EHR Functional Model and Standard
Health Level Seven (HL7) EHR SIGGary Dickinson, Linda Fischetti, Sam Heard
SIG Co-Chairs
© HL7 2003
Outline
History & Catalyst Functional Model
– EHR Functions– Profiles
Plan of attack!
© HL7 2003
AHRQ Agency for Healthcare Research and Quality (DHHS)
CMS Centers for Medicare and Medicaid Services (DHHS), formerly Health Care Financing Administration (HCFA)
DHHS US Dept. of Health and Human ServicesEHR Electronic Health RecordEHRFM EHR Functional ModelEHR SIG HL7 EHR Special Interest GroupHIMSS Health Information Management Systems
SocietyVA/VHA US Veterans Health Administration
Glossary
© HL7 2003
Expert Panel
Jeff Blair– NCVHS, Medical Record Institute
Diane Carr– Queens Health Network– 2002 Davies Recognition Award
Simon Cohn, MD– Kaiser Permanente, IOM
Ed Hammond, PhD– Duke University, IOM, HL7 BOD
© HL7 2003
Expert Panel, con’t
Thomas Handler, MD– Gartner, HIMSS EHR/Davies Criteria
Dipak Kalra, MD– NHS, UK
Clem McDonald, MD– Regenstrief Institute, University of Indiana– LOINC
Ron Parker– Canadian Health Infoway
© HL7 2003
Expert Panel, con’t
Paul Tang, MD– Stanford University, IOM
Charlene Underwood– Siemens, HIMSS EHR/Davies Criteria
© HL7 2003
History & Catalyst
© HL7 2003
EHR SIG Co-Chairs
Linda Fischetti, RN MSUS Department of Veterans Affairs
Gary DickinsonPer-Sé Technologies, Inc. US
Sam Heard, MDOpenEHR, Australia
© HL7 2003
HL7 EHR SIG
Formed January, 2002Establishes EHR related priorities for
HL7 Standardization– Architectural issues – working with other
technical committees– Functional specification
© HL7 2003
Original timeline
Take 18 months to 2 years to write the standard
And then….. A customer arrived……
© HL7 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.”
Dateline, Washington, DC21st March 2003:
© HL7 2003
Functional Model
© HL7 2003
Project Target
Initial Target EHR Functional Model and Standard-
– Draft Standard for Trial Use
Subsequently Full HL7 Standard
– Normative Document
© HL7 2003
Task
Create a Functional Model– 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
© HL7 2003
EHR Functional Model
Infrastructure functions
Care Delivery Functions
FunctionalProfiles
Vary across profiles
FunctionalProfiles
© HL7 2003
EHR Functions
© HL7 2003
Core functionality
Functional Profile 2
Functional Profile1
Core specificfunctions
Essential
Core specific functions
Essential
Core generic functions<- Essential ->
Infrastructure functions<- Essential ->
© HL7 2003
Core and Added Functionality
Profile 2Profile 1
Core specific functions
Essential
Added functions
Desirable
Added functions
Desirable
Core specificfunctions
Essential
Infrastructure functionsEssential
Performance and reliability enhancement Desirable
Core generic functions Essential
Added and innovative care delivery functions Desirable
© HL7 2003
Example functions
Infrastructure functions
Care delivery functions
Functional Profiles
Inpatient
Medication Administration Record
Bed management
Demographic Management Demographic Management
Security Security Security Security Security Security Security Security
Standards Compliance Standards Compliance
Order Management Order Management Order Management
Event Capture Event Capture Event Capture Event Capture
Notes Notes Notes Notes Notes Notes
Results Reporting Results Reporting Results Reporting
Drug-Drug Interactions Drug-Drug Interactions Drug-Drug Interactions.
© HL7 2003
Increasing granularity
OrdersManagement
RecordingFunctions
WorkflowManagement
Care DeliveryFunctions
© HL7 2003
Increasing granularity
MedicationManagement
LaboratoryManagement
ImagingManagement
ReferralsManagement
OrdersManagement
RecordingFunctions
WorkflowManagement
Care DeliveryFunctions
© HL7 2003
Functional domain hierarchies
Medication orders
Warnings
Patient preferences
Administration recording
Care Delivery Functions
ePrescribing
© HL7 2003
Functional dependencies
Clinical workstation Medicationknowledgebase
Prescriptionprinting
Adverse reactionwarnings
ePrescribing
© HL7 2003
Functional dependencies
Problemlist
Pastmedications
Currentmedication list
Adversereactions
Allergies Patientpreferences
Therapeuticprecautions
Historicalrecording
Demographicservice
Userauthentication
Clinical workstation
Drug-druginteractions
Drug-diseaseinteractions
Indicationscontraindications
Medicationknowledgebase
Prescriptionprinting
Adverse reactionwarnings
ePrescribing
© HL7 2003
EHR FunctionSpecification Triplet
For each functional element specified:
1) WHAT - Statement of function(ality)
2) WHY - Rationale (for inclusion)
3) Conformance Criteria
How = Implementation - OUT OF SCOPE
© HL7 2003
Functional profiles
© HL7 2003
What are functional profiles?
