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Introduction to the HITSP


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Title: Introduction to the HITSP

  • October 2, 2008 200 330 pm (Eastern)
  • Presenters HITSP Population Perspective
    Technical Committee
  • Floyd Eisenberg, MD, MPH, Senior Key Expert,
    Siemens Healthcare and co-chair of the Population
    Perspective TC
  • Lori Fourquet, e-HealthSign, LLC

Learning Objectives
a webinar series on U.S. healthcare
  • During this 90-minute webinar, participants will
    explore the population perspective of health
    information sharing for quality, gaining a basic
    knowledge of
  • quality measure specification data element types
    and value sets
  • defining and selecting a sub-population of
    patients (measure denominator)
  • defining and identifying expected interventions
    (measure numerator)
  • terminology issues in identifying inclusion and
    exclusion criteria

Learning Objectives (continued)
a webinar series on U.S. healthcare
  • expectations for information transfer from EHRs
    to quality reporting organizations
  • HITSP specifications for quality information
  • the relationship of the quality use case and
    interoperability specification to other efforts
    for public health and for data repurposing

a webinar series on U.S. healthcare
  • Quality
  • Quality Measure Specification
  • Clinical Data for Analysis
  • Inclusion Criteria
  • Exclusion Criteria
  • Quality Reporting
  • Security and privacy requirements for Quality
  • HITSP Interoperability Specification for Quality
    (HITSP IS 06)
  • Units of Exchange
  • Health Information Summary Documents
  • Health Information Messages
  • Conformance Subsets
  • Questions and Answers

Introduction Steves Story . . . part six
  • Patient is a 26-year-old male coping with the
    long-term effects of a brain tumor that was
    removed during his childhood
  • Patient is assisting with home care for his
    grandfather, a recent widower and diabetic who
    has become despondent and non-compliant with
    self-care requirements
  • The family is becoming concerned about the
    quality of care Steves grandfather is receiving
  • A search for new providers and a successful
    diabetes program is being conducted by the family
  • Fact-based information is needed, more than
    practice locations, hours of operation, frequency
    of procedures and anecdotes based on reputation,
  • Critical care information such as comparative
    outcomes of care for diabetic patients and those
    with depression
  • General preventive care success factors

  • HITSP is a volunteer-driven, consensus-based
    organization that is funded through a contract
    from the Department of Health and Human
  • The Panel brings together public and
    private-sector experts from across the healthcare
    community to harmonize and recommend the
    technical standards that are necessary to assure
    the interoperability of electronic health records.

Deliverables and Mode of Operation
  • The HITSP Standards Harmonization Framework
  • Identify a pool of standards for an AHIC
    (American Health Information Community) Use Case
  • Identify gaps and overlaps in the standards for
    this specific Use Case
  • Make recommendations for resolution of gaps and
  • Select standards using HITSP-approved Readiness
  • Develop Interoperability Specifications (IS) that
    use the selected standard(s) for the specific
  • Test the IS

Deliverables and Mode of Operation
  • Each HITSP Interoperability Specification defines
    a set of constructs that
  • specify how to integrate and constrain selected
    standards to meet the business needs of a Use
    Case and
  • define a Roadmap to use emerging standards and to
    harmonize overlapping standards when resolved.
  • In essence, a HITSP IS represents a suite of
    documents that integrate and constrain existing
    standards to satisfy a Use Case

Deliverables and Mode of Operation
  • HITSP construct types, in decreasing breadth of
    scope, include
  • Interoperability SpecificationsIntegration of
    all constructs used to meet the business needs of
    a Use Case
  • Transaction PackagesLogical grouping of
  • TransactionsLogical grouping of actions that use
    components and/or composite standards to realize
    the actions
  • ComponentsLogical grouping of base standards
    that work together, such as messaging and

