Value Proposition of EHR System Functional Model (EHRS-FM) US-Realm Profile with DoD and VA Sub-Profiles



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Value Proposition of EHR System Functional Model (EHRS-FM) US-Realm Profile with DoD and VA Sub-Profiles PREPARED FOR VA MANAGEMENT by Stephen Hufnagel PhD, Tiag subcontractor to Edmond Scientific March 27, 2014 DRAFT-J

Agenda Value Proposition for Simultaneous Engagement with EHR System Functional Model (EHRS-FM) Federal Health Information Model (FHIM) Fast Healthcare Interoperability Resources (FHIR) Executive Summary and Acronyms (Slides 3-15) EHRS-FM Background and Overview (Slides 17-19) EHRS-FM Profile Approach (Slides 22-27) (1) Example: HL7 Population Health & the Public Health Functional Profile (1) EHRS-FM Meaningful-Use Functional-Profile Methodology (1) Potential US-Realm EHRS-FM-FHIR-FHIM plus DoD-and-VA Sub-Profiles (4) US-Realm Profile Vision, Methodology, Value, Next Steps (1) Questions & Discussion (Slide 29) Backup (Slides 30-46) (3) Knowledge Engineering, Data Management Needs (4) EHRS-FM, FHIR and FHIM content and DoD-VA Shared-Data Example (5) Gartner CPR generations and Evidence-Based-Medicine (EBM) Requirements (3) S&I Framework Use-Case Simplification and NIST Tooling Strategy NOTE: Executive Summary Talking-Points Slides are hidden in Presentation Model 2

Executive Summary EHRS-FM The goal of the Electronic Health Record (EHR) Work Group is to support the HL7 mission of developing standards for EHR data, information, functionality, and interoperability. Functional-and-Information Requirements for Electronic Health Records (EHR) and systems (EHRS), Functional-and-Information Requirements for Personal Health Records (PHR) and systems (PHRS), An objective of the EHR Interoperability WG team is to create a clear, complete, concise, correct and consistent 2017 EHRS FIM R3.0 in Sparx Systems Enterprise Architect tool; where, a DoD-VA EHRS-FM-FHIR-FHIM can address the structural-consistency issues identified by the VA negative R2 ballot. A second objective of the EHR Interoperability WG is to produce a Meaningful-Use profile for R2.0 & R3.0 The objective of the Resource Management Evidentiary Support (RM-ES) project team, within the EHR WG is to provide expertise on records management, compliance, and data/record integrity and related to governance to support the use of medical records for clinical care and decision-making, business, legal and disclosure purposes. NOTE: EHRS-FM does NOT imply a specific architectures or workflows; but, profiles can be architecture & workflow specific. 3

Executive Summary (Recommendation) US-Realm Profile with DoD and VA Sub-Profiles 4

Enterprise Information Architecture EHRS-FM, FHIM-LEGO-based FHIR-CDA/CCDA-NIEM 10

