Introduction to the HITSP

1
Biosurveillance

• Webinar 4 July 10, 2008 200 330 pm
  (Eastern)
• Presenters HITSP Population Perspective
  Technical Committee
• Floyd Eisenberg, MD, MPH, Senior Key Expert,
  Siemens Healthcare and co-chair of the Population
  Perspective TC
• Lori Fourquet, e-HealthSign, LLC

2
Learning Objectives
a webinar series on U.S. healthcare
interoperability

• During this 90-minute webinar, participants will
  explore the population perspective of health
  information sharing for natural and human
  assisted events with local, regional and national
  import, gaining a basic knowledge of
• syndromic surveillance through repurposing
  existing clinical information to detection of new
  patterns of disease as a routine process and
  during emergency situations
• situational awareness using repurposed clinical
  information to determine the extent and location
  of disease presentation as well as resource
  availability

(continued)
3
Learning Objectives (continued)
a webinar series on U.S. healthcare
interoperability

• expectations for information transfer from EHRs
  to biosurveillance information systems
• HITSP specifications for biosurveillance
  information sharing
• the relationship of the biosurveillance use case
  and interoperability specification to other
  efforts for public health and for data
  repurposing.

4
Agenda
a webinar series on U.S. healthcare
interoperability

• Biosurveillance
• Syndromic Surveillance
• Situational Awareness
• Disease Burden
• Healthcare Resources
• Security and privacy requirements for
  Biosurveillance

• HITSP Interoperability Specifications for
  Biosurveillance (HITSP IS 02)
• Units of Exchange
• Health Information Summary Documents
• Health Information Messages
• Conformance Subsets
• Questions and Answers

5
Introduction Steves Story . . . part four

• Patient is a 26-year-old male coping with the
  long-term effects of a brain tumor that was
  removed during his childhood
• While traveling to San Diego with his family,
  Steve and his sister become ill with fever,
  diarrhea and dehydration
• Both present to different local Emergency
  Departments
• Steve is discharged in 48 hours
• His sister requires several weeks in the hospital
  for kidney failure complications
• Public Health receives notification of Steves
  sisters presenting symptoms and stool culture
  results indicating E coli 0157H7. Steves
  culture is negative and no report of his illness
  is received by Public Health
• The source of the E coli 0157H7 is not
  identified until approximately 100 cases present
  over the next three months

6
Introduction Steves story (continued)

• The Future Healthcare in an interoperable world
• Steves and his sisters presenting complaints
  and initial orders (i.e., stool culture
  requests) are transmitted within 24 hours to a
  Public Health Biosurveillance Information System
  (BIS)
• The Biosurveillance Information System flags a
  significant increase in febrile diarrheal
  illness in the region not correlated to a
  specific zip code and prompts a case
  investigation
• Within 48 hours of Steves presentation, Public
  Health identified the common thread in 95 of 20
  known cases of eating salad at a roadside café
  on a local highway.
• 48 hours later a common source is identified in
  home grown lettuce used exclusively in that café.
  The item is removed from the menu and no further
  cases occur.

7
Overview

• HITSP is a volunteer-driven, consensus-based
  organization that is funded through a contract
  from the Department of Health and Human
  Services.
• The Panel brings together public and
  private-sector experts from across the healthcare
  community to harmonize and recommend the
  technical standards that are necessary to assure
  the interoperability of electronic health records.

8
Deliverables and Mode of Operation

• The HITSP Standards Harmonization Framework
• Identify a pool of standards for an AHIC
  (American Health Information Community) Use Case
• Identify gaps and overlaps in the standards for
  this specific Use Case
• Make recommendations for resolution of gaps and
  overlaps
• Select standards using HITSP-approved Readiness
  Criteria
• Develop Interoperability Specifications (IS) that
  use the selected standard(s) for the specific
  context
• Test the IS

9
Current Interoperability Specifications (IS)
IS 01 Electronic Health Record (EHR) Laboratory Results Reporting
IS 02 Biosurveillance
IS 03 Consumer Empowerment and Access to Clinical Information via Networks
IS 04 Emergency Responder Electronic Health Record (ER-EHR)
IS 05 Consumer Empowerment and Access to Clinical Information via Media
IS 06 Quality
IS 07 Medication Management
10
Current Interoperability Specifications (IS)
IS 01 Electronic Health Record (EHR) Laboratory Results Reporting
IS 02 Biosurveillance
IS 03 Consumer Empowerment and Access to Clinical Information via Networks
IS 04 Emergency Responder Electronic Health Record (ER-EHR)
IS 05 Consumer Empowerment and Access to Clinical Information via Media
IS 06 Quality
IS 07 Medication Management
11
IS 02 Biosurveillance

