Government Projects SIG Meetingtuesday, September 28, 1999

Government Projects SIG MeetingTuesday, September 28, 1999

Attendees:

I.Introductions and Review of Meeting Minutes from Toronto Meeting – Marco Johnson opened the meeting by asking attendees to introduce themselves. Minutes were reviewed and accepted as printed.

II.Public Health Data Standards Consortium – Hetty Kahn provided a brief update from the consortium. The history of the consortium was reviewed as was the consensus recommendations, which include:

• Organizing public health and health services research representation on standards development bodies
• Educating public health and research communities about data standards issues
• Participating in efforts to assure continued access to information
• Convening organizations around data standards issues
• Identifying high priority needs
• Seeking representation on data content committees

Consortium members include:

• NCHS/CDC, AHCPR, HCFA, NCVHS
• NAHDO, NAPHSIS, CSTE, ASTHO, AHSR
• NACCHO, AMCHP, ASTPHLD, state Medicaid Directors, Cancer registries, mental health and substance abuse

Ms. Kahn reported that the consortium is reviewing priority items within public health among the states, especially encounter databases. Priority items include:

• Inventory of Public Health data elements – hoping to standardize data elements among the states. They are currently identifying data elements that one or two states are currently collecting but which may of interest to other states
• User-friendly data dictionary – this will be non-technical in natures so as to be useful to anyone.
• Identify high priority data needs – hoping that NADA will assist them in building a simple data model.
• Seek representation on data content committees – have currently gotten recognition at NUBC and NUCC
• Increase representation at standards development organizations – currently represented at HL7 and X12

The consortium is in the process of transferring their web site to NCHS. The current URL for accessing the consortium web site is:

To subscribe to the list server, send e-mail to with the following text in the message body: SUBSCRIBE PH-CONSORTIUM-LL YOUR NAME

Future plans for the consortium include:

• Steering committee meeting in March 2000 – several groups are being invited to participate.
• Race/ethnicity – trying to collect in claim (837) form. The DHHS is advocating that they try to get the status of these data elements changed from not used to situational.

Click here to view the presentation slides

III.Reporting requirements – Denise Koo provided an update on surveillance reporting, which included the purposes of health surveillance, such as to assess public health status, to define public health priorities, and to evaluate programs. Dr. Koo reported that public health practice involves

• identifying the problem
• identify the risk factors (answers the question: what is the cause)
• intervention evaluation (answers the question: what works)
• Implementation

Surveillance is a systematic and ongoing activity and involves collection, analysis and interpretation of data. The C DC has undertaken a project to integrate its major infectious disease surveillance systems (as a first step), and as a part of this project, is building a conceptual data model for public health surveillance.

Electronic Lab Reporting project – Dan Jernigan reported that the CDC maintains nine geographic locations where all data that is submitted ends up being reported. Washington State and Hawaii are among these nine geographic locations. The CDC has communicated with Quest and Labcore, both of which have provided them with HL7 messages that they can produce.

Jim McCain commented that the work that the CDC is doing within public health and with HL7 shows their commitment to the HL7 process. The federal agencies, he indicated, also have a need for collaboration, indicating that the CDC works mostly with state partners. Standardized lab reporting is the key barrier to sharing information among state and government agencies. Many of the federal partners feel that there is no standardization, for example, of CBCs. There is standardization down to the atomic level but not at the panel definition level.

Click here to view the presentation slides

IV.Data Registry – Marco Johnson reported that this project is built on international and national standards and has linkages to other international standards. The registry currently contains codes from X12, HL7, NCPDP and NCVHS. The Data Registry Project Goals include:

• Build, populate, demonstrate, and make available for general use a data registry to assist in cataloging and harmonizing data elements across multiple organizations
• Utilize selected Health Insurance Portability and Accountability Act (HIPAA) data elements for demonstration

The registry will be a collaborative effort of and will be funded and controlled by the DoD – Health Affairs and the DHHS – HCFA. Members of the requirements team include representatives from the Department of Veterans Affairs, HL7, DHHS and the DoD. DHHS-HCFA will load data corresponding to the HIPAA legislation into the data registry, including data from X12, HL7, NCPDP and NCVHS.

