June 30, 2009

Version 1.1.1

HITSP Quality Interoperability Specification

Submitted to:

Healthcare Information Technology Standards Panel

Submitted by:

Quality Measures Tiger Team

Document Change History

Version Number	Description of Change	Name of Author	Date Published
0.0.1	Review Copy	Population Health Technical Committee	September 18, 2007
0.0.2	Review Copy	Population Health Technical Committee	December 5, 2007
1.0	Released for Implementation	Population Health Technical Committee	December 13, 2007
1.0.1	Review Copy	Population Perspective Technical Committee	August 20, 2008
1.1	Released for Implementation	Population Perspective Technical Committee	August 27, 2008
1.1.1	Review Copy	Quality Measures Tiger Team	June 30, 2009

Table of Contents

1.0 Introduction. 8

1.1 Interoperability Specification Overview. 8

1.2 Document Scope. 8

1.3 Copyright Permissions. 9

1.4 Conformance. 9

1.4.1 Conformance Criteria. 9

1.4.2 Conformance Scoping, Subsetting and Options. 9

1.4.3 Test Methods. 9

2.0 Requirements Analysis. 10

2.1 Synopsis of Requirements. 10

2.1.1 Hospital-based Care and Clinician Capabilities Used. 13

3.0 Hospital-based Care and Clinician Design Specification. 15

3.1 Capability Orchestration. 15

3.1.1 Implementation Variants. 17

3.1.2 Additional Constraints on Required Capabilities. 19

3.2 CAP119 Communicate Structured Document Specification. 22

3.2.1 Communicate Structured Document Overview and Scope. 22

3.2.2 Capability Use. 22

3.2.3 Design Specification. 22

3.3 CAP122 Retrieve Medical Knowledge Specification. 35

3.3.1 Retrieve Medical Knowledge Overview and Scope. 35

3.3.2 Capability Use. 35

3.3.3 Design Specification. 35

3.4 CAP123 Retrieve Existing Data Specification. 38

3.4.1 Retrieve Existing Data Overview and Scope. 38

3.4.2 Capability Use. 38

3.4.3 Design Specification. 39

3.5 CAP129 Communicate Quality Measure Data Specifications. 41

3.5.1 Communicate Quality Measures Data Overview and Scope. 41

3.5.2 Capability Use. 42

3.5.3 Design Specification. 42

3.6 CAP130 Communicate Quality Measure Specification Specifications. 46

3.6.1 Communicate Quality Measure Specification Overview and Scope. 46

3.6.2 Capability Use. 47

3.6.3 Design Specification. 47

3.7 CAP135 Retrieve and Populate Form Specifications. 52

3.7.1 Retrieve and Populate Form Overview and Scope. 52

3.7.2 Capability Use. 52

3.7.3 Design Specification. 52

3.8 CAP138 Retrieve Pseudonym Specifications. 58

3.8.1 Retrieve Pseudonym Overview and Scope. 58

3.8.2 Capability Use. 59

3.8.3 Design Specification. 59

3.9 CAP143 Manage Consumer Preferences and Consents Specifications. 61

3.9.1 Manage Consumer Preferences and Consents Overview and Scope. 61

3.9.2 Capability Use. 62

3.9.3 Design Specification. 62

4.0 Standards. 66

4.1.1 Regulatory Guidance. 66

4.1.2 Selected Standards. 66

4.1.3 Informative Reference Standards. 71

4.2 Gaps Where There Are No Standards. 75

4.3 Standard Overlaps. 79

5.0 Appendix. 80

6.0 Document Updates. 101

6.1 December 5, 2007. 101

6.2 December 13, 2007. 101

6.3 August 20, 2008. 101

6.4 August 27, 2008. 101

6.5 June 30, 2009. 101

Figures and Tables

Figure 3-1 Hospital-Based Care and Clinician Component Data Flow Diagram.. 17

Table 3-2 Example 1: Clinical Repository. 18

Table 3-3 Example 2: Messaging Source Environment 18

Table 3-4 Example 3: Mixed Source Environment 18

Table 3-5 Example 4: Document Sharing Environment 18

Table 3-6 Orchestration Constraints. 19