• This Interoperability Specification defines
  specific standards needed to enable the exchange
  of data between healthcare organizations and
  providers and public health via an electronic
  network
• Version 2.1 Recognized
• Version 3.0 HITSP Panel Approved

Doctor
Public Health Agency
IS 02 VIA AN ELECTRONIC NETWORK
12
HITSP IS 02 BiosurveillanceOverall Objectives

• Implementation of near real-time, nationwide
  public health event monitoring to support early
  detection, situational awareness and rapid
  response management across care delivery, public
  health and other authorized Government agencies.
  
• Describe the process or interaction that each
  primary stakeholder will invoke to capture,
  discover, anonymize and transmit relevant data to
  public health agencies
• Relevant Data Essential ambulatory care and
  emergency department visit, utilization, and lab
  result data from electronically enabled health
  care delivery and public health systems
• Transmission Requirements Standardized and
  anonymized format
• Time frame Within 24 hours

13
HITSP IS 02 BiosurveillanceStakeholders

• Patient
• Clinicians
• Healthcare Delivery Organizations
• Laboratory Organizations

• Public Health Agencies
• Resource Suppliers
• Public

14
HITSP IS 02 BiosurveillancePurpose and Use

• Public Health Biosurveillance Information
  System
• Syndromic Surveillance Identifies new patterns
  of disease presentation recognize known and
  unknown causes (chemical, radiological,
  biological)
• Situational Awareness
• Determines patterns exceeding expected thresholds
  and location of impact
• Determines resource availability and constraints

• Data Requirements
• Patient Demographics
• Diagnostic Data
• Chief Complaints
• Triage Data
• Laboratory Orders and Results
• Physician Orders Procedures
• Capacity Information
• Admission, Discharge, Transfer Data

• Hospitals / Emergency Departments

• Ambulatory Care (Primary, Specialty Providers)

• Ancillary Providers (Lab)

15
HITSP IS 02 BiosurveillancePerspectives

• Individual Healthcare Delivery Organizations
• Stand-alone hospitals and clinics /or emergency
  departments or laboratories

Integrated Health Care Data Suppliers Organization
s that cross jurisdictional boundaries, e.g.,
interstate hospital organizations, nationwide
laboratory organizations, payer systems,
integrated delivery network claims
clearinghouses, etc.
Public Health Agencies Relevant local, state and
other public health agencies authorized to
receive and use data to perform biosurveillance
16
HITSP IS 02 BiosurveillancePerspectives
(continued)

• Individual and Integrated Organization
  Perspectives
• Healthcare organization establishes an agreement
  to send data to a Public Health biosurveillance
  information system
• Clinical
• Resource Availability
• Data are transmitted in near real-time (within 24
  hours) for information required by Public Health
  Agencies for biosurveillance
• Data are Anonymized and Pseudonymized to ensure
  full privacy compliance, with randomized data
  linker to allow authorized re-identification for
  public health investigations
• Format data using approved standards
• Communicate relevant data to Public Health
  Agencies

17
HITSP IS 02 BiosurveillancePerspectives
(continued)

• Public Health Agency Perspective
• Provide listing of required biosurveillance data
• Receive biosurveillance data
• Verify authenticity of content
• Acknowledge receipt of data
• Log receipt of data
• Analyze, investigate and respond

