July 8, 2009

Version 1.0

HITSP EHR-Centric Interoperability Specification

Submitted to:

Healthcare Information Technology Standards Panel

Submitted by:

EHR-Centric Interoperability Specification (IS) Tiger Team

Document Change History

Version Number	Description of Change	Name of Author	Date Published
V0.0.1	Review Copy	EHR-Centric IS Tiger Team	June 30, 2009
V1.0	Released for Implementation	EHR-Centric IS Tiger Team	July 8, 2009

Table of Contents

1.0 Introduction. 8

1.1 HITSP EHR-Centric Interoperability Specification Overview. 8

1.2 Copyright Permissions. 8

2.0 EHR-Centric Interoperability Requirements. 9

2.1 Introduction. 9

2.2 List of Capabilities. 9

2.3 ARRA Requirements. 13

2.4 Security and Privacy Functions. 23

3.0 Capability Specifications. 26

3.1 Capabilities Overview. 26

3.2 HITSP/CAP117 Communicate Ambulatory and Long Term Care Prescription Specification. 31

3.3 HITSP/CAP118 Communicate Hospital Prescription Specification. 34

3.4 HITSP/CAP119 Communicate Structured Document Specification. 36

3.5 HITSP/CAP120 Communicate Unstructured Document Specification. 47

3.6 HITSP/CAP121 Communicate Clinical Referral Request Specification. 50

3.7 HITSP/CAP122 Retrieve Medical Knowledge Specification. 52

3.8 HITSP/CAP123 Retrieve existing data Specification. 54

3.9 HITSP/CAP124 Establish Secure web access Specification. 56

3.10 HITSP/CAP125 Retrieve Genomic Decision Support Specification. 58

3.11 HITSP/CAP126 Communicate Lab Results Message Specification. 60

3.12 HITSP/CAP127 Communicate Lab Results Document Specification . 64

3.13 HITSP/CAP128 Communicate Imaging Information Specification. 68

3.14 HITSP/CAP129 Communicate Quality Measure Data Specification. 71

3.15 HITSP/CAP130 Communicate Quality Measure Specification. 75

3.16 HITSP/CAP131 Update Immunization Registry Specification. 78

3.17 HITSP/CAP132 Retrieve Immunization Registry Information Specification. 81

3.18 HITSP/CAP133 Communicate Immunization Summary Specification. 84

3.19 HITSP/CAP135 Retrieve and Populate Form Specification. 87

3.20 HITSP/CAP136 Communicate Emergency Alert Specification. 91

3.21 HITSP/CAP137 Communicate Encounter Information Message Specification. 93

3.22 HITSP/CAP138 Retrieve Pseudonym Specification. 96

3.23 HITSP/CAP139 Communicate Resource Utilization Specification . 99

3.24 HITSP/CAP140 Communicate Benefits and Eligibility specification. 100

3.25 HITSP/CAP141 Communicate Referral Authorization Specification. 103

3.26 HITSP/CAP142- Retrieve Communications Recipient Specification. 106

3.27 HITSP/CAP143 Manage Consumer Preference and Consents Specification. 108

4.0 Conformance Statement. 112

5.0 Appendix. 113

5.1 HITSP Capabilities Mapped to the HITSP Provider, Population and Consumer Interoperability Specifications 113

Figures and Tables

Figure 3-1 Typical Network Topologies. 27

Figure 3-2 HITSP/CAP117 Communicate Ambulatory and Long Term Care Prescription Visual Overview. 33

Figure 3-3 HITSP/CAP118 Communicate Hospital Prescription Visual Overview. 36

Figure 3-4 HITSP/CAP119 Communicate Structured Document Visual Overview. 42

Figure 3-5 HITSP/CAP120 Communicate Unstructured Document Visual Overview. 50

Figure 3-6 HITSP/CAP121 Communicate Clinical Referral Request Visual Overview. 52

