HIT Policy Committee

PCAST Report Workgroup

Friday, January 27, 2011
2:00pm ET

Paul Egerman, Chair

William Stead, Vice Chair
 AgendaCall
Call to
to Order
Order

1. Call to Order/Roll Call

– Judy Sparrow, Office of the National Coordinator for Health Information
Technology

2. Overview of the Agenda

– Paul Egerman, Chair
– Bill Stead, Vice Chair

3. Discussion: RFC on PCAST

– Jodi Daniel & Doug Fridsma, ONC

4. Use Case Examples & Comparison

– Paul Egerman & Bill Stead

5. Public Comment

6. Adjourn
 Workgroup Members
Chair: Paul Egerman, Chair
Co-Chair: William Stead, Vice Chair, Vanderbilt University
Members:
• Dixie Baker SAIC
• Hunt Blair Vermont HIE
• Tim Elwell Misys Open Source
• Carl A. Gunter University of Illinois
• John Halamka Beth Israel Deaconess Medical Center, HMS
• Leslie Harris Center for Democracy & Technology
• Stan Huff Intermountain
• Robert Kahn [invited]
• Gary Marchionini University of North Carolina
• Stephen Ondra Office of Science & Technology Policy
• Jonathan Perlin Hospital Corporation of America
• Richard Platt Harvard Medical School
• Wes Rishel Gartner
• Marc Rothstein
• Steve Stack American Medical Association
• Eileen Twiggs Planned Parenthood
Workgroup Charge

The PCAST Report Workgroup is charged to :

• Assist ONC synthesize and analyze the public comments and
input to the PCAST report;
• Discuss the implications of the report and it’s specific
recommendations to ONC on current ONC strategies;
• Assess the feasibility and impact of the PCAST report on ONC
programs;
• Elaborate on how these recommendations could be integrated
into the ONC strategic framework.
 Meeting Dates Meeting Dates

• January 7, 4:30 to 5:30 pm/ET

• Jan 14, 2 to 4 pm/ET

• Jan 27, 11 to 2 pm/ET

• Feb 10, 12 to 2 pm/ET

• Feb 15 – 16 – 17, one of these dates (or perhaps 1.5

days) for an in-person meeting in Washington -TBD
• Mar 3, 1 to 4 pm/ET

• Mar 17, 10 to 1 pm/ET

Use Case to Illustrate Stage 1 MU Patient Summary

Use Case #1:

Patient presents to the emergency department
complaining of severe chest pains that were suffered
while patient was working on a home improvement
project. In this use case, using Stage 1 of MU, the ED
clinician retrieves a CCD patient summary, which
contains important information that is needed to treat
the patient. An active medications list is necessary,
along with a problem list. Indeed, the sample data
shows an existing cardiac problem that could be
relevant.

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Sample Patient Summary - Text Form

Problems Medications Vital Signs Immunizations

1.  AV Nodal Reentry 1.  Centrum Silver 1 BP: 115/70 Hepatitis A vaccine:
Tachycardia    (Active) PO qd Pulse: 50 #1  Sep 03, 2004
Respiratory Rate: 14
2.  Glaucoma  (Active) 2.  Vitamin D3 1600 Height: 73 inches Hepatitis A vaccine:
units PO qDay Weight: 170 pounds #2  Mar 01, 2005
3.  Vegan (Active) Body Mass Index:
3.  Xalatan 1 drop  22.4 Tetanus vaccine:
4.  Lyme Disease each eye qhs Jun 20, 2008
(Resolved)
Pneumovax:       
5.  Corneal Abrasion Sep 03, 2009
(Resolved)
Influenza:       
Oct 19, 2010

Allergies Labs Procedures

1.  Penicillin (Rash) Cholesterol: 135 1.  RFID Chip Implant
Triglyceride: 59 in right triceps
HDL: 40

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Patient Summary in XML

<?xml version="1.0" encoding="UTF-8"?>

<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<realmCode code="US"/>
<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
<templateId root="2.16.840.1.113883.10.20.1"/>
<templateId root="2.16.840.1.113883.3.88.11.32.1"/>
<templateId root="2.16.840.1.113883.10.20.3"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>
<id root="809680b0-1e0d-11e0-ac64-0800200c9a66"/>

<code code="34133-9" codeSystem="2.16.840.1.113883.6.1" displayName="Summarization of episode note"/>

<title>Continuity of Care Document</title>
<effectiveTime value="20110111000000-0500"/>
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
<languageCode code="en-US"/>
<recordTarget>
<patientRole>
<id extension="996-756-495" root="2.16.840.1.113883.19.5"/>
<addr>
<streetAddressLine>5739 Hazel Street</streetAddressLine>
<city>Williamsport</city>
<state>PA</state>
<postalCode>17701</postalCode>
<country>USA</country>
</addr>

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Use Case to Compare Stage 1 of MU with PCAST
Report

Use Case #2:

Patient presents to the ED after suffering a minor laceration that
occurred during a home improvement project in a bathroom. Only
simple first aid is needed. Because of the circumstances of the
injury, the ED nurse would like to check the status of the patient's
tetanus immunization.

MU Stage 1 Transaction: Entire patient summary document is

requested. As the sample data set shows, the patient summary
would contain the immunization status, but it would also contain
other information that is not needed.

PCAST Approach: The nurse could request the Tetanus

immunization status only.   

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CCD – Summary of Patient’s Immunization Record (code)

<!--****************************************************
Immunizations section
********************************************************
-->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.1.6"/>
<!-- Immunizations section template -->
<code code="11369-6" codeSystem="2.16.840.1.113883.6.1"/>

…
<entry typeCode="DRIV">
<substanceAdministration classCode="SBADM" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.1.24"/>
<!-- Medication activity template -->
<id nullFlavor="NI"/>
<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS">
<center value="20040903"/>
</effectiveTime>
<consumable>
<manufacturedProduct>
<templateId root="2.16.840.1.113883.10.20.1.53"/>
<!-- Product template -->
<manufacturedMaterial>
<code code="52" codeSystem="2.16.840.1.113883.6.59" displayName="hepatitis A vaccine, adult dosage">
<originalText>Hepatitis A vaccine #1</originalText>
</code>
</manufacturedMaterial>
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CCD – Summary of Patient’s Immunization Record
(HTML)

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Illustration of Metadata Tagging - PCAST Approach

• XML based Structure

<Privacy>…</Privacy>
<Attributes>…</Attributes>
<Provenance> …</Provenance>
<Data>Encrypted Immunization Data</Data>

For Example:
Privacy :<ED> Yes  </>
<Referring Physicians> Yes; </>
<Exceptions>Dr. James
Research </>,
Attributes : Patient Identification , Date = June 20, 2008, Vocabulary identification (e.g.
SnomedCT 96412003),
Site Provenance : Manufacturer of immunization and batch number

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Use Case from PCAST Report

Use Case #3:

When Patient changes provider, new physician wishes

to examine multiple Mammograms that were taken at
multiple sites over a long period of time.

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Use Case #3 from PCAST Report (cont.)

•  Structure is still
<Privacy>><Attributes><Provenance<Data>
• A DEAS is used to locate additional data

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Definition of Metadata

Metadata:    Data about data

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