18
Public Health Base Facility Data
ElementsFacility Identifiers
AHIC Data Element HITSP- Selected Standards
Facility Identifier HIPAA National Provider Identifier
Facility Name Text String
Facility Location FIPS 55-3 NIST GNIS USGS
Number of Facility Beds HL7-defined
Number of Licensed Beds HL7-defined
19
Public Health Base Facility Data ElementsBed
Availability
AHIC Data Element HITSP- Selected Standards
Admissions last 24 hours HL7-defined
Discharges last 24 hours HL7-defined
Deaths last 24 hours HL7-defined
Clinical Status HAVE values as in AHIC definition OASIS
Facility Status HAVE values as in AHIC definition OASIS
Facility Operations HAVE values as in AHIC definition OASIS
Staffing HAVE values as in AHIC definition OASIS
Decontamination Capacity HAVE values as in AHIC definition OASIS
EMS Traffic Status HAVE values as in AHIC definition OASIS
EMS Capacity HL7 Defined
20
Public Health Base Facility Data ElementsPatient
Data Elements 1
AHIC Data Element HITSP- Selected Standards
Diagnosis/Injury Code ICD9-CM, SNOMED-CT
Diagnosis Type HL7 V2.5
Diagnosis Date/Time HL7 V2.5
Discharge Disposition Universal Billing Codes (UB-92/NUBC CURRENT UB DATA SPECIFICATIONS MANUAL)
Patient Class HL7 V2.5
Date and Time Illness Onset LOINC code 11368-8Illness/Injury Onset Date/timeLN
Chief Complaint This HITSP IS will use the CHI recommended SNOMED CT as a reference terminology to communicate interoperable information among and between systems, with the HITSP IS Pre-condition that the sending and using systems must use formal coded nursing terminologies such as the Clinical Care Classification (CCC) System and the Omaha System that are integrated in SNOMED CT
21
Public Health Base Facility Data ElementsPatient
Data Elements 2
AHIC Data Element HITSP- Selected Standards
Pseudonymized Data Linker None Available
Encounter Date/Time HL7 V2.5
Year of birth HL7 V2.5
Age UCUM
Gender HL7 V2.5
Zip U.S. Postal Service Zip Code
State Federal Information Processing Standards (FIPS 55-3) NIST
Date/time last update HL7 V2.5
22
Public Health Base Facility Data
ElementsClinical Data Elements
AHIC Data Element HITSP- Selected Standards
Temperature LOINC code 8310-5BODY TEMPERATURELN UCUM
Pulse Oximetry LOINC code 19960-4PULSE OXIMETRYLN UCUM
Nursing/Triage Notes This Interoperability Specification will use the CHI recommended SNOMED CT as a reference terminology to communicate interoperable information among and between systems, with the HITSP Interoperability Specification Pre-condition that the sending and using systems must use formal coded nursing terminologies such as the Clinical Care Classification (CCC) System and the Omaha System that are integrated in SNOMED CT
Provider Identifier None Available
23
Public Health Base Facility Data
ElementsLaboratory / Microbiology Results
AHIC Data Element HITSP- Selected Standards
Result SNOMED-CT
Method type SNOMED-CT
Result unit UCUM
Test interpretation HL7 V2.5
24
Public Health Base Facility Data
ElementsLaboratory / Microbiology Results
(continued)
AHIC Data Element HITSP- Selected Standards
Reporting Laboratory Identifier CLIA Unique Laboratory ID FDA
Performing laboratory CLIA Unique Laboratory ID FDA
Report date/time Hl7 defined
Report status HL7 V2.5
Collection date None specified
Collection method HL7 V2.5 SNOMED-CT
Specimen Source SNOMED-CT
Specimen HL7 V2.5 Specimen Type Codes OR SNOMED-CT Specimen Codes
Ordered test code LOINC code associated with test/procedure
Resulted test LOINC Laboratory Test Identifiers
25
Public Health Base Facility Data
ElementsRadiology Results
AHIC Data Element HITSP- Selected Standards
Study ID/Radiology Number None Available
Study date and time None Available
Report date/time None Available
Report Status HL7 V2.5
Test Performed AMA CPT Textual Description which can include modification
Impressions LOINC tag 19005-8X-RAY IMPRESSIONLN
Date / Time Revised HL7
26
HITSP IS 02 BiosurveillanceMain Business Actors
Document-Based Transmission
Hospital Physician Health Plan Laboratory Radiolo
gy Service
Public Health Reporting / Biosurveillance
Information System
Message-Based Transmission
More Info Appendix A
Other Communities
27
HITSP IS 02 BiosurveillanceSharing Clinical /
Operational Information
Encounter Message
Encounter Document
C 39
C 48
Lab Result Terminology
C 35
Lab Report Document
Lab Result Message
C 37
C 36
Sharing Radiology Results
Radiology Result Message
TP 49
C 41
Resource Utilization
C 47
28
HITSP IS 02 BiosurveillancePrivacy and Security
Secured Communication Channel
Entity Identity Assertion
T 17
C 19
Manage Consent Directives
Collect Communicate Security Audit Trail
TP 30
T 15
Consistent Time
Nonrepudiation of Origin
T 16
C 26
Access Control
TP 20
29
HITSP IS 02 BiosurveillanceInfrastructure
Manage Sharing of Documents
Anonymize
T 13
C 25
Pseudonymize
Notification of Document Availability
T 24
T 29
Patient ID Cross-Referencing
Retrieve Form for Data Capture
TP 22
TP 50
HL7 Messaging
30
Units of Information Exchange HITSP IS
Constructs - Re-Use and Re-Purpose
Type 1 Base or Composite Standards