Deliverables and Mode of Operation
  • IS Status State in the acceptance process
  • Released Panel approved for submission to HHS
  • Accepted Secretary of HHS has accepted for a
    period of testing
  • Recognized Secretary of HHS has recognized the
    IS for immediate implementation
  • Revisions and updates may mean that multiple
    versions of some Interoperability Specifications
    exist with differing status levels

Current Interoperability Specifications (IS)
IS 06 Quality
  • This Interoperability Specification defines
    specific standards that capture the integration
    of data to support quality measurement feedback
    and reporting into electronic health records
    (EHRs), use of quality measures to support
    clinical decision making, and public reporting of
    healthcare quality through the exchange of data
    between healthcare organizations and providers
    and public health via an electronic network.
  • Version 1.0 Recognized
  • Version 1.0.1 Panel Review

Healthcare Provider
Quality Reporting Organizations
IS 06 QualityOverall Objectives
  • Hospital-based quality measures
  • Automate data capture and reporting of Hospital
    Quality Alliance (HQA) measures through EHRs in
    support of provider workflows
  • Communicate HQA measure data to external agencies
  • Clinician-level data
  • Automate data capture and reporting of Ambulatory
    Quality Alliance (AQA) measures through EHRs in
    support of provider workflows
  • Communicate AQA quality measure data to external
    entities for aggregation and reporting

IS 06 QualityOverall Objectives (continued)
  • Feedback to Clinicians
  • enable real-time or near-real-time feedback
    regarding specific quality indicators which are
    relevant for a particular patient
  • enable provision of tailored performance
    information to clinicians on quality measures for
    specific patient groups
  • (continued)

IS 06 QualityOverall Objectives (continued)
  • Public Reporting
  • Aggregate data across multiple sources (claims
    data, medication data, laboratory data, etc.)
  • Support quality measurement, promote
    accountability among providers, and aid consumers
    in making informed choices
  • Communicate quality measurement data quickly and
    clearly in a manner that makes it useful to a
    wide variety of decision makers (patients,
    healthcare providers, payers, health plans, and
    regulators who are involved with this process)

IS 06 QualityStakeholders
  • Ancillary Entities
  • Clinicians
  • Consumers
  • Government Healthcare Agencies
  • Healthcare Delivery Organizations
  • Health Information Exchange
  • Health Information Management Personnel
  • Health Information Technology System Developers
  • Healthcare Payers
  • Healthcare Purchasers
  • Health Researchers
  • Processing Entities
  • Public Health Agencies
  • Quality Organizations

IS 06 QualityRequirements
  • Quality Measure Specification
  • Structured and codified
  • Denominator and Numerator Inclusions Value Sets
  • Denominator and Numerator Exclusions Value Sets
  • Data Capture / Aggregation
  • Data Reporting to External Agencies

IS 06 QualityRequirements (continued)
Integrating the Healthcare Enterprise (IHE)
Quality, Research Public Health Domain,
Performance Measurement Value Set White Paper,
August 2008
IS 06 QualityPerspectives
  • Hospital-based care

Clinician / Ambulatory-based care
IS 06 Quality Data Elements / Types
  • Healthcare Information Technology Expert Panel
  • Convened by the National Quality Forum (NQF)
  • Identified 84 Institute of Medicine (IOM) High
    Priority Measures
  • Common data types
  • Reduce logic to common data types
  • Analyze frequency
  • 88 Data Elements (9 additional subtypes added by
  • Facility / clinician demographics
  • Patient demographics
  • Clinical data

IS 06 QualityData Elements / Types / Examples
  • Base Facility Data Elements
  • Identifier
  • Name
  • Location
  • Patient Data Elements
  • Pseudonymized Data Linker
  • Encounter Date/Time
  • History
  • Birth
  • Gender
  • Visit Data
  • Location
  • Discharge
  • Death
  • Clinical Data Elements
  • Problem Data
  • Diagnosis Data
  • Allergy / Adverse Reaction
  • Vital Signs
  • Procedures and Diagnostic Tests
  • Medication Data
  • Study Findings/Test Results Laboratory
  • Study Findings/Test Results Radiology and Other
  • Other (e.g. clinician-clinician communications,
    provider-patient communications, care
    classification-comfort measure only, clinical

