Friday, June 22, 2012

Summer is for Standards

Over the past two weeks we've heard about at least five different new S&I Framework projects:  Health eDecisions, Closed Loop Referrals (see Scenario 1), HREx, Auto BlueButton,  and Patient Generated Health data. Not all of these are yet "officially" announced projects on the S&I Framework site.

On top of that, there are a half dozen HL7 projects that are being worked on concurrently that support some of the existing projects (e.g., Query Health), and others which could support new projects.  This is a recent set of project scope statements that were recently approved by the Structure and Semantic Design Steering Division for the HL7 Structured Documents Workgroup (which had already approved them).

Some of these projects (such as HQMF Release 2) are already well under way.  I've been spending about 8 hours a week in meetings on them due to some extremely tight deadlines.  Just to give you an idea, anything like the Consolidated CDA revisions for patient assessments and QRDA Release 2, already in ballot, which might need to get into Meaningful Use stage 2 final rules, would needs to get published by the middle of next month, if it were to show up in a rule published at the end of August.  That early deadline is really good, because after that, I'm off to IHE meetings to finish up just a few other small things ;-)

HL7/IHE Health Story Implementation Guide Consolidation – additional templates for patient assessment data, at Project Insight # 728 for SDWG and TSC Tracker # 2305. The Patient Assessment Summary Work group (PAS WG), a work group within the ONC Standards and Interoperability (S&I) framework, identified a subset of data elements from patient assessment instruments for exchange in a summary document. This project will review and map the PAS WG identified clinically relevant elements to templates in the Consolidated CDA Templates DSTU. When existing templates are unavailable, or underspecified, this project will update, or add new templates to the Consolidated CDA Templates DSTU as specified by SDWG. The new CDA templates can be derived from the source instruments automatically. An appropriate document-level title, template, and document type code will be determined under this project. The project will be scoped to elements in the PAS SWG identified subset. The ballot will be scoped to these new and updated templates, and the SDWG agreed upon errata. The project will not introduce a review of content of existing document-level templates. The entire DSTU will not be re-balloted. Scope Statement is at

CDA Implementation Guide for Patient Assessments, at Project Insight ID# 381 and TSC Tracker # 2304 for SDWG. The scope of the project is to update the CDA Implementation Guide for Patient Assessments DSTU to conform to the new Consolidated CDA US Realm Header, and IG format. The DSTU will continue to include a universal header and body. Add guidance for communicating elements in the CMS Continuity Assessment Record and Evaluation (CARE) assessment tool. Scope statement is at

QDM-based Health Quality Measure Format (HQMF) Implementation Guide at Project Insight # 756 and TSC Tracker # 2302 for SDWG cosponsored by CDS. This project is intended to create a domain analysis model to describe the content required within EHRs to measure quality and performance and maintain safety standards.  The information model content will be derived from the Quality Data Model (QDM) established in a public consensus process by National Quality Forum (NQF) in the United States.  QDM is a model of information based on the needs of quality measure developers and clinical decision support rule creators. It has now been tested in the retooling of 113 existing quality measures into HQMF format and in a number of CDS rules in an eRecommendations project funded by the Agency for Healthcare Research and Quality (AHRQ). Scope statement is at

Health Quality Measure Format (HQMF) Specification, Release 2, at Project Insight ID#508 and TSC Tracker # 2302. The DSTU will be updated to address new requirements identified through testing/implementation. Scope statement is at

QRDA Draft Standard for Trial Use, Release 3, at Project Insight # 210 and TSC Tracker # 2301, for SDWG. This project will further enhance the QRDA Category I DSTU following updates to the HQMF specification to support alignment. Scope statement is at

Patient Authored Documents, for Structured Documents WG at PI# 900, and TSC Tracker # 2300. In the “era of patient empowerment”, we want to define a specification for patient-authored clinical documents.  Medical practices are looking for ways to allow patients to electronically complete certain tasks online such as filling out registration forms, health history forms, consenting to certain practice policies, and other types of clinical documents yet to be defined. As electronic document interchange increases, we see a growing need to communicate documents created by patients (including those needed by providers and/or those document types defined by patients). Often, this is done through a secure web interface controlled by the patient such as a patient portal or a personal health record. As more and more practices incorporate EMR  technology into their practice workflow, they want to be able to import patient provided structured information into their EMR’s. This is being driven by the need to meet Meaning Use 2 requirements for patient engagement as well as other needs to reduce manual processes managing patient-provided data. Scope statement is at

HL7/S&I Framework QRDA II/III Draft Standard for Trial Use, Release 3, for SDWG at PI# 896 and TSC tracker # 2299. This project will define and bring to ballot a set of specifications for reporting quality data representing query results. The queries themselves use the Health Quality Measure Format (HQMF). This work effort will include a U.S. Realm QRDA Category II (QDM-based) and Category III Implementation Guide to direct implementers on how to construct QRDA Category II and III instances in conformance with HITECH eMeasures to represent the query results obtained from the distributed queries. This work effort will further align with the work taking place in HL7 to update the Health Quality Measure Format (HQMF) Implementation Guide. In addition, this project will leverage and harmonize with similar activities within and outside HL7 to avoid duplication of existing efforts. Scope statement is at


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