Traceability & Interoperability Dashboard Enterprise Compliance and Conformance Framework (ECCF) Service Aware Interoperability Framework (SAIF) ECCF Enterprise Dimension Why - Policy Information Dimension What - Content Computational Dimension Who/How - Behavior Engineering Dimension Where - Implementation Technical Dimension Where - Deployments Conceptual Perspective Business Mission, Vision, Scope Glossary Inventory of Requirements Regulations Capabilities Policies Procedures Performance Metrics Inventory of Domain Entities Activities Associations Information Requirements Information Models Conceptual Business Objects Inventory of Reusable Scenarios Business Activities System Functions Requirements Accountability, Roles Profiles, Behaviors, Interactions Interfaces, Contracts Inventory of SW Platforms, Layers SW Environments SW Components SW Services Technical Requirements Enterprise Service Bus Technical Requirements Performance Requirements Inventory of HW Platforms HW Environments Network Devices Communication Devices Capacity Requirements Logical Perspective Business Policies Governance Implementation Guides Interoperability Specs Design Constraints Standards Clinical Templates Organization Contracts Information Models Detailed Clinical Common Logical Concept Maps Terminologies Value Sets Content Specifications Documents Services Messages Specifications Scenario Events Use Cases Workflow Use Cases Components, Interfaces Collaboration Actors Collaboration Types Collaboration Roles Function Types Interface Types Service Contracts Models, Capabilities, Features and Versions SW Environments SW Capabilities SW Libraries SW Services SW Transports Models, Capabilities, Features and Versions HW Platforms HW Environments Network Devices Communication Devices Implementable Perspective Business Nodes Business Rules Business Procedures Business Workflows Technology Specific Standards Schemas for Databases Messages Documents Services Transformations Automation Units Technical Interfaces Technical Operations Orchestration Scripts SW Specifications for Applications GUIs Components SW Deployment Topologies HW Deployment Specifications HW Execution Context HW Application Bindings HW Deployment Topology HW Platform Bindings Fit-for-Purpose View Responsibility: Business Architecture Programs Management Office Developers/Venders 3/27/2014 Based on ISO Reference-Model Open Distributed Processing (RM ODP), See notes page for ECCF description 12

How VA, DoD and IPO Can Help VA, DoD, IPO request ONC/FHA to sponsor an HL7 US-Realm EHRS-FM Profile including DoD-and-VA Sub-Profiles including HITSP/S&I Framework Use-Cases and ISs, FHIM/LEGObased FHIR-CCDA-NIEM, MU2 and DoD-VA-HHS Health Standards Profiles (HSP), DoD-VA ibrm (Activities), iprms (Processes), requirements including IERs; Providing a baseline-for IPO-and-GAO Monitoring-and-Reporting on DOD-and-VA sharing Alignment of the DoD-VA Business, Information/Informatics, Exchange and Standards architectures. Harmonizing EHRS-FM FHIM-LEGO-FHIR within source systems to support CCDA and NIEM Information Exchange and FHIRbased Data Management Services (DMS). 14

Agenda Value Proposition for Simultaneous Engagement with EHR System Functional Model (EHRS-FM) Federal Health Information Model (FHIM) Fast Healthcare Interoperability Resources (FHIR) Executive Summary and Acronyms (Slides 3-15) EHRS-FM Background and Overview (Slides 17-19) EHRS-FM Profile Approach (Slides 22-27) (1) Example: HL7 Population Health & the Public Health Functional Profile (1) EHRS-FM Meaningful-Use Functional-Profile Methodology (1) Potential US-Realm EHRS-FM-FHIR-FHIM plus DoD-and-VA Sub-Profiles (4) US-Realm Profile Vision, Methodology, Value, Next Steps (1) Questions & Discussion (Slide 29) Backup (Slides 30-46) (3) Knowledge Engineering, Data Management Needs (4) EHRS-FM, FHIR and FHIM content and DoD-VA Shared-Data Example (5) Gartner CPR generations and Evidence-Based-Medicine (EBM) Requirements (3) S&I Framework Use-Case Simplification and NIST Tooling Strategy NOTE: Executive Summary Talking-Points Slides are hidden in Presentation Model 16

Introduction ISO/TC215, HL7 & EHR WG ISO International Standards Organization ISO membership - a network of national standards bodies National bodies represent ISO in their respective country In USA ANSI is the national standards body ISO TC215 - Technical Committee on Health Informatics HL7 International ANSI accredited Standards Development Organization (SDO) for Health IT standards Individual, Corporate & Governmental membership International Affiliates in 36 countries (including US) HL7 EHR Work Group was formed in 2003 Many common members between the two entities 17