IS 06 Quality Main Business Actors
Processing Entity / HIE
Document-Based Transmission
Hospital Clinician/Ambulatory Provider
Quality Measurement Organization
Message-Based Transmission
Measurement Consumer
Other Communities
IS 06 Quality Implementation Option 1 EHR does
the work
Acronym Legend MDO Measure Development
Organization NQF National Quality Forum
measure endorsement, maintenance, syndication,
and live broadcast
Quality Measure imported
Quality Measure
Quality report detail exported
Quality Report
EHR creates patient data summary internally, uses
imported measure to calculate quality scores and
export quality report
Patient Data
IS 06 Quality Implementation Option 2Quality
Improvement Organization (QIO) / HIE
Acronym Legend HIE Health Information
Exchange MDO Measure Development
Organization NQF National Quality Forum
measure endorsement, maintenance, syndication,
and live broadcast
Quality Measure imported
Quality Measure
Data transmit
Quality report detail exported
Patient Data
Clinical Data imported
Quality Report
QIO uses imported Quality measures and clinical
details to calculate quality scores and export
Quality report
Quality data assembled internally
IS06 QualityTraditional HL7 Messaging
IS06 QualityDocument Sharing
IS06 QualityAssembly of Patient-Level Quality
IS 06 Quality New Constructs for IS06
Query for Existing Data (NEW)
TP 21
Supports dynamic queries for clinical data to
gather patient-level quality data elements
Patient Level Quality Data Message (NEW)
Patient Level Quality Data Document (NEW)
C 34
C 38
Support the process of sending patient-level
quality data to an aggregator for analysis and
aggregation of quality measures
Patient Demographics Query (NEW)
T 23
Provide a list of patients and their demographics
IS 06 Quality Privacy and Security
Collect Communicate Security Audit Trail
Secured Communication Channel
T 17
T 15
Ensure the authenticity, integrity, and
confidentiality of transactions, and the mutual
trust between communicating parties
Record audit event in repository
Access Control
Consistent Time
T 16
TP 20
Provides a mechanism to ensure that all the
entity systems communicating within the network
have synchronized system clocks
Ensure that an entity is the person or
application that claims the identity provided
Nonrepudiation of Origin
C 26
Describes the mechanisms to define and identify
security relevant events and the data to be
collected and communicated as determined by
policy, regulation or risk analysis. It also
provides the mechanism to determine the record
format to support analytical reports that are
IS 06 Quality Privacy and Security
Entity Identity Assertion
C 19
C 25
Ensure that an entity is the person or
application that claims the identity provided
Provides specific instruction for anonymizing
data that is ready for repurposing. Anonymization
According to the International Organization for
Standardization (ISO), is the process that
removes the association between the identifying
data set and the data subject.
Manage Consent Directives
TP 30
T 24
Defined to support pseudonymization of protected
health information. Pseudonymization The
process of supplying an alternative identifier
that permits a patient to be referred to by a key
that suppresses his/her actual identification
Deals with the capture and communication of
patient consent directives and non-patient
originated authorizations for disclosure of
health information
IS 06 Quality Infrastructure
Patient ID Cross-Referencing
Manage Sharing of Documents
TP 22
T 13
Deals with identifying and cross-referencing
different patient attributes for the same
Facilitates the registration, distribution and
access of patient electronic health records
across health enterprises
Notification of Document Availability
Retrieve Form for Data Capture
T 29
TP 50
Notifies its recipient that a document is
available and provides the information needed to
retrieve the document
Supports public health authority reportable
conditions monitoring and management. Enables
capture of supplemental data variables not
typically maintained in an electronic health
record or laboratory information system
Transfer of Documents on Media (NEW)
Document Reliable Interchange (NEW)
T 33
T 31
Supports media interchange of metadata and
Supports a point-to-point interchange of metadata
and documents
IS 06 Quality Future Direction
Measurement Criteria Document
Measurement Criteria Message
Current Activities Collaborative for
Performance Measure Integration with EHR
Systems National Committee for Quality Assurance
(NCQA) American Medical Association
(AMA) Electronic Health Records Association
(EHRA, formerly EHRVA) http//
New Constructs Required
IS 06 Quality Future Direction (continued)
Quality Measurement Message
Quality Measurement Document
Current Activities Quality Reporting Document
Architecture (QRDA) September 2008 Ballot HL7,
Vancouver, BC
New Constructs Required
IS 06 Quality Future Direction (continued)
Validation, Data Quality Checking
Derived Information
Quality check of the output for a quality report
Describe how to derive information from existing
data element, e.g., duration of medication from
frequency and dispensed.
Case Review Message
Case Review Document
Feedback mechanism to the provider to assure
patients represented in the quality report are
valid review step
New Constructs Required
Units of Information Exchange HITSP IS
Constructs - Re-Use and Re-Purpose
Type 1 Base or Composite Standards
  • Re-UseApplying an existing construct to more
    than one IS
  • Re-PurposeUpdating a construct to meet the
    needs of a new Use Case
  • Can extend or constrain when reusing or
  • Specifications contain a common superset
  • Superset can be extended as new requirements are
  • Superset can be constrained with use-specific