Figure 3-7 HITSP/CAP122 Retrieve Medical Knowledge Visual Overview. 54

Figure 3-8 HITSP/CAP123 Retrieve Existing Data Visual Overview. 56

Figure 3-9 HITSP/CAP124 Establish Secure Web Access Visual Overview. 58

Figure 3-10 HITSP/CAP125 Retrieve Genomic Decision Support Visual Overview. 60

Figure 3-11 HITSP/CAP126 Communicate Lab Results Message Visual Overview. 63

Figure 3-12 HITSP/CAP127 Communicate Lab Results Document Visual Overview. 67

Figure 3-13 HITSP/CAP128 Communicate Imaging Information Visual Overview. 71

Figure 3-14 HITSP/CAP129 = Communicate Quality Measure Data Visual Overview. 75

Figure 3-15 HITSP/CAP130 Communicate Quality Measure Specification Visual Overview. 78

Figure 3-16 HITSP/CAP131 Update Immunization Registry Visual Overview. 81

Figure 3-17 HITSP/CAP132 Retrieve Immunization Registry Information Visual Overview. 84

Figure 3-18 HITSP/CAP133 Communicate Immunization Summary Visual Overview. 87

Figure 3-19 HITSP/CAP135 Retrieve and Populate Form Visual Overview. 91

Figure 3-20 HITSP/CAP136 Communicate Emergency Alert Visual Overview. 93

Figure 3-21 HITSP/CAP137 Communicate Encounter Information Message Visual Overview. 96

Figure 3-22 HITSP/CAP138 Retrieve Pseudonym Visual Overview. 98

Figure 3-23 HITSP/CAP139 Communicate Resource Utilization Visual Overview. 100

Figure 3-24 HITSP/CAP140 Communicate Benefits and Eligibility Visual Overview. 103

Figure 3-25 HITSP/CAP141 Communicate Referral Authorization Visual Overview. 106

Figure 3-26 HITSP/CAP142 Retrieve Communications Recipient Visual Overview. 108

Figure 3-27 HITSP/CAP143 Manage Consumer Preference and Consents Visual Overview. 111

Table 2-1 HITSP Information Exchange Capabilities. 9

Table 2-2 Map of Requirements to Capabilities. 14

Table 2-3 ARRA Gap Analysis and Resolution Recommendations. 17

Table 2-4 Security and Privacy Functions Mapped to Capabilities. 24

Table 2-5 Service Collaborations Definitions. 25

Table 3-1 Information Exchange Topologies Mapped to Capabilities . 28

Table 3-2 Network Topologies Mapped to Service Collaborations. 29

Table 3-3 Service Collaborations Mapped to HITSP Constructs. 29

Table 3-4 Global Constraints and Assumptions. 30

Table 3-5 Interacting Systems. 31

Table 3-6 Constraints and Assumptions. 32

Table 3-7 List of Constructs. 32

Table 3-8 HITSP/CAP117 Communicate Ambulatory and Long Term Care Prescription Specified Interfaces 32

Table 3-9 Interface Conditions and T/TP/SC/Content Optionality. 33

Table 3-10 Interacting Systems. 34

Table 3-11 Constraints and Assumptions. 34

Table 3-12 List of Constructs. 35

Table 3-13 HITSP/CAP118 Communicate Hospital Prescription Specified Interfaces. 35

Table 3-14 Interface Conditions and T/TP/SC/Content Optionality. 36

Table 3-15 Interacting Systems. 37

Table 3-16 Constraints and Assumptions. 37

Table 3-17 List of Constructs. 38

Table 3-18 HITSP/CAP119 Communicate Structured Document Specified Interfaces. 39

Table 3-19 Interface Conditions and T/TP/SC/Content Optionality . 40

Table 3-20 Creator Registration Subset Content Modules. 43

Table 3-21 Creator Medication and Immunization History Subset Content Modules. 43

Table 3-22 Creator Conditions and Allergy Subset Content Modules. 44

Table 3-23 Creator Laboratory Subset Content Modules. 44

Table 3-24 Creator Medication and Allergies Information Subset Content Modules. 45

