S&I+Framework+Newsletter+-+2011-03-25

Click [|here] to view the .pdf.

=CDA Consolidation Project=

Project Timeline

 * 3/22: Review and resolve outstanding analysis questions
 * 3/29: Review draft of publication
 * 4/4: Ballot submission review, full sample files
 * 4/7: HL7 Ballot submission

Harmonization Workgroup Meeting – 3/15

 * Complex issues will have wiki pages created, which allow more input than is possible on calls. All S&I members can comment and if consensus is achieved it will be incorporated; if no consensus we will bring to call.
 * [|Discharge Summary cardinality conflicts]
 * [|Problems Discussion Page]
 * [|Results Discussion Page]
 * [|Header – actRelationship Proposals]
 * Medications, Immunizations, Allergies and Procedures are under development.
 * Discussed [|R4 - effectiveTime]
 * Decision: Review HL7 RIM to provide updated prose for effectiveTime.
 * Discussed [|Vital Signs]
 * Decision: Adopt further restrictions from IHE currently posted on the wiki
 * Discussed Source of Information
 * Decision: The consolidated IG for ballot will not require source of information.

Consolidation Workgroup Meeting – 3/16

 * The documentation workgroup is reviewing a [|strawman IG], prepared by Dave Carlson. The current strawman includes the problems section.
 * HAI R6 guide was referenced for structuring of conformance statements. An adjusted format was presented to HL7’s Structured Documents workgroup (SDWG).
 * The diagrams in the strawman IG were UML Class Diagrams, which were generated from the UML model of existing templates to demonstrate the relationship between templates

=Transition of Care Initiative=

Coordinator’s Introduction – Arien Malec
The work that we are doing with the Transition of Care Initiative is front and center to profound improvements in the quality of care for all Americans. The user stories that have been presented illustrate real-world experiences for patients every day; care transitions that are often characterized by providers doing their best with insufficient information and can be dramatically improved by providing the right information at the right times. As we proceed towards harmonization and specification work, I want to keep three principles front and center:


 * 1) The Transitions of Care initiative has been wonderfully clinically centered, and we need to keep that focus on the clinician and the patient, even while some of us start work on highly technical tracks
 * 2) The timelines are tight, but the opportunities to make information-informed care transitions a key part of certified EHRs and EHR modules meaningfully used are incredibly significant
 * 3) At some point in this project, we will run into controversy (of the "whose XML is better" sort); we will have strong opinions, held for good reasons, but at the end of the day this need to be about the patient and the clinicians who support the patient.

Key Dates

 * 3/25: Launch ToC Harmonization Workgroup
 * Dial-in: 1-866-816-4209, Passcode: 3980879
 * Webinar: Register for the GoToMeeting [|here].
 * 3/27-3/29: Review of Final Use Case package
 * 3/31: Final Consensus

Use Case & Requirements Workgroup Meeting 3/16

 * [|User Story SWG]Update
 * Reviewed Complex ToC
 * Reviewed Hospital Discharge to Provider-Simple ToC
 * Reviewed Closed-Loop Referral
 * Resolutions:
 * User Stories should be more illustrative than descriptive; adding or removing the information in terms of how it flows; making the story simpler; add practice and clinical variation only if it changes the interpretation of the data.
 * There is a need to clarify the User Story vs. the Use Case; User Stories are part of the overall Use Case.
 * [|Scenario 1] and [|Scenario 2]Updates
 * Our most recent additions to the SWGs, the Scenario 1 and Scenario 2 SWGs have been formed to complete the activity diagram, sequencing diagram, functional requirements and data set considerations for the Provider-to-Provider and Provider-to-Patient scenarios, respectively. The User Stories defined to date have been subsumed within these SWGs and will help provide the appropriate context to the remaining work.
 * [|Use Case Simplification SWG]Update
 * Overview and description of Gary’s Model on the Wiki; specifically referencing the various tabs at the bottom of the spreadsheet; requirements, scenarios, common actions, common templates-How would we establish these data elements?
 * Reconciliation of the User Stories and Use Case Diagrams/Scenarios/Functional Requirements with UC Simplification on Monday, March 21, 2011
 * [|Use Case Diagram SWG]Update
 * Further updates to the Use Case Diagram will be necessary to reflect the intricacies of the Three Use User Stories and the respected Scenarios
 * [|Discharge Instructions SWG] & [|Care Planning SWG]Update
 * The content that has been developed speaks to D/C Instructions and why D/C Instructions are important. As this content was developed, MU has been taken into consideration and the need to conform to MU for both D/C Instructions and Care Planning (see chart on the Wiki)
 * Data elements for these sections need to be defined