Introduction EHRS-FM HL7/ISO-10781 Electronic Health Record System Functional Model (EHRS-FM) Describes functions and related conformance criteria for EHR Systems HL7 Draft Standard (2004), HL7 Normative R1 (2007), ISO/HL7 Normative R1.1 (2009) Release 1.1 had 130 functions with 1000 conformance criteria HL7 Normative R2 (Mar 2014), ISO/HL7 Normative R2.1 (May 2014-planned) Release 2.0 has 320 functions with 2300 conformance criteria Linda Fischetti, Chief Health Informatics Officer, VA proponent (2003-2008) Nancy Orvis, MHS Business Architecture, DoD proponent (2003-present) Nona Hall, S&I Monitoring and Reporting, IPO proponent (2009-present) Release 2.1 is in ballot: ISO TC215, CEN TC251, IHTSDO, CDISC and GS1 18

130 functions 1000 CCs Introduction EHRS-FM R1.1 R2.0 Chapter (re)organization Direct Care (DC) Supportive (S) Information Infrastructure (IN) 2009 Release 1.1 Excel Based 320 functions 2300 Conformance Criteria (CCs) Care Provision Support (CPS) 2014 Release 2.0 Overarching (O) Care Provision (CP) Population Health Support (POP) Enterprise Architect based Administrative Support (AS) Record Infrastructure (RI) Trust Infrastructure (TI) 19

Introduction EHRS-FM-FHIR-FHIMs Conformance EHR Systems do not conform directly to HL7/ISO-10781 EHRS-FM Instead EHR Systems conform to one or more Functional Profiles Functional Profiles (of FM R1.1) Ambulatory Care, Behavioral Health, Child Health, Clinical Research, Emergency Medicine, Long-Term Care, Pharmacy/Pharmacist, Records Management/Evidentiary Support (RM-ES), Vital Records Emerging R2 Profiles Public Health (8 sub-domains), Dental, Nutrition, Meaningful Use (MU) Potential ONC/FHA US-Realm Profile with DoD-VA Sub-Profiles as Data-Sharing Baseline for IPO-and-GAO Monitoring-and-Reporting BEA Reference-Model for Acquisition, Test and Certification NOTE: a US-Realm EHRS-FM-FHIR-FHIM Profile with DOD-VA Sub-Profiles can specify specific architectures and workflows! 20

Introduction EHRS-FM & FP Methodology Functional Profiles (FP) are tailored to specific realms/domains, services and specialties Functional Profiles allow: Required-ness upgrade: e.g., MAY or Should to SHALL Designation of applicable FM functions, criteria New or revised conformance criteria New or revised functions, statements, descriptions Proposals for inclusion in next FM release US-Realm (DoD-VA) Profile can address VA s Release-2 concerns and be the foundation for Release-3 21

EXAMPLE Public Health Functional Profile and 8 Sub-Profiles Birth Defects Vital Records (Birth, Death Events) Cancer Registries Early Hearing Detection and Intervention Common Public Health Functions Public Health Laboratory Health Statistics Deep Vein Thrombosis/Pulmonary Embolism Occupational Disease, Injury and Fatality 22

EHRS MU FP: Methodology Map ONC/NIST EHRS Test Procedures to related HL7/ISO 10781 EHRS-FM Functions/Criteria ONC/NIST Objectives and EHRS Test Procedures (MU Stages 1&2 2014) HL7/ISO 10781 EHRS-FM-FHIR- FHIM Functions and Criteria (R2 MU Profile May 2014) 23

Potential EHRS-FM US-Realm Profile, including DoD-VA Sub-Profiles Conformance to ISO/HL7 EHRS-FM Standard and US-Realm profile, including HITSP/S&I Framework Use-Cases and ISs, MU2, FHIM-LEGO-based FHIR-CCDA-NIEM, DoD-VA Information Exchanges mapped to DoD-VA-HHS Standards, ibrm, iprm, DoD-VA Sub-Profiles Includes EHRS-FM functional profile for the US Realm EHR systems or health care delivery settings, including the specific needs of DoD and VA Describes the DoD-VA specific requirements to support continuity-of-care, VLER Health Information Exchange, analytics, decision-support, etc. Articulates the functional requirements needed to support data exchange among purchased-care providers, DoD-VA stakeholders, VLER program and other federal and health agencies. 24

