Control/Query Meeting Minutes (Heading 1) s2

Government Projects Tuesday, January 8, 2002 1:45 – 5:00 pm

Participants:

Name Organization E-mail Address Karen Van Hentenryck HL7 Headquarters [email protected] Mike Davis VHA [email protected] Pam Akison NAPHSIS [email protected] Amy Page VHA [email protected] Denise Warzel NCI [email protected] Marco Johnson DoD Health [email protected] Steve Brown VA [email protected] Ken Rubin EDS/VHA [email protected] Benjamin C. Schoenbrun Booz Allen Hamilton Schoenbrum_benjamin@bah. com Gavin Tong CIHI [email protected] Steve Wagner VA [email protected] Graeme Boon Interfaceware Graeme.boon@interfaceware. com Tim Benson Office of E-Envoy, London [email protected] Sheila Frank CMS [email protected] Susan Abernathy CDC [email protected] Jeff Blair Medical Records Institute [email protected] Nancy Orvis DoD Health [email protected] Suzie Burke Bebee NCHS/CDC [email protected] Michelle Williamson NCHS/CDC [email protected] Jim Case CAAFS [email protected] Dan Jernigan CDC [email protected]

Steve Wagner was re-elected to another term as co-chair I. Public Health Data Standards Consortium –

Michelle Williamson provided an update on the activities of the Public Health Data Standards Consortium (PHDSC). The PHDSC is a consortium of 32 organizations committed to the promotion of data standards for public health and health services research. They currently represent public health and the health services community in standard development organizations including:

 Health Level Seven (HL7)

 National Uniform Billing Committee (NUBC)

 National Uniform Claim Committee (NUCC)

 ANSI ASCX12

In 2001 PHDSC contracted with The Lewin Group to develop an education strategy under NAHDO to:

 Build partnerships/educate constituencies

 Participate in development of national standards

 Support the implementation of standards

The PHDSC’s educational strategy priorities included:

 Creating a public health implementation guide for selected national standards as they related to public health

 Developing a web-based resource center to track data integration and standards development efforts relevant to public health and health services research

 Securing funding for consortium initiatives

 Developing an action plan for overcoming barriers to migrating to national standards

Four work groups have been established to meet the priorities noted above:  Health Care Service Data Reporting Implementation Guide Work Group – This group is chaired by Robert Davis, New York Department of Health – Statewide Planning and Research Cooperative Systems. Their goal is to provide a standardized format for reporting health care service data compatible, but not compliant with HIPAA standards. They approved, in June 2001, a proposal to develop ANSI ASCX12 837 Health Care Service Data Reporting Guide; and they will present Draft 2 of the Guide to the X12 TG2WG2 in February of 2002.

 Web-based Resource Center Work Group – This group is chaired by Tom Doremus, Public Health Foundation. They are focused on the conceptual development of an Internet-based resource center to track standards development, implementation and data integration. They have developed a Health Data Standards survey to obtain feedback from the public health and health services research community to create a resource to address the needs for educational material on health data standards issues. The survey can be obtained at: http://www.cbay.tv

 Business Development and Marketing Work Group – This group is chaired by Elliot Stone, Massachusetts Health Data Consortium and Walter Suarez, Minnesota Health Data Institute. This group first convened in January of 2001 and is charged with developing strategies to overcome barriers to migrating to national standards

For additional information on the PHDSC:

 Visit their web site at http//www.cdc.gov/nchs/otheract/phdsc/phdsc.htm

 Send e-mail to [email protected] In the message body enter SUBSCRIBE PH-CONSORTIUM-L-YOUR NAME

 Contact Marjorie Greenberg at [email protected] or (301) 458-4245 Suzie Burke Beebe at [email protected] or (301) 458-4125 Michelle Williamson at [email protected] or (301) 458-4618

Click here to view the slide presentation

II. Medication Terminology Model Status Steve Brown reported on the VA’s experience with building the National Drug File Reference Terminology model (NDF RT Model). The main reasons for wanting to build a terminology model were:

 Improved use of drug information by single systems

 Improved sharing of drug information by adding semantic understand to the syntax defined by HL7 messaging between systems.

More than a decade ago, the VA created the VA National Drug File (NDF), which is a centrally maintained file of drug products. The NDF has been distributed to 128 VA Medical Centers, incorporated into VistA Pharmacy Applications, and is used within the VA for Consolidated Mail Outpatient Pharmacy, which consists of seven sites that fill 57 million prescriptions each year. It also drives the VA’s Interaction and Order Checking.

The problems the VA faces with the NDF include:

 Maintenance – they process 4000 NDF edits/month, which are done largely by hand.

 Mapping local formularies to NDF – again this is a manual process, but one which is required for the Consolidated Mail Outpatient Pharmacy

 Class-based approach to Decision Support is problematic.

The advantages of moving to a formal terminology include those gleaned from using computer-based tools (i.e., 90% reduction in maintenance costs and 60% reduction in mapping efforts), plus the ability to compare and aggregate data.