Sets of functions– Care setting specific
Based on consensus
– Purpose specific Registered for specific use Not controlled through standards process
Standard
Registered
© HL7 2003
Care setting profiles
Institute of Medicine– Agree standard care settings– Minimal functionality required
Express in EHR Functional Model– Review functions– Ballot functions
© HL7 2003
Example functions
Infrastructure functions
Care delivery functions
Profiles
OutpatientInpatient Home
Wellness Reminders
Medication Administration Record
Bed management
LifestyleWellness
Reminders
Medication Administration Record
Demographic Management Demographic Management
Security Security Security Security Security Security Security Security
Standards Compliance Standards Compliance
Order Management Order Management Order Management
Event Capture Event Capture Event Capture Event Capture
Notes Notes Notes Notes Notes Notes
Results Reporting Results Reporting Results Reporting
Drug-Drug Interactions Drug-Drug Interactions Drug-Drug Interactions.
© HL7 2003
What are registered functional profiles?
Sets of functions– Determined by users– Determined by authoritative bodies– Defined by quality or safety initiatives– Defined by regulation– Defined by payors
© HL7 2003
Profiles
Infrastructure functions
Care Delivery Functions
Use Profiles
Care SettingProfiles
Profiles
© HL7 2003
Profiles
Provider Profiles
Care SettingProfiles
Profiles
Vendor Profiles
Regulation Profiles
Professional Association
Profiles
Accreditation Profiles
Part of StandardRegistered – Not in standard“How-to” is part of Standard
© HL7 2003
Use of Profiles
Provider Profiles
Care SettingProfiles
Profiles
Vendor Profiles
Regulation Profiles
Professional Association
Profiles
OutpatientOncologist
Guideline
HIPAA
ProductX
© HL7 2003
Use of the Model: VendorApplication profile
ApplicationProfile 1
ApplicationProfile 1
ePrescribing
Laboratory resultmanagement
Chronic diseasePrompts and recalls
Dom
ain
s
© HL7 2003
Providerprofile
Use of the Model: Provider
ApplicationProfile 1
ApplicationProfile 2
ePrescribing
Laboratory resultmanagement
Chronic diseasePrompts and recalls
Dom
ain
s
© HL7 2003
EHR SIG Work PlanDeliverables
Top down functional decomposition– References and sources
Standard care setting functional profiles– EHR SIG/IOM collaboration
Functional profile “How-to”– Guidance: build, adapt, extend and integrate
profiles– Registry, conformance
© HL7 2003
Project Work & Timeline
© HL7 2003
Plan of Attack
EHR Functions HL7 EHR SIG
EHR Care Setting Profiles HL7 EHR SIG, IOM collaboration Profile per setting
– E.g. acute inpatient, ambulatory, long-term care, care in the community, home health, Integrated Delivery Network
© HL7 2003
Plan of Attack (cont.)
EHR Registered Use Profile “How-to” Government: CMS, VA, FDA… Accreditation Providers, Practitioners Vendors Professional Societies Patients, consumers?
© HL7 2003
Project Timeline…
21 July Ballot draft published - ready for meeting
23-24 July Open EHR SIG MeetingEnd July Ballot draft revised - ready to ballot
1 August Ballot opens
1 September Ballot closes
© HL7 2003
Project Timeline…
8-12 September 2003 HL7 Fall Working Group Meeting Memphis, Tennessee
9-11 September 2003 EHR SIG Meeting Reconciliation of ballot comments
© HL7 2003
How to Participate
Join HL7 Subscribe to HL7 EHR SIG Listserver (HL7 members) Attend open public sessions (no HL7 membership
required) Join teleconference calls (HL7 members) Join ballot group (HL7 members) Review ballot draft (no HL7 membership required) Vote and submit pertinent comments (HL7 members)
ContactsLinda Fischetti, RNVeterans Health [email protected]
Gary DickinsonPer-Sé Technologies, [email protected]
Sam Heard, MDOpenEHR, [email protected]
© HL7 2003
© HL7 2003
EHR SIG Work PlanFunctional Perspectives
Front-end user functions– Explicit functions
– Extrinsic - externally invoked process/action
Embedded functions– Implicit functions– Intrinsic - bound to internal process
© HL7 2003
EHR SIG Work PlanFunctional Perspectives, con’t
Service Oriented Architecture functions
Communication functions
– Interface functions
– Multimedia functions
Interface functions
– HL7 trigger events, messages, query/response– In and outbound data streams
© HL7 2003
EHR SIG Work PlanFunctional Perspectives, con’t
Reporting and notification functions– Outbound data streams
© HL7 2003
Functional dependencies
Historicalrecording
Demographicservice
Userauthentication
Clinical workstation
Drug-druginteractions
Drug-diseaseinteractions
Indicationscontraindications
Medicationknowledgebase
Prescriptionprinting
Adverse reactionwarnings
ePrescribing