=Laboratory Results Interface Initiative=

Coordinator’s Introduction – Jitin Asnaani
Our continued mission is to drive down the costs and time to implement results interfaces between labs and ambulatory primary care providers. And we must do this while not turning a blind eye to harmonization with Public Health and Acute Care in the long term.

The Use Case and Requirements (UCR) workgroup has taken - and will continue to take - long strides in refining the requirements to achieve our mission. And now, with the kickoff of the Harmonization workgroup, we have the opportunity and means to tackle the key challenge underlying this project: how can we best leverage existing specifications to inform HITPC/HITSC recommendations for Meaningful Use Stage 2 in June?

This challenge suggests the need for laser-like focus, driven by three guiding principles:
 * 1) Value to the Customer - solve real problems that ambulatory primary care physicians are facing today
 * 2) Implementability - form solutions that vendors can actually use to get data flowing between labs and providers
 * 3) Speed - take actions now that will impact Meaningful Use Stage 2 and enable adoption of the lab results interface in in 2011

Our challenge is significant, but so will be the value of the results.

Key Dates

 * 3/24: Launch LRI Harmonization Workgroup
 * Dial-in: 1-866-816-4209, Passcode: 3980879
 * Webinar: Register for the GoToMeeting [|here].

Use Case & Requirements Workgroup Meeting 3/17

 * [|In Scope Tests SWG]Update – details in documents posted here.
 * Harmonization workgroup and its vocabulary workgroup will define actual list of LOINC codes to be used
 * LOINC code itself is not specified as requirement but as attribute of list of analytes in scope. Analytes might have multiple LOINC codes – at least requirement is use of valid LOINC code.
 * Set up scorecard from 1 to 4 describing complex of result value from simple numeric to data blob
 * [|Success Metrics]Update
 * Kick-off held Monday March 14th. The purpose of this WG is to identify appropriate baseline data to use as a metric for measuring success of the Lab Result Interface Initiative. The members of this sub-workgroup have been asked to sign up to represent one (or more) of the four perspectives listed below to help identify the appropriate baseline costs.
 * Laboratories
 * EHR Vendors
 * Providers
 * Infrastructure
 * Please Note: We need more representation from the stakeholder community for each of these four perspectives so we are seeking participants who are interested in helping us achieve our goals! To sign up please contact the LRI UCR Support Lead Merideth Vida or sign up on the [|wiki].
 * [|Structured Data]Update
 * Completed its mission in providing definitions for structured data and standardized structured data for the Overview and Scope section of the LRI Use Case. The definition was presented to the LRI UCR WG on March 17th and approved through verbal consensus by the workgroup members. The definition can be found on the [|SWG Wiki page].
 * [|Use Case Diagrams & Scenarios]Update
 * A combination of two existing SWGs, the Use Case Diagrams and Scenarios team is focused on building out the following sections of the use case: User Story, Assumptions, Pre Conditions, Post Conditions, Actors and Roles, Use Case Diagrams, Scenarios, Activity Diagram, Base Flow, Sequence Diagram and any Issues and Obstacles. Great progress has been made to date and is being reviewed with the full workgroup.
 * [|Functional Requirements & Data Set Considerations]Update
 * Calling all participants! The LRI UCR Functional Requirements & Dataset Consideration sub-workgroup will be kicking off in the next two weeks! To ensure appropriate stakeholder balance we are looking for representatives from hospital laboratories and EHR Vendors to participate, please visit the [|SWG page] to sign up.