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Certification Commissionfor HealthcareInformation Technology
CCHIT Roundtables: Interoperability 09 and Beyond Open Source Forum
Mark Leavitt, MD, PhD – ChairmanAmit Trivedi – Certification Manager & Strategic Work Group Leader, InteroperabilityDennis Wilson – Certification Technology Director
Hyatt Regency McCormick PlaceChicago, ILApr 6, 2009
© 2009 | Slide 2 | Apr 6, 2009
Roundtable Sessions
Interoperability 09 and BeyondSession #1: 1:00 – 2:00pm CDT
Open Source ForumSession #2: 2:00 – 3:00pm CDT
© 2009 | Slide 3 | Apr 6, 2009
Agenda
• 09 Interoperability Criteria• 09 Interoperability Testing• Laika EHR 2009• Roadmap• Q & A
© 2009 | Slide 4 | Apr 6, 2009
09 Interoperability Criteria
08 Criteria 09 Criteria
CCD/C32Import & Export
• Registration, Medication, andAllergy modules
• File/Display: Level 2• Generate/Format: Level 2
• Registration, Medication, andAllergy modules
• File/Display: Level 2• Generate/Format: Level 3
Lab ResultImport
• Import HL7 2.5.1ORU messages (no changes from 08)
DICOMImage Display
• Display image viaWADO or C-Move protocol (no changes from 08)
eRXTransactions
• NCPDP SCRIPT 8.1• New, Refill, Eligibility,
Formulary, and Med Hxtransactions
(no changes from 08)
XDSTransactions
• Advanced Interoperability• PIX or PDQ query• XDS.a or XDS.b:
• Provide & Register• Query + Retrieve
© 2009 | Slide 5 | Apr 6, 2009
CCD/C32 CodingLevel 2 = “Structured Naratives”Level 3 = “Coded Vocabularies”Sections Requiring Coding:
Medications:Product Code: NDC or RxNorm
(use of NDF-RT or FDA UNII not required) Allergy / Drug Sensitivity:
Product Code: RxNorm (meds), FDA UNII (food/substances)(use of NDF-RT codes not required)
Adverse Event Type: SNOMED CTSeverity Code: SNOMED CT
Conditions, Immunizations, Encounters, Procedures, Results,Vital Signs, Pregnancy
© 2009 | Slide 6 | Apr 6, 2009
Advanced Interoperability
Advanced Criteria:•Required forincentives?•Distinguished frombasic criteria
© 2009 | Slide 7 | Apr 6, 2009
09 Interoperability Testing
09 Testing Procedures
CCD/C32Import & Export
Laika test cases for Display/File and Generate/Format•Checklists for Display verification•Level 3 coding validated, code sets checked
Lab Result Import ORU messages dynamically generated withconformance tools
DICOMImage Display Images served by DICOM server
eRX Transactions surescripts certification accepted
XDS Transactions
Laika test cases for: XDS Provide & Register,Query/Retrieve, PIX Feed/Query, PDQ•Checklists for queries•Comparison of transaction results in test servers
© 2009 | Slide 8 | Apr 6, 2009
Laika EHR 2009
• Complete, ready to use, fully integratedtest environment
• Private virtual instances allocated forpractice and final inspection testing
EHRUnderTestforCertification
PIXMgr
Laika2009
AWSInstanceofLaika2009Environment
PDQSupplier XDS
Repository
Registry
XDSDICOM
© 2009 | Slide 9 | Apr 6, 2009
Testing Endpoints
Laika Interface https://<hostname>.compute-1.amazonaws.com
XDS.a Registry https://<hostname>.compute-1.amazonaws.com:9080/axis2/services/xdsregistrya
XDS.a Repository https://<hostname>.compute-1.amazonaws.com:9080/axis2/services/xdsrepositorya
XDS.b Registry https://<hostname>.compute-1.amazonaws.com:9080/axis2/services/xdsregistryb
