ToC+-+Appendices

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Appendix A: Related Use Cases

 * AHIC Consultations and Transfers of Care
 * AHIC Consumer Empowerment; Consumer Access to Clinical Information
 * AHIC Common Data Transport
 * AHIC Clinical Notes Detail
 * AHIC Personalized Healthcare
 * NHIN Direct Primary care provider refers patient to specialist including summary care record
 * NHIN Direct Primary care provider refers patient to hospital including summary care record
 * NHIN Direct Specialist sends summary care information back to referring provider
 * NHIN Direct Hospital sends discharge information to referring provider

Appendix B: Previous Work Efforts Related to Clinical Information Exchange

 * Health Information Technology Standards Panel Specification 03: The Consumer Empowerment and Access to Clinical Information via Networks Interoperability Specification defines specific standards needed to assist patients in making decisions regarding care and healthy lifestyles (i.e., registration information, medication history, lab results, current and previous health conditions, allergies, summaries of healthcare encounters and diagnoses). This Interoperability Specification defines specific standards needed to enable the exchange of such data between patients and their caregivers via networks.


 * Health Information Technology Standards Panel Specification 09: The Consultations and Transfers of Care Interoperability Specification describe the information flows, issues and system capabilities that apply to a provider requesting and a patient receiving a consultation from another provider.


 * HITSP Information Technology Standards Panel Specification C32: The Summary Documents Using HL7 Continuity of Care Document (CCD) Component describes the document content summarizing a consumer's medical status for the purpose of information exchange. The content may include administrative (e.g., registration, demographics, insurance, etc.) and clinical (problem list, medication list, allergies, test results, etc) information. This Component defines content in order to promote interoperability between participating systems such as Personal Health Record Systems (PHRs), Electronic Health Record Systems (EHRs), Practice Management Applications and others.


 * Health Information Technology Standards Panel Specification C83: The CDA Content Modules Component defines the content modules for document based HITSP constructs utilizing clinical information. These Content modules are based on IHE PCC Technical Framework Volume II, Release 4. That technical framework contains specifications for document sections that are consistent with all implementation guides for clinical documents currently selected for HITSP constructs. View the most current version as HTML


 * Health Information Technology Standards Panel Specification 107: This Interoperability Specification consolidates all information exchanges and standards that involve an EHR System amongst the thirteen HITSP Interoperability Specifications in place as of the February 13, 2009 enactment of the American Recovery and Reinvestment Act (ARRA). This Interoperability Specification is organized as a set of HITSP Capabilities, with each Capability specifying a business service that an EHR system might address in one or more of the existing HITSP Interoperability Specifications (e.g., the Communicate Hospital Prescriptions Capability supports electronic prescribing for inpatient prescription orders).


 * Health Level 7: The CDA Release 2.0 provides an exchange model for clinical documents (such as discharge summaries and progress notes) - and brings the healthcare industry closer to the realization of an electronic medical record. By leveraging the use of XML, the HL7 Reference Information Model (RIM) and coded vocabularies, the CDA makes documents both machine-readable - so they are easily parsed and processed electronically - and human-readable - so they can be easily retrieved and used by the people who need them. CDA documents can be displayed using XML-aware Web browsers or wireless applications such as cell phones. While Release 2.0 retains the simplicity of rendering and clear definition of clinical documents formulated in Release 1.0 (2000), it provides state-of-the-art interoperability for machine-readable coded semantics. The product of 5 years of improvements, CDA R2 body is based on the HL7 Clinical Statement model, is fully RIM-compliant and capable of driving decision support and other sophisticated applications, while retaining the simple rendering of legally-authenticated narrative.

Appendix C: Privacy and Security Assumptions
Security attributes includes capabilities needed to establish trust between systems, provide confidentiality while in-transit, ensure authenticity of the data, and ensure that only authorized individuals have access to the data.
 * **Feature** || **Feature Applicability** ||
 * Audit Logging || X ||
 * Authentication (Person) || X ||
 * Authentication (System) || X ||
 * Data Integrity Checking || X ||
 * Error Handling || X ||
 * HIPAA De-Identification || X ||
 * Holding Messages ||  ||
 * Non-repudiation || X ||
 * Pseudonymize and Re-Identify ||  ||
 * Secure Transport || X ||
 * Transmit Disambiguated Identities || X ||
 * User Login || X ||


 * Table 1: Common Transactions. These are not displayed as part of the sequence diagram.**

Appendix D: Glossary
These items are included to clarify the intent of this use case. They should not be interpreted as approved terms or definitions but considered as contextual descriptions. There are parallel activities underway to develop specific terminology based on consensus throughout the industry.


 * Access Logs:** An integrated view of who has accessed the consumer/patient’s health information for the purposes of direct or indirect patient care.


 * Acute Care:** Treatment for a short period of time in which the patient is treated for a brief episode of illness. Acute Care is generally associated with care in a short term facility which is usually a non-emergency department setting.


 * AHIC:** American Health Information Community; a federal advisory body chartered in 2005, serving to make recommendations to the Secretary of the U.S. Department of Health and Human Services in regards to the development and adoption of health information technology.