The plan for creating the reference terminology includes:

 Creating a model of use case-based definitional attributes

 Creating a reference hierarchy for each definitional attribute

Defining concepts using terms from reference hierarchies

Progress to date

 The NDF is contained in a terminology tool  The model is created - the form strength and structure reference taxonomy is done while the MoA, physiologic effect and therapeutic intent and pharmacokinetcs reference taxonomies are under development.

 The Concept definition has been initialized algorithmically, although it still needs human review.

There are some sample applications in use now that are demonstrating the use of this system.

Next steps:

 VA hopes to show the NDF RT at the spring AMIA conference

 VA hopes to expand collaboration with NLM, FDA, NCI and Regenstrief among others. This will be a freely available medication model that can be used by anyone.

Click here to view the presentation

III. UK e-Government Interoperability Framework (e-GIF) Project –

Tim Brinson reported on this project, whose main interest is the adoption of Internet and World Wide Web standards in the UK to attain interoperability.

They have proposed an e-services development framework that is comprised of 3 x 3 framework. Bottom 3 box consist of requirements, design, implementation, while the top level is comprised of a common information model, a message reference information model (akin to HL7’s RIM) and the e-GIF technical specifications. The middle level consists of re-usable business patterns (RBP), design components (DC) and XML architectural schemas.

The framework itself provides a structure for developing semantic specification and standards for e-services. The framework document is available on the web and has been approved by the national committees.

For more information, go to www.govtalk.gov.uk Go into the Interoperability section and find the e-GIF set of documents. Tim reported that much of this project is mandatory across the country.

IV. CDC V3 Projects – Mead Walker reported on CDC message development using HL7 V3 principles.

CDC is developing an integrated surveillance system platform on which all new and updated CDC surveillance software will be built. The core of the system, the NEDSS Base System, provides a data repository accessed through a web application server. Various programs at CDC will develop different modules that will utilize the NEDSS Base System. Three examples of these extensions are notification of disease reports, vital statistics (birth and death data), and reporting of antibiotic susceptibility pharmacy drug use. The vision for this project was to:

 Gather health data automatically for various sources on a real-time basis.

 Monitor the health of communities.

 Assist in ongoing analyses of trends and detection of emerging public health problems

 Provide information for setting public health policies

NEDSS is not a single piece of software but rather a system of interoperable systems. It is a series of surveillance systems at the state and local government and includes tools for electronic data transfer to health departments from health care systems. The architecture is built on an integrated data repository. While the initial goal was infectious diseases, the scope will likely go beyond that.

Philosophy of CDC Messaging project:

 Develop HL7 V3 messages - they will use the RIM and MDF and the vocabulary domains. They plan to create a consistent set of work products across the projects.

 Plan to influence HL7 by suggesting RIM changes and vocabulary items and submitting message formats for standardization. Their style is to map relevant data to the RIM using data mapping as a source for the R-MIM.

 Will work within the technical architecture developed by NEDSS

Current Projects:  Notification Message – to communicate electronic notifiable disease reports from states to CDC. This is a core component of NEDSS

 Vital Statistics – intended to provide a specification for birth and death information.

 Antimicrobial Unit Reporting – monthly reporting of antibiotics use and organism susceptibility from providers to CDC. Reporting done on paper today but the would like to create a transaction to support this electronically. This activity is one part of the larger NEDSS initiative to provide a tool for monitoring patient safety called the National Healthcare Safety Network. This is the integration of existing CDC surveillance systems for nosocomial infections, dialysis adverse events, and healthcare worker safety.

 Messaging Analysis – Statement of requirements, messaging scenarios, interaction diagrams, interaction grid.

Lessons learned:

 The HL7 process for creating message specification works

 XML has wide credibility and is a major selling point

 The HL7 tooling is still evolving

V. GCPR Project –

John Leslie reported that the purpose/scope of the GCPR project was to integrate records of all active and retired servicemen. This included the VA, DoD and Indian Health. However, as time passed, other issues such as privacy arose. The result has been a reduction in scope to include only discharged and retired people. They now provide clinical records in HL7 templates. These templates describe the structure of data and are represented internally as graphs. The near-term solution is concerned only with laboratory, radiology reports and outpatient medications. They are in the process of integrating person identity information to correlate between DoD and VA and the location the records. Current Status:

 They are loading files

 Performing beta testing (including sites in San Diego, Alaska, El Paso and Washington, DC)

Future Plans:

 Provide more robust set of information including adverse reactions and discharge summaries

Click here to view the presentation Government Projects Thursday, January 10, 2002 9:00 am – 12:30 pm

Participants:

Name Organization E-mail Address Karen Van Hentenryck HL7 Headquarters [email protected] Mike Davis VHA [email protected] Pam Akison NAPHSIS [email protected] Amy Page VHA [email protected] Denise Warzel NCI [email protected] Marco Johnson DoD Health [email protected] Jim McCain HIS/VA [email protected] Fra Blum On Web Technologies, LLP [email protected] Christian Bremeau Meta Integration [email protected] Penny Sanchez EDS Steve Wagner VA [email protected] Sheila Frank CMS [email protected] Dan Jernigan CDC [email protected] VI. Review of CMS-ESRA e-Reporting System –

Christian Bremeau reported on this project. It consists basically of transforming the ESDR Reporting Process at CMS from paper forms to HL7 v3 XML based e-reporting. The Standardized Information Management System (SIMS) is a large distributed network consisting of a large database. It has standardized the way in which End Stage Renal Disease (ESRD) network collect, enter and report data pertaining to dialysis and transplant patients.