Table 3-25 Structured Family History Creator-Structured Family History Subset Content Modules. 45

Table 3-26 Structured Family History Content Creator Subset Content Modules. 46

Table 3-27 Interacting Systems. 48

Table 3-28 Constraints and Assumptions. 48

Table 3-29 List of Constructs. 48

Table 3-30 HITSP/CAP120 Communicate Unstructured Document Specified Interfaces. 49

Table 3-31 Interface Conditions and T/TP/SC/Content Optionality . 49

Table 3-32 Interacting Systems. 50

Table 3-33 Constraints and Assumptions. 51

Table 3-34 List of Constructs. 51

Table 3-35 HITSP/CAP121 Communicate Clinical Referral Request Specified Interfaces. 51

Table 3-36 Interface Conditions and T/TP/SC/Content Optionality. 51

Table 3-37 Interacting Systems. 52

Table 3-38 Constraints and Assumptions. 53

Table 3-39 List of Constructs. 53

Table 3-40 HITSP/CAP122 Retrieve Medical Knowledge Specified Interfaces. 53

Table 3-41 Interface Conditions and T/TP/SC/Content Optionality. 53

Table 3-42 Interacting Systems. 54

Table 3-43 Constraints and Assumptions. 55

Table 3-44 List of Constructs. 55

Table 3-45 HITSP/CAP123 Retrieve Existing Data Specified Interfaces. 55

Table 3-46 Interface Conditions and T/TP/SC/Content Optionality. 55

Table 3-47 Interacting Systems. 56

Table 3-48 Constraints and Assumptions. 57

Table 3-49 List of Constructs. 57

Table 3-50 HITSP/CAP124 Establish Secure Web Access Specified Interfaces. 57

Table 3-51 Interface Conditions and T/TP/SC/Content Optionality. 57

Table 3-52 Interacting Systems. 58

Table 3-53 Constraints and Assumptions. 59

Table 3-54 List of Constructs. 59

Table 3-55 HITSP/CAP125 Retrieve Genomic Decision Support Specified Interfaces. 59

Table 3-56 Interface Conditions and T/TP/SC/Content Optionality. 59

Table 3-57 Interacting Systems. 60

Table 3-58 Constraints and Assumptions. 61

Table 3-59 List of Constructs. 61

Table 3-60 HITSP/CAP126 Communicate Lab Results Message Specified Interfaces. 62

Table 3-61 Interface Conditions and T/TP/SC/Content Optionality . 62

Table 3-62 Interacting Systems. 64

Table 3-63 Constraints and Assumptions. 64

Table 3-64 List of Constructs. 65

Table 3-65 HITSP/CAP127 Communicate Lab Results Document Specified Interfaces. 65

Table 3-66 Interface Conditions and T/TP/SC/Content Optionality . 66

Table 3-67 Interacting Systems. 69

Table 3-68 Constraints and Assumptions. 69

Table 3-69 List of Constructs. 69

Table 3-70 HITSP/CAP128 Communicate Imaging Information Specified Interfaces. 70

Table 3-71 Interface Conditions and T/TP/SC/Content Optionality . 70

Table 3-72 Interacting Systems. 72

Table 3-73 Constraints and Assumptions. 72

Table 3-74 List of Constructs. 72

Table 3-75 HITSP/CAP129 Communicate Quality Measure Data Specified Interfaces. 73

