EHR Functional Model and Standard version 10.2
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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” 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 Linda.Fischetti@med.va.gov Gary Dickinson Per-Sé Technologies, Inc. gary.dickinson@per-se.com Sam Heard, MD OpenEHR, Australia sam.heard@bigpond.com © 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