Figure 3-7 CAP119 Communicate Structured Document Visual Overview. 28

Figure 3-8 CAP122 Retrieve Medical Knowledge Visual Overview. 38

Figure 3-9 CAP123 Retrieve Existing Data Visual Overview. 40

Figure 3-10 CAP129 Communicate Quality Measure Data Visual Overview. 46

Figure 3-11 CAP130 Communicate Quality Measure Specification Visual Overview. 51

Figure 3-12 CAP135 Retrieve and Populate Form for Data Capture Visual Overview. 58

Figure 3-13 CAP138 Retrieve Pseudonym Visual Overview. 61

Figure 3-14 CAP143 Manage Consumer Preferences and Consents Visual Overview. 64

Table 2-1 Description of Scenarios. 10

Table 2-2 System Descriptions and Mapping to Stakeholders. 10

Table 2-3 Information Exchange Requirement Description. 11

Table 2-4 Hospital-based Care and Clinician Capabilities mapped to IERs. 13

Table 2-5 Exchange Content Gaps. 14

Table 3-1 Orchestration of Capabilities for Each System.. 15

Table 3-2 Conditions. 16

Table 3-3 Additional Constraints on Required Capabilities. 20

Table 3-4 Additional Constraints on XDS Metadata Elements. 21

Table 3-5 Interacting Systems. 22

Table 3-6 Constraints and Assumptions. 22

Table 3-7 List of Constructs. 23

Table 3-8 Communicate Structured Document by Electronic Health Record (EHR) Systems. 24

Table 3-9 Communicate Structured Document by Health Information Exchange (HIE) 26

Table 3-10 Communicate Structured Document by Quality Measure Processing Entity. 26

Table 3-11 Communicate Structured Document Implementation Conditions. 27

Table 3-12 Creator Registration Subset Content Modules. 29

Table 3-13 Creator Medication and Immunization History Subset Content Modules. 29

Table 3-14 Creator Conditions and Allergy Subset Content Modules. 30

Table 3-15 Creator Laboratory Subset Content Modules. 30

Table 3-16 Creator Medication and Allergies Information Subset Content Modules. 31

Table 3-17 Structured Family History Creator-Structured Family History Subset Content Modules. 31

Table 3-18 Structured Family History - Content Creator Subset Content Modules. 32

Table 3-19 Interacting Systems. 35

Table 3-20 Constraints and Assumptions. 36

Table 3-21 List of Constructs. 36

Table 3-22 Retrieve Medical Knowledge by Electronic Health Record (EHR) System.. 36

Table 3-23 Retrieve Medical Knowledge by Health Information Exchange (HIE) 36

Table 3-24 Retrieve Medical Knowledge by Quality Measure Processing Entity. 37

Table 3-25 Retrieve Medical Knowledge by Performance Measurement Information Resource. 37

Table 3-26 Retrieve Medical Knowledge Implementation Conditions. 37

Table 3-27 Interacting Systems. 38

Table 3-28 Constraints and Assumptions. 39

Table 3-29 List of Constructs. 39

Table 3-30 Retrieve Existing Data by Electronic Health Record (EHR) System.. 39

Table 3-31 Retrieve Existing Data by Quality Measure Processing Entity. 39

Table 3-32 Retrieve Existing Data Implementation Conditions. 40

Table 3-33 Interacting Systems. 42

Table 3-34 Infrastructure and Security/Privacy Matrix. 42

Table 3-35 Constraints. 42

Table 3-36 List of Constructs. 43

Table 3-37 Communicate Quality Measure Data Interfaces by Electronic Health Record (EHR) System.. 43

Table 3-38 Communicate Quality Measure Data Interfaces by Health Information Exchange (HIE) System.. 44

Table 3-39 Communicate Quality Measure Data Interfaces by Quality Measure and Reporting System.. 44

Table 3-40 Communicate Quality Measure Data Interfaces by Quality Measure Processing Entity System.. 45

