“ jericho / ut austin pilot” privacy with dynamic patient review september 17, 2013 presented...
TRANSCRIPT
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“Jericho / UT Austin Pilot”
Privacy with Dynamic Patient Review
September 17, 2013
Presented by:David Staggs and Michael Dufel
Jericho Systems Corporation
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209/17/2013
Agenda
• Administrative issues • Pilot scope• Pilot data flow • Test scenarios• Transaction and Document tests• Discussion • Pilot Timeline• Plan of Action
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309/17/2013
Pilot Administrivia
• This pilot is a community led pilot– Limited support provided by the ONC
• Johnathan Coleman (Security Risk Solutions)• Zachary May (ESAC)• Penelope Hughes (ONC)• Libbie Buchele (ONC Sponsor)
• In conjunction with DS4P bi-weekly return of an All Hands meeting• Access to DS4P Wiki, teleconference, and calendar • Meeting times: Tuesdays 11AM (ET)
– Dial In: +1-650-479-3208Access code: 662 197 169URL:https://siframework1.webex.com/siframework1/onstage/g.php?t=a&d=662197169
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409/17/2013
Scope of the Pilot
1. Define the exchange of HL7 CDA-compliant PCD between a data custodian and a PCD repository that includes a report on the outcome of the request to the healthcare consumer (subject).
2. Additional goal: use identifiers to identify the subject/ PCD repository for use in reporting the outcome of the “secondary user” request use case to subject by subsequent EHR custodians.
3. Stretch goal: mask and/or redact the clinical document based on data segmentation and PCD choices retrieved from the PCD repository.
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509/17/2013
Pilot Data Flow
Custodian of Data being Provided at
Patient
PCD Repository2nd Requestor
1st Requestor
B
, = Clinical data
A,B =PCD data
= audit record
And Subsequent Custodian of Data being Provided at
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Test Approach
Sections included in each test scenario in the DS4P Pilot Execution Script:
1. Scenario
2. Actors
3. Preconditions
4. Test steps
5. Test results
6. Log Capture
7. Data Set Verification
09/17/2013 6
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Test Cases
09/17/2013 7
DS4P Pilot Execution Script:
1. Consent To Patient Discovery : No Consent
2. Consent To Patient Discovery : 1st Requestor (1st)
3. Consent To Patient Discovery : 2nd Requestor (2nd)
4. Consent To Document Query : No Consent
5. Consent To Document Query : 1st To PC - Allow
6. Consent To Document Query : 2nd To PC - Deny
7. Consent To Document Query : 2nd to SC - Deny
8. Consent To Document Retrieve : No Consent
9. Consent To Document Retrieve : 1st to PC - Allow
10. Consent To Document Retrieve : 2nd To PC - Deny
11. Consent To Document Retrieve : 2nd to SC - Deny
12. Consent To Document Retrieve : With Segmentation
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Test Cases (Visual Representation)
09/17/2013 8
Scenario PCD ITI-55 ITI-38 ITI-391st Requestor → PC Y 2 5 92nd Requestor → PC Y 3 6 102nd Requestor → SC Y 7 111st Requestor → PC N 1 4 8Clinical Data Segmentation Y 12
PC = Primary Custodian
SC = Secondary Custodian
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Original Query & Response
909/17/2013
Complete solution must retrieve PCD during ITI 55, ITI 38, ITI 39
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J-UT Pilot Sequence Detail (A)
09/17/2013 10Retrieving & applying PCD, reporting during patient discovery
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J-UT Pilot Sequence Detail (B)
09/17/2013 11
Retrieving & applying PCD, reporting when returning document list
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J-UT Pilot Sequence Diagram (C)
09/17/2013 12Retrieving & applying PCD, reporting when returning a clinical document
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1309/17/2013
Transaction Tests (Last Meeting)• NwHIN messages
o Test messages must comply with NwHIN specification• Request for PCD from Document Custodian
o ITI 55: Data Set Ao ITI 38: Data Set Bo ITI 39: Data Set C
• ATNA audit record from Document Custodiano ITI 55: Audit data Set Ao ITI 38: Audit data Set Bo ITI 39: Audit data Set C
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1409/17/2013
Document Tests
• HL7 Documents o HL7 Documents must comply with HL7 specification
• Clinical document from Document Custodiano Must include a reference to the patient consent repository