IS 06 Quality Strengths
  • Effective interoperability
  • Quality Measurement is based on existing EHR
    available data
  • Reporting is processed in a standard, machine
    readable format
  • Current activities that increase data entry for
    quality measurement are reduced
  • Implementation is flexible for local architecture
  • Data are secure and private
  • Near real-time feedback is available for
  • Information is available for consumers to make
    healthcare choices

Steves story . . . the future
  • Patients can make informed decisions about the
    ongoing care of themselves and their family
  • consumers have access to quality and safety
    reports about individual providers and care
  • Data is collected automatically during routine
    care and reused for performance measurement
  • Outcome data is available for determining best
    care protocols, enables standards-based and
    evidence-based care
  • Reports are standard and comparable enabling true
    benchmarking and continuous improvement
  • Transparency is the rule
  • Decision support is part of the workflow, with
    useful safety alerts 

Healthcare in an interoperable world . . . The
Future is Now
  • HIT data exchange is becoming transparent so that
    the quality of care delivered by providers and
    hospitals can be known no matter where the
    patient is located
  • Consumers are empowered to
  • get the right information at the right time
  • find appropriate, quality and safe care for
    themselves and their families
  • assume that repeatable information will be safe
    and secure while also being accessible by those
    who need it before, during and after a visit to
    a care provider
  • Care providers are empowered to
  • provide safe, effective and evidence-based care
    with information integrated within a clinical
    care workflow

How YOU can become involved
  • Use or specify HITSP Interoperability
    Specifications in your HIT efforts and in your
    Requests for Proposals (RFPs)
  • Ask for CCHIT certification
  • Leverage Health Information Exchanges to promote
    HITSP specifications to make connections easier
    in the future
  • Ask . . . Is there a HITSP standard we could be
  • Get involved in HITSP . . . Help shape the

How YOU can become involved
Learn more about specific HITSP activities in
these webinars available for replay
Webinar Series II Coming soon Stay Tuned same
time Thursdays 200-330 pm EDT Send your
Webinar ideas to
Join HITSP in developing a safe and secure
health information network forthe United States.

Visit or contact . . .
Michelle Deane, ANSI Re
HITSP, its Board and Coordinating Committees
Jessica Kant, HIMSS Theresa Wisdom,
HITSP Technical Committees
A Successful Collaboration
  • Interweaving many different standards to address
    business needs
  • A successful collaboration between HITSP and
    several HITSP member organizations developing
    base standards and implementation guides/profiles

Questions and Answers