• Re-UseApplying an existing construct to more
  than one IS
• Re-PurposeUpdating a construct to meet the
  needs of a new Use Case
• Can extend or constrain when reusing or
  re-purposing
• Specifications contain a common superset
• Superset can be extended as new requirements are
  encountered
• Superset can be constrained with use-specific
  constraints

31
List Units of Information Exchange

• HITSP C 35 (Component) Laboratory Terminology
• HITSP C 47 (Component) Resource Utilization
• HITSP C 48 (Component) Encounter Document
  Using IHE Medical Summary (XDS-MS)
• HITSP C 39 (Component) Encounter Message
• HITSP TP 49 (Transaction Package) Sharing
  Radiology Results
• HITSP C 41 (Component) Radiology Results
  Message
• HITSP C 37 (Component) Laboratory Report
  Document
• HITSP C 36 (Component) Laboratory Result Message

More Info Appendix B
32
Example Lab Report
33
HITSP IS 02 BiosurveillanceConstructs Content
Document Document Description
HITSP/C35 HITSP Lab Terminology Component
HITSP/C37 HITSP Laboratory Report Document Structure Component
HITSP/C48 HITSP Encounter Document Component Using IHE Medical Summary XDS-MS
HITSP/TP49 HITSP Sharing Radiology Results Transaction Package
HITSP/C36 HITSP Laboratory Result Message Component
HITSP/C39 HITSP Encounter Message Component
HITSP/C41 HITSP Radiology Results Message Component
HITSP/C47 HITSP Resource Utilization Message Component
(continued)
34
HITSP IS 02 BiosurveillanceConstructs
Security, Privacy and Infrastructure
Document Document Description
HITSP/C25 HITSP Anonymize Component
HITSP/T24 HITSP Pseudonymize Transaction
HITSP/TP22 HITSP Patient ID Cross-Referencing Transaction Package
HITSP/TP13 HITSP Manage Sharing of Documents Transaction Package
HITSP/T29 HITSP Notification of Document Availability Transaction
HITSP/TP50 HITSP Retrieve Form for Data Capture Transaction Package
HITSP/T16 HITSP Consistent Time Transaction
HITSP/T17 HITSP Secured Communication Channel Transaction
HITSP/C26 HITSP Non-Repudiation Component
HITSP/C19 HITSP Entity Identity Assertion Component
HITSP/TP20 HITSP Access Control Transaction Package
More Info Appendix C
35
www.HITSP.org
36
IS 02 Biosurveillance on www.hitsp.org
37
A Successful Collaboration

• Interweaving many different standards to address
  business needs
• A successful collaboration between HITSP and
  several HITSP member organizations developing
  base standards and implementation guides/profiles

38
HITSP IS 02 BiosurveillanceStrengths

• Effective interoperability
• Independent conforming implementations will
  interoperate
• all dimensions of interoperability covered,
  including sharing/selective access, transport,
  identity management, anonymization,
  pseudonymization
• Semantic Interoperability with core clinical
  content
• Basic core data set for biosurveillance syndromic
  surveillance and situational awareness
• Designed to equally empower the providers and
  Public Health with the same level of robustness

(continued)
39
HITSP IS 02 BiosurveillanceStrengths (continued)

• Practical interoperability
• Standards that already have implementation
  feasibility validated
• IHE Connectathon, HIMSS Interoperability
  Demonstration
• Testing in real-world environments - NHIN, CDC
• Flexible interoperability
• Designed to allow receivers of information to
  operate at various levels of richness (explicitly
  defined IS conformance subsets)
• Document-based data transmission
• Message-based data transmission
• Secured and Private interoperability
• Encryption, public health authorization, user
  authentication
• Anonymization, Pseudonymization

40
A concrete achievement for Steve

• Implementation of HITSP IS 02 will allow Public
  Healthto identify relatively quickly foodborne
  disease risks and manage product recalls, and to
  quickly identify the presence and/or the extent
  of impact of illness due to chemical or
  biological agents whether naturally occurring or
  human assisted.
• Future expansion of the IS may be able to assist
  in determining available resources for providing
  needed care, e.g., hospital beds availability in
  a region.
• Steve, his sister, and other patients across the
  U.S. will therefore be better protected as Public
  Health will be able to provide appropriate
  warnings in a more timely fashion and to redirect
  healthcare resources where they are most needed.