Vision EHRS-FM US-Realm Profile, including DoD-VA Sub-Profiles HL7 Peer Reviewed foundation for DoD-VA Business and Data-Sharing Architectures. Baseline DoD-and-VA Functions-and-Information Models (FIM) Information Exchange (IEs) Requirements and applicable standards; where, IE requirements-specifications define the DoD-VA Exchange Architecture Contain a core or common set of US-Realm functional and Information requirements for all Federal health domains Contain unique functional requirements for specific DoD and/or VA health domains analogous to Public Health strategy HL7 International peer-review of EHRS-FM US-Realm profile, including DoD-and-VA EHR sharing sub-profile requirements-specifications IPO-and-GAO Monitoring-and-Reporting baseline 25

Methodology EHRS-FM US-Realm Profile, including DoD-VA Sub-Profiles Map DoD DHMSM and VA VistA Evolution EHRS Use Cases, Requirements-Specifications and objectives and criteria to related HL7/ISO 10781 EHRS-FM Functions/Criteria Use-Cases Rqmnts-Specs. Objectives and Criteria DoD DHMSM VA VistA Evolution HL7/ISO 10781 EHRS-FM-FHIR- FHIM Functions and Criteria US-Realm Common DoD Specific VA Specific 26

Value EHRS-FM US-Realm Profile, including DoD-VA Sub-Profiles HL7 Standardization of DOD-VA Interoperability Strategy Configuration Baseline for FHIM-LEGO-Based FHIR, NIEM, CCDA Profiles Baseline for IPO-and-GAO Monitoring-and-Reporting on DoD-VA sharing Reference-Model for BA Alignment, Acquisition, Test and Certification VALUE CHAIN: High reuse starting with Use-Cases/Scenarios mapped-to EHR Functions and their Information Exchanges (IEs) mapped to DoD-VA-HHS Health Standards Profile (HSP) DoD-VA FHIM-based FHIR-profile, using ISAAC-MDHT, to specify IGs DoD & VA sharing s Data Management Services (DMS) VLER s Consolidated CDA (CCDA) document sharing 27

Potential Next Step EHRS-FM US-Realm Profile, including DoD-VA Sub-Profiles 1. EHRS-FM FP include DoD-VA Information Exchange Requirements (IERs) IERs specified by FHIM-FHIR-based FHIR-profiles for DMS & CCDA 2. HL7 FHIR 1.1 for CCDA planned for DSTU publication in May 2015. 3. ISAAC-MDHT, FHIM harmonized to support DoD-VA FHIR Profile, NIEM and CCDA Implementation Guides (IGs) 4. Align configuration baselines for EHRS-FM, FHIM, FHIR, LEGO profiles 5. Integration contractors use EHRS-FM/FHIR profile IGs for DMS & CCDA VistA Evolution, DHMSM, VLER interoperability IPO and GAO Monitoring-and-Reporting baseline 28

THANK YOU Questions & Discussion HL7 EHR WG Weekly Calls (770) 657-9270 510269# Rec Mgmt/Evidentiary Support: Mon 12 Noon ET EHR Interop WG (Release 3): Tues 1PM ET EHR Interop WG (Meaningful Use): Tues 1PM ET EHR Work Group: Tues 3PM ET Personal Health Record WG: Wed 12 noon ET EHR Usability WG: Wed 3PM ET 29

US-Realm EHRS-FM Traceability Approach 30

US-Realm, EHRS-FM-FHIR-FHIM including DoD-VA Sub-Profiles Supports Data Management Mission Needs 31