Currently, HCFA and DoD have developed the registry to demonstrate the use of a data registry that:

• Focuses on HIPAA data
• Contains data definitions from X12, HL7, and NCPDP
• Functions based on ISO/IEC 11179 metadata standard
• Utilizes the Australian Institute of Health and Welfare (AIHW) high-level information model to facilitate group of data definitions.

The registry is currently available for review at:

Current Status:

• HL7 and X12 information will be refreshed by end of October 1999
• DoD and HCFA are populating Agency version of the data registry for internal use
• Department of Veterans Affairs is using parts of the registry for its internal data registry
• HCFA has offered to support the operation of the data registry by HISB for one year in order for HISB and the SDOs to utilize and evaluate the registry’s benefits.

V.CDC’s Secure Data Network – At this point in the meeting, Joseph Reid and others from the Secure Transactions SIG joined the Government Projects SIG for a joint meeting.

Mr. Reid walked attendees thought the CDC’s secure data network, which involves bulk file transfer of information from outside partners to the CDC. The network provides a secure means for outside clients to access the site, select an activity from the secure web server and get the data back through their Internet browser. This whole operation is outside the firewall. The other side of the firewall includes a distribution server that routes the information (routes data and keeps track of whether data was received at the program end) and which can send an e-mail to indicate whether the processes succeeded or failed.

At the program level, a designated individual sets up secure activities and controls the digital certificates. A business steward who is responsible for the actions being taken is designated for every program. When an outsider makes a connection, his/her record is accessed from the database and a menu of authorized activities is presented. The outside parties can select the file they want, which then resides outside the firewall for a brief time. Information about the person who requested the file and the file they requested is passed back to the program. If someone who is not authorized to use the system tries to gain access, they will receive a message back inquiring whether they want a certificate. The request for the certificate is submitted as soon as the CDC indicates that the person who applied is granted access to the activity. The requestor receives an e-mail directing them to the site where they can download their certificate. The act of downloading installs it on their machine.

VI.DoD MHS Model View of Information Assurance – Marco Johnson provided a brief summary of the Military Health System Information Assurance Concept. In the MHS model, data assurance is comprised of three components: 1) information security – to protect information from unauthorized access, manipulation, corruption, destruction and denial of data invading privacy, 2) data quality – to assure the validity, timeliness, completeness and reliability of data, and 3) effective data usage – to convert data into information and provide correct information to support business operations and decision making. The model includes input and output to and from various external and internal initiatives and results in improved care outcomes, increased customer satisfaction, efficient use of resources, reduced costs, better communication, and improved operational efficiency.

The MHS has developed this model to safeguard against:

• Threats to national security
• Unauthorized access, manipulation/corruption, description/denial of data
• Compromised care
• Jeopardized national and economic security

Current risks include stolen secrets and computer crimes and damage to national and international communication systems.

The model also safeguards the patient’s rights and thus calls for:

• Consent for the collection, use and sharing of personal health information
• Access rights
• Rights to have incorrect information rectified
• Protection again accidental/unlawful destruction of data/unauthorized access
• Protection against tampering
• Principle of disclosure
• Principles of informed consent

The business model is comprised of four facets:

• Management controls – includes Standards, policies development/enforcements, procedures, awareness and training, accreditation/certification, testing, monitoring/incident reporting, audits, contingency planning, etc.
• Technical controls – includes audit trails, user IDs/passwords, firewalls, use of cryptography, access controls, digital signature, anti-virus protections, system and application security, etc.
• Environmental controls – includes locks, physical barriers, alarms, surveillance, incident reports, guards/badges, etc.
• Personnel controls – includes security checks and clearances and position sensitivity designations

Click here to view presentation slides

Government Projects SIG MeetingThursday, September 30, 1999

Attendees:

Marco Johnson opened the meeting by reporting on the Technical Steering Committee meeting, which convened the previous night. Marco’s report was followed by introductions.

VII.Briefing by Clem McDonald – Clem reported that there has been a request that reporting of race and ethnicity be allowed as part of the billing standard. The X12 Implementation Guide, however, does not allow reporting of these data elements. There is some concern about race information being sent back to providers because there is a danger that there might be some biases. The suggestion was to include this type of information in the HL7 message. There was also discussion about going back to the x12 837 group to determine if race could be a conditional rather than a not allowed field. There is a series of fields that are needed for public health and there was consensus that HL7 and the government projects SIG should be proactive in including these fields. After some discussion, the group supported the idea of reviewing the NVCHS core health data elements and ensuring that they can be expressed in HL7. This will require that we draft a list of variables that can be sent with an OBX.

