EHR Functional Model and Standard Health Level Seven

EHR Functional Model and Standard Health Level Seven (HL 7) EHR SIG Gary Dickinson, Linda Fischetti, Sam Heard SIG Co-Chairs

Outline l l History & Catalyst Functional Model – – l EHR Functions Profiles Plan of attack! © HL 7 2003

History & Catalyst © HL 7 2003

HL 7 EHR SIG Formed January, 2002 l Establishes EHR related priorities for HL 7 Standardization l – – Architectural issues – working with other technical committees Functional specification © HL 7 2003

Original timeline l l Take 18 months to 2 years to write the standard ‘Let the standard write itself’ – S. H. And then…. . A customer arrived…… © HL 7 2003

Dateline, Washington, DC 21 st 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. ” © HL 7 2003

Functional Model © HL 7 2003

Project Target Initial Target l EHR Functional Model and Standard– Draft Standard for Trial Use Subsequently l Full HL 7 Standard – Normative Document © HL 7 2003

Task l Create a Functional Model – – l 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 © HL 7 2003

EHR Functional Model Profiles Vary across profiles Care Delivery Functions Infrastructure functions © HL 7 2003 Profiles

EHR Functions © HL 7 2003

Core functionality Profile 1 Profile 2 Core specific functions Static Core generic functions Static Infrastructure functions Static © HL 7 2003

Core and Added Functionality Profile 1 Profile 2 Added functions Dynamic Core specific functions Static Added and innovative care delivery functions Dynamic Core generic functions Static Performance and reliability enhancement Dynamic Infrastructure functions Static © HL 7 2003

Example functions Inpatient Profiles Medication Administration Record Bed management Drug-Drug Interactions. Notes Notes Results Reporting Care delivery functions Results Reporting Order Management Event Capture Event Capture Security Security Management Infrastructure. Demographic functions Demographic Management Standards Compliance © HL 7 2003 Standards Compliance

Increasing granularity © HL 7 2003

Increasing granularity © HL 7 2003

Functional domain hierarchies Care Delivery Functions e. Prescribing Medication orders Administration recording Warnings Patient preferences © HL 7 2003

Functional dependencies © HL 7 2003

Functional dependencies © HL 7 2003

EHR Function Specification Triplet For each functional element specified: l A functional statement (what) l Rationale (why included) l Compliance Metric/Test l (How? Implementation - OUT OF SCOPE) © HL 7 2003

Functional profiles © HL 7 2003

What are functional profiles? l Sets of functions – Care setting specific l – Based on consensus Standard Purpose specific l l Registered for specific use Not controlled through standards process © HL 7 2003 Registered

Care setting profiles l Institute of Medicine – – l Agree standard care settings Minimal functionality required Express in EHR Functional Model – – Review functions Ballot functions © HL 7 2003

Example functions Inpatient Outpatient Profiles Medication Administration Record Bed management Wellness Reminders Home Medication Administration Record Lifestyle Wellness Reminders Drug-Drug Interactions. Notes Notes Results Reporting Care delivery functions Results Reporting Order Management Event Capture Event Capture Security Security Management Infrastructure. Demographic functions Demographic Management Standards Compliance © HL 7 2003 Standards Compliance

What are registered functional profiles? l Sets of functions – – – Determined by users Determined by authoritative bodies Defined by quality or safety initiatives Defined by regulation Defined by payors © HL 7 2003

Profiles Use Profiles Care Setting Profiles Care Delivery Functions Infrastructure functions © HL 7 2003

Profiles Care Setting Profiles Part of Standard Provider Vendor Profiles Professional Regulation Accreditation Profiles Association Profiles Registered – Not in standard “How-to” is part of Standard © HL 7 2003

Use of Profiles Care Setting Profiles Provider Profiles Professional Regulation Association Profiles Vendor Profiles Outpatient Oncologist Product X Guideline HIPAA © HL 7 2003

Use of the Model: Vendor Application profile Domains Application Profile 1 Laboratory result management Chronic disease Prompts and recalls e. Prescribing © HL 7 2003 Application Profile 1

Use of the Model: Provider Domains Laboratory result management Application Profile 1 Chronic disease Prompts and recalls e. Prescribing © HL 7 2003 Application Profile 2 Provider profile

EHR SIG Work Plan Deliverables Top down functional decomposition l – References and sources Standard care setting functional profiles l – EHR SIG/IOM collaboration Functional profile “How-to” l – – Guidance: build, adapt, extend and integrate profiles Registry, conformance © HL 7 2003

Project Work & Timeline © HL 7 2003

Plan of Attack EHR Function Axis l HL 7 EHR SIG EHR Use Axis, Care Setting Profiles l l HL 7 EHR SIG, IOM collaboration Profile per setting – E. g. acute inpatient, ambulatory, long-term care, care in the community, home health, Integrated Delivery Network © HL 7 2003

Plan of Attack (cont. ) EHR Registered Profiles l l l Government: CMS, VA, FDA… Accreditation Providers, Practitioners Vendors Professional Societies Patients, consumers? © HL 7 2003

Project Timeline… Mid-July l Ballot draft complete Late July l l Possible second open meeting? Ballot opens Late August l Ballot closes © HL 7 2003

Project Timeline… 8 -12 September 2003 l l HL 7 Fall Working Group Meeting Memphis, Tennessee 9 -11 September 2003 l l EHR SIG Meeting Reconciliation of ballot comments © HL 7 2003

How to Participate l l l l Join HL 7 Subscribe to HL 7 EHR SIG Listserver (HL 7 members) Attend open public sessions (no HL 7 membership required) Join teleconference calls (HL 7 members) Join ballot group (HL 7 members) Review ballot draft (no HL 7 membership required) Vote and submit pertinent comments (HL 7 members) © HL 7 2003

Linda Fischetti, RN Contacts Veterans Health Administration Linda. Fischetti@med. va. gov Gary Dickinson Per-Sé Technologies, Inc. gary. dickinson@per-se. com Sam Heard, MD Open. EHR, Australia sam. heard@bigpond. com

© HL 7 2003

Functional dependencies © HL 7 2003