DoDAF Traceability & Interoperability Dashboard Enterprise Compliance and Conformance Framework (ECCF) Service Aware Interoperability Framework (SAIF) ECCF Enterprise Dimension Why - Policy Information Dimension What - Content Computational Dimension Who/How - Behavior Engineering Dimension Where - Implementation Technical Dimension Where - Deployments SRR Conceptual Perspective CV-1: Mission Needs CV-2: Cap Taxonomy CV-3: Cap Phasing CV-4: Cap Dependencies CV-5: Cap vs. Development CV-6: Cap vs. Op Activities CV-7: Cap vs. Services StdV-2 Standards Forecast DIV-1 Data Models Business Domains Business Objects Data Dictionary Data Structures OV-1 CONOPS OV-2 Resource Flow OV-3 IERs OV-4 Op Relationships OV-5 Business Activities OV-6a Op Rules Model OV-6b State Transitions OV-6c Event-Trace SV-4 System Functions SV-5 Op vs. Sys Functions SvcV-4 Functionality Desc SvcV-7 Measures Matrix SvcV-8 Evolution Desc SvcV-9 TecSkills Forecast Inventory of HW Platforms HW Environments Network Devices Communication Devices Capacity Requirements PDR Logical Perspective StdV-1 Std Profile Data Stds Business Rules Business Stds Workflow Stds Tec Stds DIV-2 Data Models Detailed Clinical Structured Content Spec Terminology Value Sets SV-1 Interface Description SV-2 Resource Flows SV-3 Sys-Sys Matrix SV-5a Activity vs Function SV-5b Activity vs System SvcV-1 Context Desc SvcV-2 Resource Flows SvcV-3a Sys vs Svc SvcV-3b Srv vs Srv SvcV-5 Activity vs Service Models, Capabilities, Features and Versions SW Environments SW Capabilities SW Libraries SW Services SW Transports CDR Implementable Perspective Business Nodes Business Rules Business Workflows DIV-3 Schemas for Databases Messages Documents Services Transformations Automation Units Technical Interfaces Technical Operations Orchestration Scripts APIs for Applications GUIs Components Deployment Topologies HW Deployment Specifications HW Execution Context HW Application Bindings HW Deployment Topology HW Platform Bindings Fit-for-Purpose View Responsibility : Business Architecture Program Management Office Developers/Venders 3/27/2014 Based on ISO Reference-Model Open Distributed Processing (RM ODP), See notes page for ECCF description 32

Care Provision (CP) 1. CP.1 Manage Clinical History 2. CP.2 Render Externally Sourced Information 3. CP.3 Manage Clinical Documentation 4. CP.4 Manage Orders 5. CP.5 Manage Results 6. CP.6 Manage Treatment Administration 7. CP.7 Manage Future Care 8. CP.8 Manage Patient Education & Communication 9. CP.9 Manage Care Coordination & Reporting Care Provision Support (CPS) 1. CPS.1 Record Management 2. CPS.2 Support Externally Sourced Information 3. CPS.3 Support Clinical Documentation 4. CPS.4 Support Orders 5. CPS.5 Support for Results 6. CPS.6 Support Treatment Administration 7. CPS.7 Support Future Care 8. CPS.8 Support Patient Education & Communication 9. CPS.9 Support Care Coordination & Reporting Trust Infrastructure (TI) 1. TI.1 Security 2. TI.2 Audit 3. TI.3 Registry and Directory Services 4. TI.4 Standard Terminology and Terminology Services 5. TI.5 Standards-Based Interoperability 6. TI.6 Business Rules Management 7. TI.7 Workflow Management 8. TI.8 Database Backup and Recovery EHRS-FM R2.0 Dimensions and Stakeholders Population Health Support (PHS) 1. POP.1 Support for Health Maintenance, Preventive Care and Wellness 2. POP.2 Support for Epidemiological Investigations of Clinical Health Within a Population 3. POP.3 Support for Notification and Response 4. POP.4 Support for Monitoring Response Notifications Regarding a Specific Patient s Health 5. POP.5 Donor Management Support 6. POP.6 Measurement, Analysis, Research and Reports 7. POP.7 Public Health Related Updates 8. POP.8 De-Identified Data Request Management 9. POP.9 Support Consistent Healthcare Management of Patient Groups or Populations 10.POP.10 Manage Population Health Study-Related Identifiers Administration Support (AS) 1. AS.1 Manage Provider Information 2. AS.2 Manage Patient Demographics, Location and Synchronization 3. AS.3 Manage Personal Health Record Interaction 4. AS.4 Manage Communication 5. AS.5 Manage Clinical Workflow Tasking 6. AS.6 Manage Resource Availability 7. AS.7 Support Encounter/Episode of Care Management 8. AS.8 Manage Information Access for Supplemental Use 9. AS.9 Manage Administrative Transaction Processing Record Infrastructure (RI) 1. RI.1 Record Lifecycle and Lifespan 2. RI.2 Record Synchronization 3. RI.3 Record Archive and Restore 9. TI.9 System Management Operations and Performance 33 33

