EHR Systems Functional Model and Standard Triplets what

EHR Systems Functional Model and Standard • • • Triplets (what + why + criteria) Hierarchies/Decompositions Timelines Open Process Screens Ballot Reconciliation 2 July 2003

Functional Decomposition l Functional decomposition – – l Based on a functional hierarchy Abstract to specific EHR Function Specification Triplet – – At arbitrary level of decomposition: 3+ (? ) Deemed useful for applicability across functional profiles or conformance measure

EHR Function Specification Triplet l l WHAT Statement of Function, Functionality WHY Rationale, with references Conformance Criteria HOW Out of Scope

Statement of Function - WHAT l l Statement of EHR System function(ality) Final Proposed Form [EHR Systems] “must/should/may” [verb-first function statement] l Considered per care setting – – – must/shall : : essential should : : desirable may : : optional

Core v. profile specific l Core – – l Deemed essential in all care settings Deemed desirable in all care settings Functional Profile Specific – – Deemed essential in one care setting and not in another Deemed desirable in one care setting and not in another

Statement of Function - WHAT Example: Care delivery l Example hierarchy, decomposition – – – L 1: Prescribing L 2: Prescription validation L 3: Drug-Disease interaction warnings

Statement of Function - WHAT Example: Care delivery (cont. ) l Short statement, verb-first – l “Warn of drug-disease interactions” Full statement – “EHRS provide a synchronous warning if a clinician is about to order a medication when the patient has an entry in their problem list which is a contraindication to this medication”

Rationale - WHY l Rationale for inclusion of function(ality) – – l Utility based – efficiency, workflow Safety based – prevent medical errors Outcome based – improved patient outcomes Empowerment based – patient in a better position to manage their own care References

Rationale - WHY Example: Care delivery l l Prescription validation Safety – Proven reduction in medication errors l l Reference… Utility – Proven reduced requirement for medication review by other staff (including pharmacist. l Reference…

Statement of Function - WHAT Example: Infrastructure l Example hierarchy, decomposition – – – L 1: Security L 2: Entity authentication L 3: User authentication

Statement of Function - WHAT Example: Infrastructure (cont. ) l Short statement, verb-first – l “Ensure user authentication” Full statement – “EHRS must/should/may ensure user authentication: l l at signon, at start of user session; and throughout user session. ”

Rationale - WHY Example: Infrastructure (cont. ) l l User Authentication example “To ensure… – – – “User identity is verified at signon; “User identity is established for duration of user session; “Accountable actions can be attributed (traced) to authenticated users, including acts of EHR authorship and amendment. ”

Rationale - WHY Example: Infrastructure (cont. ) l User authentication references – – – HIPAA JCAHO IOM ISO 18308, 18307, 21089, 17799 ASTM E 1462, E 1467 …

Conformance Criteria l Method or basis for measuring conformance – Of EHR systems

Conformance Criteria Example: Infrastructure l l User Authentication example EHRS conforms if user identity – – – Is actively verified at each signon or session start (and thus) is actively verified before EHR function(s) or content is accessed Is maintained for duration of user session

Contribution l l Propose functional triplets Process documents and derive functional triplets Review functional triplets in an agreed manner and with agreed criteria Review functional triplets from limited set from the perspective of a care setting

Contribution (cont. ) l l Join the email lists Join the Groove collaboration Lead the Groove collaboration Others…(Ken)

Proposal for Initial Ballot l Functional Hierarchy and Decomposition (v 1. 0) – – l Infrastructure: 3 -5 levels Care delivery: 3 levels Triplet – – What, Why: v 1. 0 Conformance Criteria: v 1. 1, v 2…

EHR Ballot Schedule 21 July Draft published: Co-Chairs and Staff 23 -24 July EHR SIG Open Meeting Rockville, MD - AHRQ Conference Center Attendees must register, no meeting fee Draft reviewed and vetted

EHR Ballot Schedule, con’t 1 Aug v 1. 0 ballot opens 1 September v 1. 0 ballot closes

EHR Ballot Schedule, con’t 9 -11 September Memphis, Tennessee Ballot reconciliation HL 7 Fall Plenary and Working Group Open meeting Attendees must register w/HL 7 and pay meeting fees Sept/Oct Next ballot draft and ballot round…

EHR Roadmap l Now – – – l v 1. 0 Draft Standard for Trial Use 60% consensus needed Future – – v 1. 1, , v 2… Progressive iterations, each with greater specificity

EHR Roadmap (cont. ) Functional Hierarchy and Decomposition v 1. 0 General v 1. 1, v 2… More Specific Infrastructure Functions 1 -5 levels 1 -n levels Care Delivery Functions 1 -3 levels 1 -n levels Triplet WHAT, WHY + Conformance Criteria

EHR Ballot, Part 1 (proposed) EHR Functional Model l l Framework Horizontal Axis - EHR Function – – l Vertical Axis - EHR Use – – l EHR Infrastructure Functions EHR Care Delivery Functions EHR Care Setting Profiles EHR Use Profiles Informative

