachments and store them when received
– It’s easier for you – just need to see which partners can do it
– It’s WAY easier than logging onto their web-site and uploading charts
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www.DirectTrust.org 1629 K Street NW, Suite 300, Washington, DC 20006 8
www.DirectTrust.org 1629 K Street NW, Suite 300, Washington, DC 20006 9
www.DirectTrust.org 1629 K Street NW, Suite 300, Washington, DC 20006
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Scott Stuewe President and CEO, DirectTrust.org Scott.Stuewe@DirectTrust.org 913-222-0630 David C. Kibbe MD MBA Senior Advisor David.Kibbe@DirectTrust.org kibbedavid@mac.com 913.205.7968
Brian Levy MD
Bio Sample Cases Telehealth Interoperability Problem Use cases Solutions Conclusion
Physician Informatacist Internist Telehealth provider Hospitalist Interoperability specialist –
former CMO at Health Language for 17 years
Member of HIMSS HIE and
Interoperability Committee
CC: Rash HPI: 55 yo man complains of a rash for the last couple of days. Before the rash started, he had pain in the area. The rash is limited to one area on the back. PMH: HTN ALL: PCN Meds: HCTZ Objective: Assessment: Likely shingles. Differential: contact dermatitis, tinea, cellulitis, folliculitis Plan: Valacylovir
CC: Sore biceps HPI: 45 year old man who did 100 pullups yesterday and is very sore. He also complains of red urine. PMH: None MEDS: None ALL: Penicillin Objective: On the video, appears in no acute distress.
Assessment: Rhabdomyolysis Plan: Send to ER right away.
‘Telehealth encompasses a broad variety of technologies and tactics
to deliver virtual medical, health, and education services. Telehealth is not a specific service, but a collection of means to enhance care and education delivery.’ (from CCHPCA)
‘The use of electronic information and telecommunications
technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.’ (from HRSA)
http://www.cchpca.org/what-is-telehealth
Live video Phone calls Store and forward Remote patient monitoring Mobile health
Urgent care Specialists Behavioral health Telestroke Dermatology Kiosk
Telemedicine advancing faster
than States can keep up
SOURCE: American Telemedicine Association
‘Electronically exchanged information’ HIMSS: Interoperability is the ability of different information technology
systems and software applications to communicate, exchange data, and use the information that has been exchanged.
ONC: Interoperability: the ability of a system to exchange electronic health
information with and use electronic health information from other systems without special effort on the part of the user.
Allergies
Appointments/scheduling
Devices
Event Notification
Medications
Notes
Orders
Prescriptions
Problem Lists
Encounter summaries / Patient summaries
Lack of interoperability Disparate data spread across multiple patient charts Separate platforms - even in the same hospital system Duplicating documentation practices Timing is critical for Telestroke Telehealth visits will become just as important as in person
Secure video Phone Scheduling Waiting room EMR Patient portal Billing Medical malpractice
HL7 FHIR SMART on FHIR CDAs Proprietary APIs
HL7
FHIR
CDA
Fast Healthcare Interoperability Resources (FHIR) is a standard describing data formats and elements (known as "resources") and an application programming interface (API) for exchanging electronic health records.
Faster to learn and implement, Lower cost, Scales well from simple to complex, Flexible, Free
Substitutable Medical Applications and Reusable Technologies SMART on FHIR is a set of open specifications to integrate apps with Electronic Health Records, portals, Health Information Exchanges, and other Health IT systems.
SNOMED LOINC RxNORM Proprietary pharmacy terminologies ICD-10-CM CPT Proprietary
Problem Lists Lab results Medications Allergies CPOE Billing Lab, Radiology Orders
Value sets of existing standards CVX Race and Ethnicity (CDC, OMB) FDA Device Identifiers Unified code for units of measure CDISC NCI HCPCS, APC, DRG
CDA
MRI of left hip MRI of hip MRI of left lower limb Procedure on hip MRI of lower extremity MRI Left hip region structure MRI - action
Laterality Left
Entire hip region CPT 73721: MRI extremity lower joint W/O contrast knee, ankle, mid/hindfoot, hip CPT 73723: MRI extremity lower joint W W/O contrast knee, ankle, mid/hindfoot, hip MRI of left hip with contrast
There is overlap between the terminology and information model
The FHIR information model can also be used to represent anatomy context
For example, the Procedure Request resource (https://www.hl7.org/fhir/procedurerequest.html) has a slot for bodySite with location values that can used the SNOMED Body Structures.
Thus body site can be represented using the terminology model (SNOMED Procedure Site)
Laterality context can be represented in the terminology concept itself, in the terminology model, or the FHIR information model
MRI of left hip is a pre-coordinated SNOMED concept
MRI of left hip uses a laterality relationship (where laterality itself is a SNOMED concept) to left
FHIR also has a laterality object which uses the SNOMED concepts of left, right, and
bilateral as its terminology binding
Most EMRs though would have a proprietary code for ordering the procedure
Grey area between information model and terminology where the context of
a concept can be represented in either model
Consider
Use terminology model for concepts (MRI, left, hip) Use information model for context (laterality, allergy, family history)
Telehealth is here to stay
But adds to the multiple records for a patient
Existing interoperability standards can be used.
Brian.Levy@peakinformatics.com