December 18, 2008

Version 1.0

HITSP Patient-Provider Secure Messaging Interoperability Specification

Submitted to:

Healthcare Information Technology Standards Panel

Submitted by:

Consumer Perspective Technical Committee
(Formerly Consumer Empowerment Technical Committee)

Document Change History

Version Number	Description of Change	Name of Author	Date Published
	Template V2.4	Project Team	July 31, 2008
0.0.1	Review Copy	Consumer Perspective Technical Committee	September 26, 2008
0.0.2	Review Copy	Consumer Perspective Technical Committee	December 10, 2008
1.0	Released for Implementation	Consumer Perspective Technical Committee	December 18, 2008

Table of Contents

1.0 Introduction. 7

1.1 Interoperability Specification Overview. 7

1.2 Interoperability Specification Document Map. 7

1.2.1 List of Constructs. 8

1.3 Copyright Permissions. 9

1.4 Reference Documents. 9

1.4.1 Glossary Term Clarifications. 10

2.0 Requirements. 12

2.1 Use Case Synopsis. 12

2.2 Use Case Requirements. 13

2.2.1 Mapping of Use Case Actions to Information Exchange Requirements. 14

2.2.2 Data and Information Exchange Requirements. 14

2.2.3 Identification of Business Actors Mapped to Requirements. 15

2.2.4 High-Level Diagrams. 17

3.0 Design. 21

3.1 Scope of Design. 21

3.1.1 Assumptions. 23

3.1.2 Constraints. 24

3.1.3 Pre-conditions. 24

3.1.4 Post-conditions. 25

3.1.5 Process Triggers. 25

3.2 Detailed Design. 26

3.2.1 Technical Actor Role Descriptions. 26

3.2.2 Construct Requirements. 27

3.2.3 Mapping of Business Actors to Technical Actors and Constructs with Optionality. 30

3.2.4 Construct Dependencies. 32

3.2.5 Additional Constraints on Required Constructs. 33

4.0 Standards Selection. 34

4.1 Standards. 35

4.1.1 Regulatory Guidance. 35

4.1.2 Selected Standards. 35

4.1.3 Informative Reference Standards. 37

4.2 Gaps Where There Are No Standards. 38

4.3 Standard Overlaps. 39

5.0 Conformance. 40

5.1 Conformance Criteria. 40

5.2 Conformance Scoping, Subsetting and Options. 40

5.3 Test Methods. 40

6.0 Appendix. 41

6.1 Description of Standards. 41

6.2 Use Case to Information Exchange and Data Requirements. 44

6.3 Use Case Sequence Diagrams. 48

6.4 Mapping of Constructs to Information Exchange and Data Requirements. 54

7.0 Document Updates. 57

7.1 December 10, 2008. 57

7.1.1 Updates from Public Comment 57

7.2 December 18, 2008. 57

Figures and Tables

Figure 1-1 Interoperability Specification Document Map. 7

Figure 2-1 Legend for Component Diagrams. 18

Figure 2-2 Implementation Variants. 19

Figure 2-3 Component Data Flow. 19

Figure 2-4 Patient-Provider Secure Messaging Component Data Flow Diagram.. 20

Figure 3-1 Detailed Sequence Diagram for Scenario 1. 29

Figure 3-2 Detailed Sequence Diagram for Scenario 2. 30

Figure 6-1 Scenario 1: Patient-Initiated Communication High Level Sequence Diagram.. 49

Figure 6-2 Scenario 1: Secure Communication Using Two Secure Messaging Systems High Level Sequence Diagram 50

Figure 6-3 Scenario 1: Secure Communication Using a Third-Party Secure Messaging System High Level Sequence Diagram.. 51

Figure 6-4 Scenario 2: Clinician Initiated Communication High Level Sequence Diagram.. 52

Figure 6-5 Scenario 2: Secure Communication Using Two Secure Messaging Systems High Level Sequence Diagram 53

Figure 6-6 Scenario 2: Secure Communication Using a Third-Party Secure Messaging System High Level Sequence Diagram.. 54

Table 1-1 List of Constructs. 8

Table 1-2 Reference Documents. 9

Table 1-3 Glossary Term Clarifications. 10

Table 2-1 Data Element and Information Requirements (DR) 14

Table 2-2 Information Exchange Requirements (IER) 15

Table 2-3 Business Actors. 16

Table 3-1 Scoping Clarifications. 21

Table 3-2 Assumptions. 23

Table 3-3 Constraints. 24

Table 3-4 Pre-conditions. 24

Table 3-5 Post-conditions. 25

Table 3-6 Process Triggers. 25

Table 3-7 Technical Actor Role Descriptions. 26

Table 3-8 Unstructured Document Metadata Requirements. 28

Table 3-9 Business-Technical Actor Mapping to Transaction and/or Content 31

Table 3-10 Implementation Conditions/Constraints. 32

Table 3-11 Construct Dependencies. 33

Table 3-12 Additional Constraints on Required Constructs. 33

Table 4-1 Regulatory Guidance. 35

Table 4-2 Selected Standards Linked to HITSP Constructs. 35

Table 4-3 Informative Reference Standards. 37

Table 4-4 Use Case Requirements and Associated Standards Gaps. 39

Table 4-5 Use Case Requirements and Associated Standards Overlaps. 39

Table 6-1 Description of Standards. 41

Table 6-2 Mapping of Use Case Actions to Information Exchange Requirements - Patient-Provider Secure Messaging: 7.1 Patient 1 Patient-Initiated Communication. 44

Table 6-3 Mapping of Use Case Actions to Information Exchange Requirements - Patient-Provider Secure Messaging: 7.2 Clinician Support Staff 1 Patient-Initiated Communication. 45

Table 6-4 Mapping of Use Case Actions to Information Exchange Requirements Patient-Provider Secure Messaging: 7.3 Clinician 1 Patient-Initiated Communication. 46

Table 6-5 Mapping of Use Case Actions to Information Exchange Requirements Patient-Provider Secure Messaging: 8.1 Patient 2 Clinician-Initiated Communication. 46

Table 6-6 Mapping of Use Case Actions to Information Exchange Requirements Patient-Provider Secure Messaging: 8.2 Clinician Support Staff 2 Clinician-Initiated Communication. 47

Table 6-7 Mapping of Use Case Actions to Information Exchange Requirements Patient-Provider Secure Messaging: 8.3 Clinician 2 Clinician-Initiated Communication. 48

Table 6-8 Mapping of Requirements to HITSP Constructs. 55