9.0 Document Updates

[1] A separate spread sheet and/or database, is available at hitsp.org, contains the value sets of the HITSP Exchange Architecture set of Exchange Actions, Exchange Contents, Systems, and their mapping to the 13 legacy Interoperability Specification (IS) Information Exchange Requirements (IERs).

[2] previously known as Business Actor

[3] previously known as Technical Actor

[4] The terms RHIO and Health Information Exchange or HIE are often used interchangeably. An HIE is a more general instances of a RHIO (regional health information organization). Both are a grouping of organizations with a business stake in improving the quality, safety and efficiency of healthcare delivery. NHIEs are HIEs that support the building blocks of the National Health Information Network (NHIN) initiative proposed by the Office of the National Coordinator (ONC) for Health Information Technology (HIT). To build a national network of interoperable health records, the effort must first develop at the local and state levels. The concept of NHIN requires extensive collaboration by a diverse set of stake holders. The challenges are many to achieve success for a health Information Exchange or a RHIO [HIMSS].

[5] HITSP Scope includes Exchange Actions, which are typically the culmination of (prior) predicate Actions. For example: 1) an order is placed; 2) allergies, interactions and contraindications are checked; 3) order is verified; 4) Event/Action scheduling is requested as ordered; 5) resources (equipment, locations, supplies, medications) are requested as ordered; 6) order is transmitted to one or more systems. From HITSPs perspective only Action 6 is an Exchange Action and thus considered or documented in the IS. In the preceding example, each predicate Action 1-5 captures essential information and each is likely evidenced by a persistent entry in the EHR. HITSP ISs ignore these EHR-Centric Event/Actions and thus do not reflect data capture, flow and transition prior to (and typically as input to) Exchange Actions. HITSP ISs also ignore the integrity relationship between persistent EHR entries and what is interchanged between EHR (and other) systems. A simple approach to resolving this gap is to record the predicate (e.g., pre Information Exchange) action; but, this does not achieve harmonization. A more comprehensive harmonization approach is to also standardize the EHR information/data model to assure full EHR semantic interoperability, throughout its lifecycle.

[6] HL7 V3 null value might imply that data may be available later or masked means the sender has it; but, chooses not to send it or pending authorization.