Table 3-76 Interface Conditions and T/TP/SC/Content Optionality. 74

Table 3-77 Interacting Systems. 76

Table 3-78 Constraints and Assumptions. 76

Table 3-79 List of Constructs. 76

Table 3-80 HITSP/CAP130 Communicate Quality Measure Specified Interfaces. 77

Table 3-81 Interface Conditions and T/TP/SC/Content Optionality. 77

Table 3-82 Interacting Systems. 79

Table 3-83 Constraints and Assumptions. 79

Table 3-84 List of Constructs. 79

Table 3-85 HITSP/CAP131 Update Immunization Registry Specified Interfaces. 80

Table 3-86 Interface Conditions and T/TP/SC/Content Optionality. 80

Table 3-87 Interacting Systems. 82

Table 3-88 Constraints and Assumptions. 82

Table 3-89 List of Constructs. 82

Table 3-90 HITSP/CAP132 Retrieve Immunization Registry Information Specified Interfaces. 83

Table 3-91 Interface Conditions and T/TP/SC/Content Optionality. 83

Table 3-92 Interacting Systems. 85

Table 3-93 Constraints and Assumptions. 85

Table 3-94 List of Constructs. 85

Table 3-95 HITSP/CAP133 Communicate Immunization Summary Specified Interfaces. 86

Table 3-96 Interface Conditions and T/TP/SC/Content Optionality. 86

Table 3-97 Interacting Systems. 88

Table 3-98 Constraints and Assumptions. 88

Table 3-99 List of Constructs. 89

Table 3-100 HITSP/CAP135 Retrieve and Populate Form Specified Interfaces. 89

Table 3-101 Interface Conditions and T/TP/SC/Content Optionality. 90

Table 3-102 Interacting Systems. 91

Table 3-103 Constraints and Assumptions. 92

Table 3-104 List of Constructs. 92

Table 3-105 HITSP/CAP136 Communicate Emergency Alert Specified Interfaces. 92

Table 3-106 Interface Conditions and T/TP/SC/Content Optionality. 92

Table 3-107 Interacting Systems. 94

Table 3-108 Constraints and Assumptions. 94

Table 3-109 List of Constructs. 94

Table 3-110 HITSP/CAP137 Communicate Encounter Information Message Specified Interfaces . 95

Table 3-111 Interface Conditions and T/TP/SC/Content Optionality . 95

Table 3-112 Interacting Systems. 97

Table 3-113 Constraints and Assumptions. 97

Table 3-114 List of Constructs. 97

Table 3-115 HITSP/CAP138 Retrieve Pseudonym Specified Interfaces. 98

Table 3-116 Interface Conditions and T/TP/SC/Content Optionality . 98

Table 3-117 Interacting Systems. 99

Table 3-118 Constraints and Assumptions. 99

Table 3-119 List of Constructs. 99

Table 3-120 HITSP/CAP139 Communicate Resource Utilization Specified Interfaces. 99

Table 3-121 Interface Conditions and T/TP/SC/Content Optionality . 100

Table 3-122 Interacting Systems. 101

Table 3-123 Constraints and Assumptions. 101

Table 3-124 List of Constructs. 101

Table 3-125 HITSP/CAP140 Communicate Benefits and Eligibility Specified Interfaces. 102

Table 3-126 Interface Conditions and T/TP/SC/Content Optionality. 102

Table 3-127 Interacting Systems. 104

Table 3-128 Constraints and Assumptions. 104

Table 3-129 List of Constructs. 104

Table 3-130 HITSP/CAP141 Communicate Referral Authorization Specified Interfaces. 105

Table 3-131 Interface Conditions and T/TP/SC/Content Optionality. 105

Table 3-132 Interacting Systems. 107

Table 3-133 Constraints and Assumptions. 107

Table 3-134 List of Constructs. 107

Table 3-135 HITSP/CAP142 Retrieve Communications Recipient Specified Interfaces. 107

Table 3-136 Interface Conditions and T/TP/SC/Content Optionality. 108

Table 3-137 Interacting Systems. 109

Table 3-138 Constraints and Assumptions. 109

Table 3-139 List of Constructs. 110

Table 3-140 HITSP/CAP143 Manage Consumer Preference and Consents Specified Interfaces. 110

Table 3-141 Interface Conditions and T/TP/SC/Content Optionality. 110

Table 5-1 HITSP Capabilities Mapped to Interoperability Specifications. 114