EHRS Information Model Using FHIM-Based FHIR Profiles http://www.hl7.org/implement/standards/fhir/ FHIR Administrative Attribution: Patient, RelatedPerson, Practitioner, Organization Resources: Device, Location, Substance, Group Workflow Management: Encounter, Alert, Supply, Order, OrderResponse Financial: Coverage FHIR Clinical General: AdverseReaction, AllergyIntolerance, CarePlan, FamilyHistory, Condition, Procedure, Questionnaire Medications: Medication, MedicationPrescription, MedicationAdministration, MedicationDispense, MedicationStatement, Immunization, ImmunizationProfile Diagnostic: Observation, DiagnosticReport, DiagnosticOrder, ImagingStudy, Specimen Device Interaction: DeviceCapabilities, DeviceLog, DeviceObservation FHIR Infrastructure Support: List, Media, Other, DocumentReference, (Binary) Audit: Provenance, SecurityEvent Exchange: Document, Message, OperationOutcome, Query Conformance: Conformance, ValueSet, Profile 34

EHRS Information Model Using FHIM-Based FHIR Profiles http://www.fhims.org/content/420a62fd03b6_root.html 35 35

Example: EHRS-FM Linkage-to FHIR & FHIM for Allergy, Intolerance & Adverse-Reaction class FHIM Allergy, Intolerance and Adverse Reaction Name: Author: Version: Created: Updated: FHIM Allergy, Intolerance and Adverse Reaction Steve Hufnagel Prototype 11/6/2013 2:56:20 PM 11/21/2013 5:27:25 AM realize Observation «EHR-S FIM» Allergy, Intolerance and Adverse Reaction realize FHIR International Specifications «FHIR» AllergyIntolerance «FHIR» AdverseReaction realize FHIR-FHIM US-Realm-Profile Specifications realize «Observation» IntoleranceConditionEntry NotificationReport «Observation» AdverseReactionReportingEvent «Observation» NoKnownAllergyEntry «Observation» IntoleranceCondition +intoleranceobservation * FHIM Allergy Domain + InformationReporter + IntoleranceCondition + IntoleranceConditionEntry + IntoleranceConditionList + NoKnownAllergyEntry + RelatedIntoleranceCondition FHIM + FHIM Adverse-Event Reporting Domain + FHIM Allergy Domain + Common + CommonProduct + Person + Provider + Public HealthReporting FHIM Adverse-Event Reporting Domain + AdverseReactionReportingEvent + ConcommittantDrugs + ReactionObservation + RelevantLabData + SuspectedAgent 36

Terminology Binding with Lightweight Expression of Granular Objects LEGOS Based on the Simple Information Model (SIM) Framework Organizes clinical information in a maximally reusable way Designed to resolve the long-standing tension between terminology models and information models The terminology plays the central role, and the information model is reduced to a bare minimum container. The SIM approach Constructed around SNOMED CT taxonomy, with Extensions Deployed alongside a description logic classifier (e.g., EL++) Allows clinical statements of arbitrary complexity to be constructed as needed Preserves the ability to aggregate and analyze the clinical information later 37