41
How YOU can become involved

• Use or specify HITSP Interoperability
  Specifications in your HIT efforts and in your
  Requests for Proposals (RFPs)
• Ask for CCHIT certification
• Leverage Health Information Exchanges to promote
  HITSP specifications to make connections easier
  in the future
• Ask . . . Is there a HITSP standard we could be
  using?
• Get involved in HITSP . . . Help shape the
  standards

42
How YOU can become involved
Learn more about specific HITSP activities during
these upcoming webinars
Webinar 1 Standardizing How We Share Information in Healthcare An Introduction to HITSP Thursday, June 5, 2008 200-330 pm EDT Webinar 6 Quality Thursday, August 7, 2008 200-330 pm EDT
Webinar 2 HITSP Foundational Components Thursday, June 19, 2008 200-330 pm EDT Webinar 7 Security, Privacy and Infrastructure Thursday, August 21, 2008 200-330 pm EDT
Webinar 3 Consumer Access to Clinical Information Thursday, June 26, 2008 200-330 pm EDT Webinar 8 EHR and Emergency Response Thursday, September 4, 2008 200-330 pm EDT
Webinar 4 Biosurveillance Thursday, July 10, 2008 200-330 pm EDT Webinar 9 Medication Management Thursday, September 18, 2008 200-330 pm EDT
Webinar 5 Electronic Health Record (EHR) and Lab Reporting Thursday, July 24, 2008 200-330 pm EDT www.HITSP.org/webinars
?
?
?
?
43
Join HITSP in developing a safe and secure
health information network forthe United States.

Visit www.hitsp.org or contact . . .
Michelle Deane, ANSI mmaasdeane_at_ansi.org Re
HITSP, its Board and Coordinating Committees
Jessica Kant, HIMSS Theresa Wisdom,
HIMSS jkant_at_himss.org twisdom_at_himss.org Re
HITSP Technical Committees
44
www.HITSP.org
45
Biosurveillance
Questions and Answers
46
Biosurveillance
APPENDIX SLIDES Appendix A link from Slide
25 Appendix B link from Slide 31 Appendix C
link from Slide 34
47
Appendix A
Biosurveillance
APPENDIX A
48
Verifying Patient Identity
Appendix A

• Need
• Link patient identifiers from multiple sources
• Anonymized and Pseudonymized Data
• Solution
• HITSP T24 Pseudonymize Transaction
• HITSP C25 Anonymize Component
• ISO TS 25237, Health Informatics - Pseudonymize
• Depends on HITSP TP 22 Patient ID
  Cross-Referencing Transaction Package
• IHE Patient Cross-Referencing Transaction
  (PIX)

49
HITSP T24 Pseudonymization TransactionBased on
ISO TS 25237, Health Informatics -
Pseudonymization
Appendix A
50
Implementation Architecture Flexibility
Appendix A

• Several instances of each Business Actor can be
  implemented
• Business Actors can be grouped
• Individual Providers / Hospitals
• Larger Multi-State Provider or Hospital
  Organizations
• Local Biosurveillance Information Systems
• National Biosurveillance Information Systems
  (e.g., BIOSENSE)
• Several such communities or Health Information
  Exchanges (HIEs) may be interconnected (e.g. NHSN
  National Health Surveillance Network)

51
Reportable Disease Information
Appendix A
52
Standard HL7 Messaging
Appendix A
53
Manage Sharing of Documents Option
Appendix A
54
Appendix B
Biosurveillance
APPENDIX B
55
Units of Information Exchange
Appendix B