Table 3-41 Communicate Quality Measure Data Implementation Conditions. 45

Table 3-42 Interacting Systems. 47

Table 3-43 Infrastructure and Security/Privacy Matrix. 47

Table 3-44 Constraints. 47

Table 3-45 List of Constructs. 47

Table 3-46 Communicate Quality Measure Specification by Electronic Health Record (EHR) System.. 48

Table 3-47 Communicate Quality Measure Specifications by Health Information Exchange (HIE) 48

Table 3-48 Communicate Quality Measure Specifications by Quality Measure and Reporting Enterprise. 49

Table 3-49 Communicate Quality Measure Specifications by Quality Measure Processing Entity. 50

Table 3-50 Communicate Quality Measure Specifications by Performance Measurement Info Resource. 50

Table 3-51 Communicate Quality Measure Specifications Implementation Conditions. 51

Table 3-52 Interacting Systems. 52

Table 3-53 Infrastructure and Security/Privacy Matrix. 52

Table 3-54 Constraints. 53

Table 3-55 List of Constructs. 53

Table 3-56 Retrieve and Populate Form for Data Capture by Electronic Health Record (EHR) System.. 54

Table 3-57 Retrieve and Populate Form for Data Capture by Health Information Exchange (HIE) 55

Table 3-58 Retrieve and Populate Form for Data Capture by Quality Measure and Reporting System.. 56

Table 3-59 Retrieve and Populate Form for Data Capture by Quality Measure Processing Entities. 56

Table 3-60 Retrieve and Populate Form for Data Capture Implementation Conditions. 58

Table 3-61 Interacting Systems. 59

Table 3-62 Infrastructure and Security/Privacy Matrix. 59

Table 3-63 Constraints. 59

Table 3-64 List of Constructs. 60

Table 3-65 Retrieve Pseudonym by Electronic Health Record (EHR) System.. 60

Table 3-66 Retrieve Pseudonym by Health Information Exchange (HIE) 60

Table 3-67 Retrieve Pseudonym by Quality Measure Processing Entities. 60

Table 3-68 Retrieve Pseudonym Implementation Conditions. 61

Table 3-69 Interacting Systems. 62

Table 3-70 Infrastructure and Security/Privacy Matrix. 62

Table 3-71 Constraints. 63

Table 3-72 List of Constructs. 63

Table 3-73 Manage Consumer Preferences and Consent Interfaces by Electronic Health Record (EHR) System 63

Table 3-74 Manage Consumer Preferences and Consent Interfaces by Quality Measure Processing Entities. 64

Table 3-75 Manage Consumer Preferences and Consent Interfaces by Health Information Exchange (HIE) 64

Table 3-76 Manage Consumer Preferences and Consent Implementation Conditions. 65

Table 4-1 Regulatory Guidance. 66

Table 4-2 Selected Standards Linked to HITSP Capabilities. 66

Table 4-3 Selected Standards Linked to HITSP Capabilities. 71

Table 4-4 Informative Reference Standards. 71

Table 4-5 Use Case Requirements and Associated Standards Gaps. 75

Table 4-6 Use Case Requirements and Associated Standard Overlaps. 79

Table 5-1 Data Elements Cross Reference. 80

Table 5-2 Patient Data Mapping. 80

Table 5-3 Visit Data Mapping. 81

Table 5-4 Problem Data Mapping. 85

Table 5-5 Discharge Diagnosis Data Mapping. 86

Table 5-6 Vital Signs Data Mapping. 87

Table 5-7 Procedures and Diagnostic Data Mapping. 87

Table 5-8 Other Clinical Data Elements Data Mapping. 89

Table 5-9 Other Clinical Data Elements Data Mapping. 89

Table 5-10 Study Findings/Test Results - Laboratory Data Mapping. 91

Table 5-11 Study Findings/Test Results - Laboratory Data Mapping. 92

Table 5-12 New Exchange Content Data Requirements. 92

Table 5-13 Use Case Requirements Analysis Table. 94