LEGO Terminology Binding Structure; where, SIM is the meta-data schema for LEGOs LEGO model instantiated as an XML Schema (polymorphic Object) Key feature is an assertion structure composed of: Observable element in the form of an assertion SOLOR (SNOMED, LOINC, RXnorm) pre-or-post coordinated expression Expression representing the subject of the assertion (i.e., the question or what is being observed ) Qualifier element How the observable-assertion is acquired (e.g., by interview or physical exam or an HL7 null flavor ) Value element (e.g., Boolean or numeric value) The value of the expression in the observable (i.e., the answer or observation result ) Timing element (optional interval) Period of time during which the assertion was valid 38

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Evidence Based Medicine (EBM) 40

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Use Case Simplification Purpose and Benefit The Use Case Simplification Initiative manages a tool-based Repository of reusable components, from existing use cases; where, the components can be used in the construction of new-or-revised use-case: The Use Case Repository components include Requirements, Actors and Entities, Roles, Scenarios, Events, Activities and Actions, which can be composed into Workflows of Actors with Roles, activities and Information Exchanges (Record-Entries, Documents, Messages, Services). Use-Case Events and Activities are defined by pre-conditions (e.g., Activity-Triggers), invariant conditions (e.g., Processes with Actors, Roles, Constraints, Activities and Actions) and post-conditions (e.g., produced Resources, constraints and next-steps) EHRS-FM system functions can be mapped to reusable Use-Case components, which can be composed into new workflows. 43

uc EHR-S & PHR-S Reference CONOPS Model Patient Patient Encounter «flow» provide Information observe Patient treat Patient write Order sign Encounter Use Case Exchange Format Objective use EHR-S or PHR-S «flow» Clinician Standard, Non-Proprietary Exchange Format Usable within NIST EHR suite-of-tools, such as Prometheus Use-Case Tool (UCT). XMI or XML importable into UML Modelling Tools, such as Sparx Enterprise Architect (EA) The Use Case Repository components include Requirements, Actors and Entities, Roles, Scenarios, Events, Activities and Actions, which can be composed into Workflows of Actors, in Roles, performing activities and their Information Exchanges (Record-Entries, Documents, Messages, Services). Use-Case and Activity Model views and their layout 44

EHRS-FM EA tool within NIST s EHR Tooling Strategy 45

Document Change History Date-Version Mar 12, 2014-A Mar 13, 2014-B Mar 14, 2014-C Mar 15, 2014-D Mar 17, 2014-E Mar 18, 2014-F Mar 19, 2014-G Mar 20, 2014-H Mar 24, 2014-I Mar 25, 2014-J Mar 26, 2014-K Comment First Draft [Steve Hufnagel] Remove HDD [Mike Lincoln], Added ISAAC/LEGO [Catherine Hoang] Added Isaac, SIM & LEGO slides [John Carter] Added Enterprise Information Architecture [Steve Hufnagel] Added Executive Summary Section [Steve Hufnagel] Added Knowledge Engineering (KE) [Steve Hufnagel] Added Data Management Strategy (DMS) [Steve Hufnagel] Added Isaac/LEGO details [Keith Campbell] Added Gartner CPR generation Levels, EBM (Nona Hall] Added ibrm & iprm [Ian Kamorowski] Added Executive Summary slide [Greg Staudenmaier] Added NIST Tooling Strategy [Gary Dickinson] Removed cover-page collaboration list [Ian Kamorowski] Modified tone to be objective [Catherine Hoang] Added S&I Framework and ECCF slides [Steve Hufnagel] Split Executive Summary into 3 slides [Steve Hufnagel] Moved SAIF ECCF to Executive Summary [Nona Hall] Added DoDAF ECCF to backup [Nona Hall] Added Executive Summary Diagram [Steve Hufnagel] 46