• HITSP C35 (Component) Laboratory Terminology
• defines the vocabularies and terminologies
  utilized by laboratories and clinicians to order
  and report the findings from laboratory tests.
• Used to constrain the vocabularies for HTISP C36
  Laboratory Result Message and for HITSP C37
  Laboratory Report Document
• Re-Use Jointly developed for Biosurveillance
  (IS02) and Electronic Health Records Laboratory
  Results Reporting

• HITSP C47 (Component) Resource Utilization
• specifies the message and content necessary to
  report utilization and status of health provider
  resources to public health agencies
• reflects the current status of harmonization
  efforts between HL7 and OASIS.
• Specifies content for bed availability data
• supports the process of bed availability resource
  utilization data from the provider to the
  Biosurveillance Information System
• Re-Use None to-date

56
Units of Information Exchange
Appendix B

• HITSP C48 (Component) Encounter Document Using
  IHE Medical Summary (XDS-MS)
• HL7 CDA Document IHE Medical Summary
• Patient encounter data are captured as part of
  the normal process of care performed by
  healthcare providers such as hospitals, emergency
  departments and outpatient clinics.
• Summarizes a clinical encounter, repurposing
  clinical information exchange documents for
  biosurveillance data capture
• supports the process of sending patient encounter
  data - facility data elements, patient data
  elements and clinical data elements (excluding
  laboratory, radiology)
• Re-Use Re-used for Emergency Responder
  Electronic Health Record (IS04)

• HITSP C39 (Component) Encounter Message
• HL7 Message Leverages HL7 V2.5 ADT data
  structure
• Patient encounter data are captured as part of
  the normal process of care performed by
  healthcare providers such as hospitals, emergency
  departments and outpatient clinics.
• Summarizes a clinical encounter, repurposing
  clinical information exchange messages for
  biosurveillance data capture
• supports the process of sending patient encounter
  data - facility data elements, patient data
  elements and clinical data elements (excluding
  laboratory, radiology)
• Re-Use Re-used for Emergency Responder
  Electronic Health Record (IS04)

57
Units of Information Exchange
Appendix B

• HITSP TP49 (Transaction Package) Sharing
  Radiology Results
• Leverages IHE Radiology Technical Framework
  (XDS-I), presenting a solution for sharing
  imaging documents based on XDS. XDS-I extends XDS
  by sharing, locating and accessing DICOM
  instances from its original local sources, e.g.
  for radiologists or oncologists.
• Radiology result data are captured as part of the
  normal process of care performed by healthcare
  providers.
• specifies sharing of imaging documents such as
  radiology images and reports, repurposing
  clinical information exchange documents for
  biosurveillance data capture
• supports the process of sending radiology result
  data from the provider to the Biosurveillance
  Information System
• Re-Use None to-date

• HITSP C41 (Component) Radiology Results Message
  
• HL7 Message Leverages the HL7 V2.5 ORUR01
  unsolicited result message.
• Radiology result data are captured as part of the
  normal process of care performed by healthcare
  providers.
• Communicates radiology reports, repurposing
  clinical information exchange messages for
  biosurveillance data capture
• supports the process of sending radiology result
  data from the provider to the Biosurveillance
  Information System
• Re-Use None to-date

58
Units of Information Exchange
Appendix B

• HITSP C37 (Component) Laboratory Report Document
  
• HL7 CDA Document IHE XDLab
• Specifies content for Laboratory Results data in
  a document-based functional flow scenario
• Laboratory result data are captured as part of
  the normal process of care performed by
  healthcare providers.
• specifies sharing of laboratory results,
  repurposing clinical information exchange
  documents for biosurveillance data capture
• supports the process of sending radiology result
  data from the provider to the Biosurveillance
  Information System
• Re-Use Jointly developed for Biosurveillance
  (IS02) and Electronic Health Records Laboratory
  Results Reporting

• HITSP C36 (Component) Laboratory Result Message
• HL7 Message Leverages the Version 2.5.1 ORU
  Unsolicited Observation Message (Event R01)
• Specifies content for Laboratory Results data .
  Laboratory result data are captured as part of
  the normal process of care performed by
  healthcare providers.
• Communicates laboratory results, repurposing
  clinical information exchange messages for
  biosurveillance data capture
• supports the process of sending laboratory result
  data from the provider to the Biosurveillance
  Information System
• Re-Use Jointly developed for Biosurveillance
  (IS02) and Electronic Health Records Laboratory
  Results Reporting (IS01)

59
Biosurveillance
APPENDIX C
60
Transaction Package TP13 Manage Sharing of
Documents
Appendix C

• Defines the methodology and metadata requirements
  for the registration, storage and retrieval of
  documents across repositories within an affinity
  domain
• Calls out a subset of transactions defined in the
  IHE XDS Cross Document Sharing Specification, Dec
  2006
• ITI 14 Register Document Set
• ITI 15 Provide and Register Document Set
• ITI 18 Registry Stored Query
• ITI 17 Retrieve Document
• ISO 15000 ebRS
• Key Concepts Sharing of source attested
  documents, document content neutral, document
  registry, document repositories distributed or
  centralized.

