Relationship of HL7 EHR System Draft Standard to X12N

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Tyler Leonard Jefferson
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1 Relationship of HL7 EHR System Draft Standard to X12N EHR Technical Committee Co-Chairs: Gary Dickinson Linda Fischetti Sam Heard Excerpt of EHR-S DSTU Class

2 Overview of Discussion Background Where We Are Framework & NHII Current Status Where This Is Going HL7 EHR Systems Draft Standard 2

3 Transaction Code Sets Final 08/2000 Employer ID Final 05/2002 Modifications Final Rule 02/2003 Attachments Rule Future Immunizations Vocabulary Physicals Vocabulary Medications Vocabulary Provider ID Final Rule 2/2004 Plan ID Future Messaging Standards HL7, IEEE, DICOM, etc. Interventions Vocabulary Laboratory Vocabulary Nursing Vocabulary Health Insurance Portability & Accountability Act Consolidated Health Informatics HIPAA Privacy Final (Modification) 08/02 HIPAA Security Final 02/03 3

4 We are all familiar with this Provider Payer Deliver a service Provider submits a claim X12N 837 Need more info to pay? No Yes Pay the claim Assemble supporting documentation X12N 277 Request for Additional information Request additional documentation X12N 275 Additional Information Sufficient to Pay? Yes No Deny the claim 4 Solicited Attachment

No Yes Pay the claim Assemble supporting documentation X12N 277 Request for Additional

5 But what really happens here? Provider Payer Deliver a service Submits a claim with Supporting Documentation X12N X12N 275 Additional Information Sufficient to Pay? Yes No Deny the claim Pay the claim 5

with Supporting Documentation X12N 837 + X12N 275

6 Health Plan Claim Clinical Encounter Attachment Response 6 ehr Data Entered ehr/practice Management System Attachment Request

7 Ambulatory Process Flow Solicited Attach. Use Case Patient presents and an ehr is developed ehrs sends necessary clinical information to PMS PMS generates an 837 Payer responds to PMS with 277 requesting additional information PMS queries ehrs for attachment data ehrs responds to PMS PMS sends 275 to payer Claim is adjudicated by payer 7

information to PMS PMS generates an 837 Payer responds to PMS with 277 requesting

8 WHY Health IT, Why Now? Newt Gingrich & Patrick Kennedy New York Times - Opinion Section 3 May 2004 The archaic information systems of our hospitals and clinics directly affect the quality of care we receive. When you go to a new doctor, the office most likely has little information about you, no ability to track how other providers are treating you, and no systematic way to keep up with scientific breakthroughs that might help you. 8

of our hospitals and clinics directly affect the quality of care we receive.

9 What? HL7 EHR System Draft Standard for Trial Use (EHR-S DSTU) As adopted by HL7 Board, the HL7 EHR Functional Model and Standard provides a common set of definitions of expected EHR System functions. These will serve these purposes: Ensure common understanding, and eventually, conformance measures of EHR System functions upon which developers, vendors, users and other interested parties can plan and evaluate systems Establish a standards-based method by which each HL7 international participating realm can apply these EHR Systems functions to its individually defined care settings and priorities 9 Allow system developer innovation by providing no constraint or suggestions on HOW functions within an EHR-S will be designed, developed or implemented.

These will serve these purposes: Ensure common understanding, and eventually, conformance measures of EHR System functions upon which developers, vendors, users and other interested parties

10 EHR-S Function Model At a Glance 10

11 Supportive Functions Definition - Supportive EHRS functions are the subset of EHRS functions that assist with the administrative and financial requirements associated with the delivery of healthcare. Supportive EHRS functions also provide input to systems that perform medical research, promote public health, and seek to improve the quality of healthcare delivered. Example - For example, when a child is being scheduled for the appointment, Supportive EHRS functions will automatically verify insurance eligibility (electronically). During the encounter, Supportive EHRS functions will electronically query local immunization registries (to insure that the child is currently registered), and will determine the child s immunization status. After treatment, Supportive EHRS functions will report any immunization to an immunization registry and will provide any encounter data required by financial and administrative systems. Users (Actors) - The Support Staff are the principal users of these functions but, under certain circumstances, the Healthcare Providers might be expected to perform certain administrative functions. 11

Example - For example, when a child is being scheduled for the appointment, Supportive EHRS functions will automatically verify insurance eligibility (electronically).

12 ID Function Name Function Statement Functional Description Rationale Secondary Citation Ambulatory C.1 Care Management Care Setting: C Health information capture, management, and review Functional Outline: ID, Function Name, Statement, Description, Rationale & Citation ISO/TS Final Draft - Health Informatics - Requirements for an Electronic Health Record Architecture; ASTM E 1769 Standard Guide for Properties of Electronic Health Records and Record Systems C C Enable the provider to identify and locate a patient record Capture Patient Demographics Maintain and identify a single patient record for each patient. Capture demographic information that is reportable and trackable over time. Key identifying information shall be stored for the patient record, and a lookup function shall use this information to uniquely identify the patient. Contact information including addresses and phone numbers, as well as key demographic information such as date of birth, sex, and other information should be stored for reporting purposes and the proper provision of care. Supports delivery of effective healthcare, Improves efficiency, Improves patient safety Supports delivery of effective healthcare, Improves efficiency, Improves patient safety Profile: Assignment Of Essential Essential-Future Optional Not Applicable Essential Essential 12

1.0 Health information capture, management, and review Functional Outline: ID, Function Name, Statement, Description, Rationale & Citation ISO/TS 18308 Final Draft - Health Informatics - Requirements

13 EHR-S Functional Model LET S LOOK Functions Direct Care Delivery D 1.0 D 1.1 D 1.2 Supportive Functions S 1.0 S 1.1 S 1.2 Information Infrastructure I 1.0 I 1.1 I 1.2 Direct Care: EHR-S functions used for providing direct health care to, or direct selfcare for, one or more persons. Supportive: EHR-S functions that most frequently use existing EHR data to support the management of health care services and organizations Information Infrastructure: Critical backbone elements of Security, Privacy, Interoperability, Registry, and Vocabulary. ID Function Name Function Statement Function Description Rationale See Also Citation 13

Supportive: EHR-S functions that most frequently use existing EHR data to support the management of health care services and organizations Information

14 DSTU Functions Relevant to X12N 14

15 DSTU Functions Relevant to X12N 15

16 HL7 EHR TC Projects 1. Health Record Interoperability 2. Minimum Function Set for EHR/eRx/PHR 3. Health Record Interchange & Data 4. Full Standard & Compliance Metrics 16

17 Relationship of HL7 EHR-S DSTU to X12N HIPAA Transactions Q & A

ISO/HL7 10781 EHR System Functional Model Standard

ISO/HL7 10781 EHR System Functional Model Standard Presented by: Gary Dickinson Director, Healthcare Standards CentriHealth Co-Chair, HL7 EHR Work Group Lead, S&I Framework Cross-Initiative Simplification