EHR Ballot, Part 2 (proposed) Functional Hierarchy/Decomposition l l Framework Hierarchical framework – – – l l Establishes functional groupings and relationships Identifies functional inter-dependencies and redundancies Supports Functional Decomposition Informative Does not dictate implementation

EHR Ballot, Part 3 (proposed) EHR Function Specification Triplets l l l One per EHR function(ality) proposed for inclusion Placed at parent or leaf nodes in Functional Hierarchy Where applicability/conformance metric is deemed useful

EHR Ballot, Part 3 (proposed, con’t) EHR Function Specification Triplets l Now – – – l v 1. 0 Informative (as DTSU) What + Why Next – – – v 1. 1, v 2… Normative What + Why + Conformance Criteria

Function Specification Triplet Basis for Inclusion, 1 st Screen l l SIG Co-Chairs and Staff Applicability: Within EHR scope? – – l Does function(ality) apply to at least one EHR system in one EHR use setting? Identify applicable use settings Now or Next Iteration: Within EHR v 1. 0 scope? – Is function(ality) within decomposition scope for v 1. 0?

Function Specification Triplet Basis for Inclusion, 1 st Screen, con’t l Position triplet within Functional Hierarchy and Decomposition l First pre-ballot draft - target 21 July 2003

Function Specification Triplet Basis for Inclusion, 2 nd Screen l Review in open session – – l l EHR SIG Open Meeting, 23 -24 July HL 7 membership not required Consensus of attendees Per triplet: – – – Applicability? Now or next iteration? Typical Use Setting(s)

Function Specification Triplet Basis for Inclusion, 2 nd Screen, con’t l l Post meeting revisions Final ballot draft Target: End July 2003

Function Specification Triplet Basis for Inclusion, 3 rd Screen l l Ballot Opens/Closes: 1 Aug to 1 Sep Ballot options – Add new function(ality), including proposed: l l l – Function Specification Triplet Placement within Functional Hierarchy and Decomposition Urgency: now or future iteration Exclude proposed function(ality) l l Reason for exclusion OK in future iteration?

Function Specification Triplet Basis for Inclusion, 3 rd Screen, con’t l Ballot options, con’t – – – Add/delete proposed EHR use setting Revise Statement of Function(ality) - WHAT Revise Rationale - WHY

Function Specification Triplet Basis for Inclusion, 4 th Screen l Review in open session – – – l l EHR SIG Meeting, 9 -11 September In conjunction with HL 7 Annual Plenary, Memphis HL 7 membership not required but meeting fee is Consensus of attendees Ballot submitters are encouraged to attend while their comments are discussed and resolution sought!!

Function Specification Triplet Basis for Inclusion, 4 th Screen, con’t Ballot Resolution Options l Accept vote to add function(ality) – – – Establish Statement of Function(ality) - WHAT Establish Rationale - WHY Within v 1. 0 scope? l – Beyond v 1. 0 scope? l – – – Place in Functional Hierarchy and Decomposition Log for future consideration, inclusion Establish related EHR Use Setting(s) Revise ballot draft Request submitter to withdraw negative (if any)

Function Specification Triplet Basis for Inclusion, 4 th Screen, con’t Ballot Resolution Options, con’t l Decline vote to add function(ality) – – – l State reason: e. g. , out of scope Offer compromise to submitter: e. g. , future consideration Notify submitter, request withdrawal of negative (if any) Votes to include or exclude care settings – – Consensus of committee No committee response to individual submitter

Function Specification Triplet Basis for Inclusion, 4 th Screen, con’t Ballot Resolution Options, con’t l Accept vote to exclude function(ality) – – l State reason: e. g. , out of scope Offer compromise to submitter: e. g. , future consideration Revise ballot draft Notify submitter, request withdrawal of negative (if any) Decline vote to exclude function(ality) – – State reason Notify submitter, request withdrawal of negative (if any)

Function Specification Triplet Basis for Inclusion, 4 th Screen, con’t Ballot Resolution Options, con’t l Accept revision to Statement of Function(ality) or Rationale – – l Revise draft Notify submitter, request withdrawal of negative (if any) Decline revision to Statement of Function(ality) or Rationale – – State reason or suggest compromise Notify submitter, request withdrawal of negative (if any)

Function Specification Triplet Basis for Inclusion, 5 th+ Screens Sep/Oct l Next ballot round l Repeat Screens 3&4 until consensus is achieved…

Accepted Submissions EHR Functional Hierarchies l Proposed EHR functional hierarchies and decompositions, as scoped for v 1. 0: – EHR Infrastructure Functions l – Decomposition - target 5 levels EHR Care Delivery Functions l Decomposition - target 3 levels

Accepted Submissions EHR Specification Triplets l Proposed EHR Specification Triplets – l 1) What 2) Why 3) Conformance Criteria Proposed in context of: – – Applicable use setting(s) Placement within Functional Hierarchy and Decomposition

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 Open. EHR, Australia sam. heard@bigpond. com