61
IS02 Constraints on TP13
Appendix C

• Support queries and stored queries for documents
  which do not require a patient id as a query
  parameter
• XDSDocumentEntry.eventCodeList
• contains a value from a controlled vocabulary
  describing reportable conditions
• should be required when there is a known
  condition as required by or of interest to
  public health authorities
• XDSDocumentEntry.confidentialityCode
• shall contain the following OID when the
  submitted document has been pseudonymized
  according to HITSP/T24 Pseudonymize
  2.16.840.1.113883.3.88.5.2.1
• XDSDocumentEntry.patientID and XDSSubmissionSet.pa
  tientID
• shall contain either the actual patient
  identifier used by the XDS registry, or a
  pseudonymized identifier generated during the
  HITSP/T24 Pseudonymize
• XDSDocumentEntry.sourcePatientID and
  XDSSubmissionSet.sourcePatientID
• shall contain either the actual patient
  identifier used by the document source,
  pseudonymized identifier generated during the
  HITSP/T24 Pseudonymize

62
C29 Notification of Document Availability
Appendix C

• notifies its recipient that a document is
  available and provides the information needed to
  retrieve the document
• IHE IT Infrastructure (ITI) Technical Framework
  (TF), Volume 2 (ITI TF-2) Supplement for
  Notification of Document Availability (NAV)
• Key Concepts
• Recommended a publish and subscribe mechanism
  to IHE to make NAV a feasible tool
• No constraints

63
TP50 Retrieve Form for Data Capture
Appendix C

• Enables capture of supplemental data variables
  not typically maintained in an electronic health
  record or laboratory information system
• Underlying source material is from the IHE IT
  Infrastructure (ITI) Technical Framework (TF)
  Supplement, RFD
• supports public health authority reportable
  conditions monitoring and management
• Key Concepts
• Form Manager
• Form Filler
• Form Retriever
• Form Archiver
• No Constraints

64
TP24 Pseudonymize Transaction
Appendix C

• Defines the methodology for assigning a
  pseudoidentifier to patient-level data in lieu of
  the patient identifiers
• Implements ISO TS 23257, Health Informatics -
  Pseudonymize
• Relies upon transactions from the IHE IT
  Infrastructure (ITI) Technical Framework (TF),
  Volume 2 (ITI TF-2), specifically
• ITI-8 Patient Identity Feed 3.8.1
• ITI-9 Pix Query 3.9.1
• Key Concepts
• Leverages a the PIX manager to assign
  pseudoidentifiers
• Constraints guided by HIPAA and Risk Analysis
• Passes patient demographic information that is
  mapped using a cryptographic algorithm by
  Pseudonymization Service

65
TP22 Patient Identity Cross-Referencing
Appendix C

• Defines the methodology for identifying and
  cross-referencing different patient attributes
  for the same patient.
• Underlying source material is from the IHE IT
  Infrastructure (ITI) Technical Framework (TF),
  Volume 2 (ITI TF-2), specifically
• ITI-8 Patient Identity Feed 3.8.1
• ITI-9 Pix Query 3.9.1
• used by any system capable of performing
  real-time HL7 query and response and/or
  unsolicited patient demographic feed
  transactions.
• Key Concepts
• Patient Identity Demographics, HL7 Query/Response

66
C25 Anonymize
Appendix C

• Specifies requirements for anonymizing AHIC
  Biosurveillance Minimal Data Set Content based
  upon risk analysis
• ISO TS 23257. Health Informatics -
  Pseudonymization (anonymization specifications)
• Key Concepts
• Specifies data element anonymization restrictions
  (e.g. HIPAA data element removal/roll-up)
• Specifies requirements for encoding Freeform text
• Specifies access protections for risks related to
  multi-variable and outliers