1. Certification Commission
for Healthcare
Information Technology
CCHIT Roundtables:
 Interoperability 09 and Beyond
 Open Source Forum
Mark Leavitt, MD, PhD – Chairman
Amit Trivedi – Certification Manager & Strategic Work Group Leader, Interoperability
Dennis Wilson – Certification Technology Director
Hyatt Regency McCormick Place
Chicago, IL
Apr 6, 2009

2. Roundtable Sessions
Session #1: 1:00 – 2:00pm CDT
Interoperability 09 and Beyond
Session #2: 2:00 – 3:00pm CDT
Open Source Forum
© 2009 | Slide 2 | Apr 6, 2009

3. Agenda
• 09 Interoperability Criteria
• 09 Interoperability Testing
• Laika EHR 2009
• Roadmap
• Q&A
© 2009 | Slide 3 | Apr 6, 2009

4. 09 Interoperability Criteria
08 Criteria 09 Criteria
• Registration, Medication, and • Registration, Medication, and
Allergy modules Allergy modules
CCD/C32
Import & Export • File/Display: Level 2 • File/Display: Level 2
• Generate/Format: Level 2 • Generate/Format: Level 3
Lab Result • Import HL7 2.5.1
(no changes from 08)
ORU messages
Import
DICOM • Display image via
(no changes from 08)
WADO or C-Move protocol
Image Display
• NCPDP SCRIPT 8.1
eRX • New, Refill, Eligibility, (no changes from 08)
Transactions Formulary, and Med Hx
transactions
• Advanced Interoperability
• PIX or PDQ query
XDS
• XDS.a or XDS.b:
Transactions
• Provide & Register
• Query + Retrieve
© 2009 | Slide 4 | Apr 6, 2009

5. CCD/C32 Coding
Level 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 CT
 Severity Code: SNOMED CT
 Conditions, Immunizations, Encounters, Procedures, Results,
Vital Signs, Pregnancy
© 2009 | Slide 5 | Apr 6, 2009

6. Advanced Interoperability
Advanced Criteria:
•Required for
incentives?
•Distinguished from
basic criteria
© 2009 | Slide 6 | Apr 6, 2009

7. 09 Interoperability Testing
09 Testing Procedures
Laika test cases for Display/File and Generate/Format
CCD/C32
•Checklists for Display verification
Import & Export
•Level 3 coding validated, code sets checked
ORU messages dynamically generated with
Lab Result Import
conformance tools
DICOM
Images served by DICOM server
Image Display
eRX Transactions surescripts certification accepted
Laika test cases for: XDS Provide & Register,
Query/Retrieve, PIX Feed/Query, PDQ
XDS Transactions
•Checklists for queries
•Comparison of transaction results in test servers
© 2009 | Slide 7 | Apr 6, 2009

8. Laika EHR 2009
XDS
DICOM
PDQ Registry
XDS
EHR Under Test Supplier
for Certification Repository
PIX Mgr
Laika 2009
• Complete, ready to use, fully integrated
AWS Instance of Laika
test environment 2009 Environment
• Private virtual instances allocated for
practice and final inspection testing
© 2009 | Slide 8 | Apr 6, 2009

9. 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 9 | Apr 6, 2009

10. Laika Components
Source
Generator: custom
CCD/C32
Import & Export Validation: NIST schematron, UMLS vocabularies
DICOM
DICOM server: dcm4chee
Image Display
XDS NIST Registry/Repository
PIX Manager
Open Health Tools OpenPIXPDQ
PDQ Supplier
Interface Engine Mirth HL7 Interface Engine
© 2009 | Slide 10 | Apr 6, 2009

11. 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 11 | Apr 6, 2009

12. Laika Example Test Case
XDS
[ITI‐19] Node Authentication
Registry
XDS
EHR Under Test
Repository
for Certification [ITI‐14] XDS.a Register Document
or
[ITI‐41] XDS.b Provide & Register Document Set‐b
Laika 2009
[ITI‐20] Record Audit Event
Instance of
Laika 2009
Environment
© 2009 | Slide 12 | Apr 6, 2009

13. Laika Example Test Case
Assign test case from view of patients in XDS Registry
© 2009 | Slide 13 | Apr 6, 2009

14. Laika Example Test Case
• Provide XDS metadata
attributes expected from
Provide & Register transaction
• Values not supplied are
ignored
© 2009 | Slide 14 | Apr 6, 2009

15. Laika Example Test Case
Executing test case triggers compare of expected versus actual values in
XDS Registry
© 2009 | Slide 15 | Apr 6, 2009

16. Laika Example Test Case
ATNA log browser enables
inspection of required entries
© 2009 | Slide 16 | Apr 6, 2009

17. Laika Example Test Case
Checklists support inspection
of query transactions
© 2009 | Slide 17 | Apr 6, 2009

18. Project Contributors
• MITRE Corporation
• CitiusTech
• OpenSourcery
http://laika.sourceforge.net/
 Contributors welcome!
© 2009 | Slide 18 | Apr 6, 2009

19. Looking Ahead
© 2009 | Slide 19 | Apr 6, 2009

20. Criteria Roadmap: 10, 11+
Additional CDA document types for quality reporting and
data 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 20 | Apr 6, 2009

21. 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 21 | Apr 6, 2009

22. 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
© 2009 | Slide 22 | Apr 6, 2009

23. Thank you!
Q&A
For more information:
www.cchit.org

24. Roundtable Sessions
Session #1: 1:00 – 2:00pm CDT
Interoperability 09 and Beyond
Session #2: 2:00 – 3:00pm CDT
Open Source Forum
© 2009 | Slide 24 | Apr 6, 2009