XDS.b Repository https://<hostname>.compute-1.amazonaws.com:9080/axis2/services/xdsrepositoryb
XDS tools https://<hostname>.compute-1.amazonaws.com:9080/xdstools
PIX Mgr mllp://<hostname>.compute-1.amazonaws.com:3600
PDQ Supplier mllp://<hostname>.compute-1.amazonaws.com:3601
ATNA Log (BSD syslog)://<hostname>.compute-1.amazonaws.com:5140
WADO http://<hostname>.compute-1.amazonaws.com/wado?requestType=WADO …
Additional configuration parameters:• Patient Identifier Assigning Authority Domains OID• Document Source sourceId OID• Digital certificates• XDS metadata code set
© 2009 | Slide 10 | Apr 6, 2009
Laika Components
Source
CCD/C32Import & Export
Generator: customValidation: NIST schematron, UMLS vocabularies
DICOMImage Display DICOM server: dcm4chee
XDS NIST Registry/Repository
PIX ManagerPDQ Supplier Open Health Tools OpenPIXPDQ
Interface Engine Mirth HL7 Interface Engine
© 2009 | Slide 11 | Apr 6, 2009
Laika Test Case Types
CCD/C32:• Display & File• Generate & Format
PIX/PDQ:• PIX Feed• PIX Query• PDQ Query
XDS:• Query & Retrieve Document• Provide & Register Document
© 2009 | Slide 12 | Apr 6, 2009
Laika Example Test Case
EHRUnderTestforCertification
XDS
Laika2009
InstanceofLaika2009Environment
[ITI‐14]XDS.aRegisterDocumentor[ITI‐41]XDS.bProvide&RegisterDocumentSet‐b
Repository
Registry
XDS
[ITI‐19]NodeAuthentication
[ITI‐20]RecordAuditEvent
© 2009 | Slide 13 | Apr 6, 2009
Laika Example Test Case
Assign test case from view of patients in XDS Registry
© 2009 | Slide 14 | Apr 6, 2009
Laika Example Test Case
• Provide XDS metadataattributes expected fromProvide & Register transaction
• Values not supplied areignored
© 2009 | Slide 15 | Apr 6, 2009
Laika Example Test Case
Executing test case triggers compare of expected versus actual values inXDS Registry
© 2009 | Slide 16 | Apr 6, 2009
Laika Example Test Case
ATNA log browser enablesinspection of required entries
© 2009 | Slide 17 | Apr 6, 2009
Laika Example Test Case
Checklists support inspectionof query transactions
© 2009 | Slide 18 | Apr 6, 2009
Project Contributors
• MITRE Corporation• CitiusTech• OpenSourcery
http://laika.sourceforge.net/
Contributors welcome!
© 2009 | Slide 19 | Apr 6, 2009
Looking Ahead
© 2009 | Slide 20 | Apr 6, 2009
Criteria Roadmap: 10, 11+
Additional CDA document types for quality reporting anddata exchanges:
• HITSP C48 – Encounter Document• HITSP C34 - Patient Level Quality Data Message• HITSP C37 – Lab Report Document• HITSP C38 - Patient Level Quality Data Document• HITSP C78 – Immunization Document
© 2009 | Slide 21 | Apr 6, 2009
Criteria Roadmap: 10, 11+
Further requirements around XDS transactions:• Document Replacement and Addendum• XDS-I (Cross Enterprise Image Information Sharing
integration profile)• PIX Update Notifications• XCA – (Cross Community Access) HIE to HIE
gateways
© 2009 | Slide 22 | Apr 6, 2009
Criteria Roadmap: 10, 11+
CCD/C32 Discrete Data Processing:• Display of data captured from external sources• Compare and selective update clinical list items• “Round trip” creation of CCD elements previously
imported
Thank you!
Q & A
For more information:www.cchit.org
© 2009 | Slide 24 | Apr 6, 2009
Roundtable Sessions
Interoperability 09 and BeyondSession #1: 1:00 – 2:00pm CDT
Open Source ForumSession #2: 2:00 – 3:00pm CDT