Action item: Steve Wagner, Jim McCain and Dan Pollock will send SIG members analysis work comparing the NCVHS minimum data set to the HL7 standard that their respective agencies previously completed. They will also lead an effort by SIG members to determine which data elements are currently supported in HL7 and which aren’t and develop a proposal for the January meeting for incorporating non-supported data elements into the HL7 standard.

VIII.Immunization Status - Susan Abernathy reported that no progress has yet been made on developing V3 messages.

IX.VA International Crosswalk – Ken Rubin reported that he has been doing an inventory of existing healthcare models internationally. This project is an objective work and will include the Canadian, Australian, UK, GCPR and HL7 models. To date, 75% of the models mentioned have gone through two iteration cycles. The inventory document will not be distributed until it is has reached a specific level of maturity. Haim Kilov provided a presentation on open distributed processing. He referenced the following two ISO documents: 1) ISO standard 10746-2 ITU-T recommendation X.902 2)Open Distributed Processing Reference Model Part3: Architecture.

X.Reference Mode for Open Distributed Processing (RM-ODP) – Haim Kilov provided a presentation on the Reference Model for Open Distributed Processing and its applicability to HL7 and government modeling efforts he referenced the following two ISO documents: 1) ISO standard 10746-2 ITU-T recommendation X.902 2) Open Distributed Processing Reference Model Part 3: Architecture.

XI.ConOps Document Discussion -Marco Johnson provided a brief presentation on the ConOps document, suggesting that people attend the introductory tutorial and take advantage of the other educational opportunities. He provided an overview of the MDF and the RIM Harmonization process and initiated discussion of methods for coming to consensus on projects within the Government Projects SIG that will be submitted for inclusion in the Standards.

Action item: Marco will complete a draft outlining this procedure within 30 days and post it to the Government Projects list server.

XII.GCPR Project Modeling – Jim McCain and others on the GCPR provided an overview/update of the GCPR modeling project, including a summary of their high-level architecture model, their data management model, the security component and their common information model/data representation.

Phase I development will include:

• Develop and maintain Reference Information Model (RIM) for clinical information domains (an on-going activity)
• Develop heritage/legacy system interface (an agency unique, on-going activity)
• Establish security standards and authorities
• Design and develop the technical environment
• Proof of concept testing
• Prototype demonstration

Government tasks/responsibilities for Phase I include:

• Select model
• Develop model
• Maintain model
• Create heritage/legacy systems interface
• Establish common security standards

Dr. Lincoln provided a brief summary of the GCPR methods for interacting with subject matter experts. There was a suggestion that the subject matter expects work with the vocabulary SIG.

Action Item: Schedule joint meeting with the vocabulary TC

Ken Rubin provided a brief overview of the GRM (Government Reference Model).The model was initially developed with five partitions:

• Person (MPI)
• Laboratory
• Patient Record Architecture
• Security
• Continuity of Care

The initial model was completed in 45 days but it is not robust or mature. They now want to mature it. To do so, they are looking to identify collaboration opportunities with HL7. They would like to create a document that indicates the deliverables, how to accomplish those deliverables, and the value(s) of the model.

The meeting concluded with open discussions about:

• when GCPR should engage HL7
• how to engage HL7
• what should be accomplished informally vs formally
• whom should be engaged, when does the Government Projects SIG become involved

Click here for presentation slides

Agenda items:

• GCPR will be able to contribute to the HL7 group on 1) security 2) PAFM information 3) vocabulary 4)clinical templates , 5) MPI 6) PRA
• 15 minute presentation from Security group, vocabulary group and MnM group on how the Government Projects SIG will collaborate with them
• Steve Wagner and Jim McCain will discuss recommendations for incorporating the NCVHS minimum data set into HL7 messages
• Marco will present his proposal for the CONOPS proposal within the Government Projects SIG and moving approved projects through other committees for inclusion in HL7 Standards

1