• PCD document from PCD Repositoryo Must follow HL7 Privacy Consent Directive o Must include specific elements
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1509/17/2013
Discussion
• Review of J-UT DS4P Test Document Draft o Overviewo Scenario Testso Transaction Tests o Document Testso Appendixes: Test Results
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1609/17/2013
Pilot Timeline
• General Timeline, conditioned on agreement of stakeholders
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17
Plan of Action
• Upon agreement of the participants the POA is: • Identify the elements available from previous DS4P pilots• Scope level of effort, decide on extended scenario• Determine first draft of functional requirements• Review standards available for returning information on requests• Determine any gaps or extensions required in standards• Stand up information holders and requestors• Create XDS.b repository holding PCD• Identify remaining pieces, create test procedures • Document and update IG with results of our experience
09/17/2013
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1809/17/2013
Backup Slides
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DS4P Standards Material• Location of DS4P Standards Inventory:
http://wiki.siframework.org/Data+Segmentation+-+Standards+Inventory
• Location of DS4P Standards Mapping Issues:http://wiki.siframework.org/file/view/Copy%20of%20DataMappingsIssues%2005102012.xlsx/333681710/Copy%20of%20DataMappingsIssues%2005102012.xlsx
• General Standards Source List:http://wiki.siframework.org/file/view/General%20SI%20Framework%20Standards%20Analysis.xlsx/297940330/General%20SI%20Framework%20Standards%20Analysis.xlsx
• Standards Crosswalk Analysis http://wiki.siframework.org/Data+Segmentation+for+Privacy+Standards+and+Harmonization (at bottom of page, exportable)
• Implementation Guidancehttp://wiki.siframework.org/file/view/Data%20Segmentation%20Implementation%20Guidance_consensus_v1_0_4.pdf/416474106/Data%20Segmentation%20Implementation%20Guidance_consensus_v1_0_4.pdf
09/17/2013 19
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2009/17/2013
DS4P References
• Use Case: http://wiki.siframework.org/Data+Segmentation+for+Privacy+Use+Cases
• Implementation Guide: http://wiki.siframework.org/Data+Segmentation+for+Privacy+IG+Consensus
• Pilots Wiki Page: http://wiki.siframework.org/Data+Segmentation+for+Privacy+RI+and+Pilots+Sub-Workgroup
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2109/17/2013
Pilot Data Flow
Custodian of Data being Provided at
Patient
PCD Repository2nd Requestor
1st Requestor
B
, = Clinical data
A,B =PCD data
= audit record
And Subsequent Custodian of Data being Provided at
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2209/17/2013
Pilot Data Flow
Custodian of Data being Provided at
Patient
PCD Repository2nd Requestor
1st Requestor
Clinical exchange #
Clinical exchange #
B
, = Clinical data
A,B =PCD data
= audit record
And Subsequent Custodian of Data being Provided at Fetch PCD Fetch
PCD
Send auditSend audit
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2309/17/2013
Pilot Data Flow (1)
Custodian of Data being Provided at
Patient
PCD Repository2nd Requestor
1st Requestor
, = Clinical data
A,B =PCD data
= audit record
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2409/17/2013
Pilot Data Flow (2)
Custodian of Data being Provided at
Patient
PCD Repository2nd Requestor
1st Requestor
, = Clinical data
A,B =PCD data
= audit record
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2509/17/2013
Pilot Data Flow (3)
Custodian of Data being Provided at
Patient
PCD Repository2nd Requestor
1st Requestor
B
, = Clinical data
A,B =PCD data
= audit record
And Subsequent Custodian of Data being Provided at
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2609/17/2013
Pilot Data Flow (4)
Custodian of Data being Provided at
Patient
PCD Repository2nd Requestor
1st Requestor
, = Clinical data
A,B =PCD data
= audit record
And Subsequent Custodian of Data being Provided at
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2709/17/2013
Pilot Data Flow (5)
Custodian of Data being Provided at
Patient
PCD Repository2nd Requestor
1st Requestor
, = Clinical data
A,B =PCD data
= audit record
And Subsequent Custodian of Data being Provided at
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2809/17/2013
Pilot Data Flow (updated)
Custodian of Data being Provided at
Patient
PCD Repository2nd Requestor
1st Requestor
B
, = Clinical data
A,B =PCD data
= audit record
And Subsequent Custodian of Data being Provided at