 * Ancillary Entities:** Organizations that perform auxiliary roles in delivering healthcare services. They may include diagnostic and support services such as laboratories, imaging and radiology services, and pharmacies that support the delivery of healthcare services. These services may be delivered through hospitals or through free-standing entities.


 * Care Coordination:** Functions that help ensure that the patient’s needs and preferences for health services and information sharing across people, functions, and sites are met over time.


 * Care Coordinators:** Individuals who support clinicians in the management of health and disease conditions. These can include case managers and others.


 * Clinical Support Staff:** Individuals who support the workflow of clinicians.


 * Clinicians:** Healthcare providers with patient care responsibilities, including physicians, advanced practice nurses, physician assistants, nurses, psychologists, pharmacists, and other licensed and credentialed personnel involved in treating patients.


 * Consultation:** Meeting of two or more clinicians to evaluate the nature and progress of disease in a particular patient and to establish diagnosis, prognosis, and therapy.


 * Consumers:** Members of the public that include patients as well as caregivers, patient advocates, surrogates, family members, and other parties who may be acting for, or in support of, a patient receiving or potentially receiving healthcare services.


 * Electronic Health Record (EHR):** An electronic, cumulative record of information on an individual across more than one healthcare setting that is collected, managed, and consulted by professionals involved in the individual's health and care. This EHR description encompasses similar information maintained on patients within a single care setting (a.k.a., Electronic Medical Record (EMR)).


 * Electronic Health Record (EHR) System Suppliers:** Organizations which provide specific EHR solutions to clinicians and patients such as software applications and software services. These suppliers may include developers, providers, resellers, operators, and others who may provide these or similar capabilities.


 * Geographic Health Information Exchange/Regional Health Information Organizations:** A multi-stakeholder entity, which may be a free-standing organization (e.g., hospital, healthcare system, partnership organization) that supports health information exchange and enables the movement of health-related data within state, local, territorial, tribal, or jurisdictional participant groups. Activities supporting health information exchanges may also be provided by entities that are separate from geographic health information exchanges/Regional Health Information Organizations including integrated delivery networks, health record banks, and others.


 * Health Information Exchange (HIE)** : An electronic network for exchanging health and patient information among healthcare delivery organizations, according to specific standards, protocols, and other agreed criteria. These functional capabilities may be provided fully or partially by a variety of organizations including free-standing or geographic health information exchanges (e.g., Regional Health Information Organizations (RHIOs)), integrated care delivery networks, provider organizations, health record banks, public health networks, specialty networks, and others supporting these capabilities. This term may also be used to describe the specific organizations that provide these capabilities such as RHIOs and Health Information Exchange Organizations.


 * Healthcare Entities:** Organizations that are engaged in or support the delivery of healthcare. These organizations could include hospitals, ambulatory clinics, long-term care facilities, community-based healthcare organizations, employers/occupational health programs, school health programs, dental clinics, psychology clinics, care delivery organizations, pharmacies, home health agencies, hospice care providers, and other healthcare facilities.


 * Healthcare Payers:** Insurers, including health plans, self-insured employer plans, and third party administrators, providing healthcare benefits to enrolled members and reimbursing provider organizations.


 * HITSP:** The American National Standards Institute (ANSI) Healthcare Information Technology Standards Panel; a body created in 2005 in an effort to promote interoperability and harmonization of healthcare information technology through standards that would serve as a cooperative partnership between the public and private sectors.


 * Laboratories:** A laboratory (often abbreviated lab) is a setting where specimens are sent for testing and analysis are resulted, and then results are communicated back to the requestor. The types of laboratories may include clinical/medical, environmental, and veterinarian, and may be both private and/or public.


 * ONC:** Office of the National Coordinator for Health Information Technology; serves as the Secretary’s principal advisor on the development, application, and use of health information technology in an effort to improve the quality, safety, and efficiency of the nation's health through the development of an interoperable harmonized health information infrastructure.


 * Patients:** Members of the public who receive healthcare services. For hospice providers, the patient and family are considered a single unit of care. Synonyms used by various healthcare fields include client, resident, customer, patient and family unit, consumer, and healthcare consumer.


 * Personal Health Record:** A health record that is initiated and maintained by an individual. An ideal PHR would provide a complete and accurate summary of the health and medical history of an individual by gathering data from many sources and making this information accessible online to anyone who has the necessary electronic credentials to view the information.


 * Pharmacies:** Entities that exist that are experts on drug therapy and are the primary health professionals who optimize medication use to provide patients with positive health outcomes


 * Providers:** An individual clinician or care delivery setting who requests or accepts the transfer of the clinical summary for the purposes of delivering care.


 * Registries:** Organized systems for the collection, storage, retrieval, analysis, and dissemination of information to support health needs. This also includes government agencies and professional associations which define, develop, and support registries. These may include emergency contact information/next of kin registries, patient registries, disease registries, etc.

Appendix E: References

 * American Health Information Community; AHIC; http://www.hhs.gov/healthit/healthnetwork/background
 * The American National Standards Institute (ANSI) Healthcare Information Technology Standards Panel; HITSP; http://www.HITSP.org
 * Health Level Seven; HL7; http://www.HL7.org
 * Meaningful Use Final Rule; Dept of Health and Human Services; http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf
 * Nationwide Health Information Network; NHIN; http://www.hhs.gov/healthit/healthnetwork/background

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