This particular project uses in person proofing (IPP) for digital signatures, which is a new business offered by the US post office.

For more information on this project, visit www.metaintegration.net/cms. They hope to have an R-MIM by summer. The plan is to eventually submit the work to HL7.

VII. Electronic death registration project -

Pam Akison is working on the electronic death registration project and reported that her group is collaborating with the CDC through NEDSS. They built a web and XML-based test system that allows the patient social security number to be sent to the state. A client can then request social security number verification. She believes that this system could be used by many other groups.

VIII. National Medicaid Work Group

Sheila Frank reported that there is a very active group of state agencies collaborating on HIPAA issues. Sheila was elected co-chair of the Attachments-related group. She wants to get the word out quickly to Medicaid states. They have about 10 subgroups working on various items. Her group develops attachments, brings them to HL7 and does the outreach. They also provide feedback to HL7 home health and DME attachments. They are trying to get HL7 to look at Pre-certification and pre-authorization. The local codes subgroup is their biggest work group and success. They want to reduce the number of local codes to 200-300. They have divided these into 33 categories and organized a small subcommittee for each to harmonize within. About 30 of those groups have finished their work.

IX. National Cancer Institute – Denise Warzel reported that she is working on an initiative to harmonize vocabulary within the NCI. The NCI will adopt the 11179 standard for exchanging data between registries and will try to use standardized vocabularies. She realized that NCI needed to liaison better with HL7 and thus we will be attending. If there are new codes, NCI will try to find a home for them and feed them back into the standards groups. She’s thinking of proposing a special SIG for cancer clinical trials. Denise was connected with individuals at CDC involved in similar issues to coordinate the government activities.

X. USHIK –

Marco Johnson reported that there is an initiative to move this registry to the National Institute of Health, National Cancer Institute. Information (although not data elements) are currently loaded for HL7, X12, DoD, Health Affiliates, NCPDP, HIPAA and NCVHS. The HISB manages this project and its scheduled release to the general public. In February of 2002 they will have a reload of HL7. They will also load CDC, ASTM and GCPR data elements in the same time frame. These will be read only. V2 of USHIK will provide online updating for designated user and will be released this summer. V2.1 will follow shortly thereafter and provide for limited metadata exchange between registries via XML. V2.2 will provide for online data element mapping. They have regularly scheduled teleconferences on Thurs at 3 pm EST.

XI. Indian Health –

Jim McCain reported on the FY03 enterprise architecture. They are trying to establish a department-level review board to move desktop management from the department level to the desktop level. They are engaged in a joint project with Josman Diabetes center. They are engaged in another joint project with DOD and VA using DICOM structured reporting retina images.

XII. CDC update – Dan Jernigan reported that NEDSS activities are moving forward. CDC is supporting activities both extramurally and intramurally to integrate surveillance systems in public health. NEDSS is being built using national standards. The architecture of NEDSS comprises an integrated data repository derived from the HL7 RIM, secure internet communications for sharing public health findings, secure user access and data encryption, electronic messaging using HL7, standard codes for data representation, and other data presentation and analysis features. The first phase of NEDSS will be the NEDSS Base System (NBS). The NBS will replace an older system used for reporting notifiable public health findings such as cases of Botulism, measles, and Salmonella. The new NBS will provide the base platform on which other surveillance systems can build. Thus, existing older "stovepipe" systems, such as those for sexually transmitted diseases and tuberculosis, can be migrated to the common surveillance tool. Three early "modules" to be added to the base system will allow for surveillance reporting of 1) Hepatitis, 2) Meningitis, and 3) Patient Safety Data. The patient safety module, called "National Healthcare Safety Network (NHSN)", will replace three existing systems for monitoring: a) nosocomial infections b) healthcare worker safety, and c) adverse events in dialysis patients. Because the NHSN is the surveillance system most closely tied to clinical data, it is leading the way in the NEDSS initiative in development of standard vocabulary terms for laboratory, pharmacy, and diagnostic activities. NEDSS is also working closely with two national laboratories, Quest and LabCorp, to develop automated electronic laboratory-based reporting of public health findings to public health agencies. When fully developed, encrypted laboratory findings will be sent from the national laboratories to state health departments using HL7 messages. Initial testing of the electronic reporting using secure internet transmission is underway and will be a part of the beta testing of the NEDSS base system this spring.

For further information, contact Dan Jernigan at 404-639-2621, [email protected].

XIII. Agenda items for Atlanta Meeting:

 NEDSS update

 EHR update – Dave Markwell

 USHIK report

 NCI update

 HIPAA Update (Sheila Frank/Penny Sanchez)