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Tuesday, April 14, 2009

What is HITSP Doing?

The American Recovery and Reinvestment Act (ARRA) has a number of provisions and deadlines which need to be completed by the end of this year. One of these is the publication of a proposed regulation by December 31st of this year. The Office of the National Coordinator (ONC) realized that many of the requirements of ARRA are already supported by publications from ANSI/HITSP, but that these need to be restructured to support the ARRA requirements.

HITSP has been asked by ONC to produce an interoperability specification to support the needs of that office in obeyance of the ARRA law. The accepted publications produced by HITSP to date (those referenced by IS01 through IS12 and IS77) are expected to be used within this specification. The end result is intended to be a simpler publication that addresses the interoperability requirements needed for meaningful use of EHR systems.

As a result, HITSP has formed five tiger teams to quickly produce this information for the HITSP Panel approval by July 15th. The tiger team leadership was selected from existing HITSP Co-chairs and Staff, and approved by John Halamka, chair of ANSI/HITSP. We recieved notification today of who was selected to co-chair the teams.

The five tiger teams are:

Tiger TeamCochairs
EHR-Context ISManick Rajendran, Eze Care LLC
Corey Spears, McKesson
Mike Nusbaum, HITSP
Data ArchitectureDon Bechtel, Siemens
Keith W. Boone, GE Healthcare
Don Van Syckle, HITSP
Exchange Architecture and Harmonization FrameworkSteve Hufnagel, DOD
Mike Lincoln, VA
Ed Larsen, HITSP
Security and PrivacyJohn Moehrke, GE Healthcare
Glen Marshall, Grok-a-lot
Jonathon Coleman, HITSP
Quality MeasuresFloyd Eisenberg, NCQA
Lori Fourqet, HITSP

The EHR-Context IS team will be developing a new implementation specification, focused on the EHR.

The data architecture team will be focusing on describing the information requirements of interoperable exchanges used by the new IS.

The Exchange Architecture and Harmonization Framework team will be addressing the exchange services and underlying base standards used by the new IS.

The Security and Privacy team will be addressing the Security and Privacy services needed in interoperable exchanges used by the new IS.

The Quality Measures team will be addressing how to exchange quality measures in the new IS.

This is all happening rather rapidly, and new information is coming to light daily. Calls will be held tommorrow and Thursday to kick off the new work for each team. If you are interested in participating in any of these teams and are already a HITSP member, I urge you to contact the leaders of the technical committees that you are a member of to see where you might best assist. If you aren't a HITSP member but want to contribute, please see, as we would welcome your assistance in this new work.

I'm especially urging those with experise in data elements used in HL7 Version 2, CDA Release 2, NCPDP and X12 standards, as well as those with expertise in vocabulary, including SNOMED, LOINC, RxNORM, et cetera to participate in the Data Architecture tiger team.


  1. Calls for Participation:

    Data Architecture (Elements/Templates/Value Sets) Tiger Team

    ¨ Scope and Plan
    — Implement Data Element Tiger Team Recommendations to clean up HITSP data elements, data templates and value sets

    — Address data element issues, eliminate data element inconsistencies

    — Institute use of USHIK for data elements and small value sets, working with USHIK developers to improve usability and applicability to HITSP data element needs

    — Work with NIST to identify and populate template repository with HITSP artifacts and make available

    — Establish approach for large value sets (e.g., diagnosis)

    — Map to Data Elements and Modules

    — Deliverables:

    — Populate USHIK with data elements and small value sets

    — Template repository populated with HITSP artifacts

    — Determine approach for large value sets

    — Update approach to c80/c83

    — Technical Note describing how we use USHIK/template repository by June 30

    EHR-context “light weight” Interoperability Specification (IS) Tiger Team

    Create the EHR-Centric “light-weight” IS based exclusively on existing constructs and selected standards

    - Prototype the new process for more rapid development of an Interoperability Specification

    - Validate new HITSP construct templates, Information Exchange Requirements (IERs) and Data Requirements (DRs)

    ¨ Scope and Plan

    — Clearly identify what “EHR-Centric” includes

    — Extract EHR-Centric requirements from ARRA

    — Extract EHR-Centric information exchanges from all 13 existing ISs and supporting constructs, annotating exchanges that address needs of children and other vulnerable populations

    — Map EHR-Centric information exchanges to ARRA requirements for EHR interoperability, particularly to Section 3002 of Title XIII (HITECH)

    — ARRA Gaps will be identified and documented for roadmap

    — Review with Committee members and refine

    — Prototype new process for more rapid development of an IS and validating the new templates

    ¨ Deliverables:

    — Requirements and design provided in mid-May

    — By June 30, Light weight IS and all supporting constructs in new templates published as minor release for Panel approval

    Quality Measures Tiger Team

    ¨ Scope and Plan
    — Continue Quality Measures project, based on HITSP/IS06

    — Note – This is the only effort expected to continue as an ongoing TC effort
    — Crucial to meeting basic objective of improved quality and efficiency

    Exchange Architecture and Harmonization Framework Tiger Team

    ¨ Scope and Plan
    — Insure consistency and clarity of concept definitions and cleanup IERs, DRs, Exchange Actions, Exchange Content

    — Establish initial catalog of IERs, DRs, Exchange Actions, and Exchange Contents to support existing IS

    — Map to Design constructs (i.e., Constructs and Services)

    — Refine IS Exchange Architecture and Harmonization Framework

    § Define types of information and exchange infrastructure needed to support enterprise to enterprise health information exchange, such that the exchange can occur directly or through HIE/NHINs.

    § Enterprises include edge systems (providers and other healthcare organizations), intermediate level consolidators, such as state public health or payers and national agencies, such as CMS, CDC, FDA, etc.

    — Deliverables
    — Final definitions and lists of initial set of IERs, DRs, Exchange Actions and Exchange Content with mappings to constructs for incorporation into re-templating and future work items by mid-May (optionally, examine mappings to use case event-actions)

    — Revised HITSP Harmonization Framework/Information architecture – ideally by June 30

    Security, Privacy, Infrastructure Tiger Team

    ¨ Scope and Plan
    — Arrange all relevant existing security, privacy, and infrastructure constructs into a service or suite of services that allows any system to directly call security services outside context of an IS

    — Specifically address ARRA security and privacy requirements, particularly Section 3002 of Title XIII (HITECH)

    — Gaps will be identified and documented in roadmap

    — Prototype the Service concept

    — Definition by Mid-May

    ¨ Deliverables
    — S,P&I exchanges in existing S,P&I constructs and TN900 and inform ONC and others, such as certification body, of supported candidate interoperability requirements

    — S,P&I requirements from ARRA

    — Map of ARRA S,P&I requirements against existing S,P&I exchanges

    — Identify which ARRA S,P&I requirements appear as gaps by June 30

    — A service construct or suite of constructs, updating the existing S&P constructs into service templates published as a minor release for Panel approval. Address Infrastructure on non-interference basis.

    — Plan for resolution of ARRA gaps

  2. thanks for publishing this.....