VERSION 0.1 - DRAFT
January 2012
National Information
Exchange Model
Health Domain
Value Proposition
NIEM HEALTH DOMAIN
NIEM.gov
Table of Contents
Introduction.................................................................................................................................................... 4
Purpose ..................................................................................................................................................... 4
Domain Value Proposition............................................................................................................................. 5
Administrative ........................................................................................................................................ 5
Domain Basics & Support ...................................................................................................................... 5
Domain Details ....................................................................................................................................... 6
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List of Tables
Table 1 Administrative Requirements ........................................................................................................... 5
Table 2 Domain Basics ................................................................................................................................. 5
Table 3 Domain Support Personnel .............................................................................................................. 6
Table 4 COI Entities ...................................................................................................................................... 7
Table 5 Domain Data by Subject Area .......................................................................................................... 7
Table 6 Anticipated Information Exchanges ................................................................................................. 8
Table 7 Relevant External Standards ......................................................................................................... 10
Table 8 POAM ............................................................................................................................................. 11
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Introduction
Purpose
The NIEM Health Domain Value Proposition will be used by ONC to propose the establishment of new
National information Exchange Model (NIEM) for the Health Domain.
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Domain Value Proposition
The following section of this document has been designed as a template for describing the value
proposition for a new NIEM domain. Please complete all portions of the template to the degree possible.
ADMINISTRATIVE
The following section of the value proposition identifies the point of contact (POC) responsible for the
submission of the template.
Table 1 Administrative Requirements
Submitter Details
Name
Doug Fridsma, Director of Standards and Interoperability
Organization
Office of the National Coordinator (ONC)
Email
[email protected]
Phone
(202) 205-4408
DOMAIN BASICS & SUPPORT
The following section of the value proposition identifies the proposed name, value proposition and domain
support information i.e., stewardship, points of contact, support staff, and membership.
Table 2 Domain Basics
Domain Basics: Provide the name of the domain being proposed and a brief summary of the value
proposition of establishing the domain both in terms of the NIEM Community as well as the added value
to the COI that the domain will represent.
Domain Candidate Name
Health Domain
Summary of Value
The Health Domain is intended to support the Health Community and the
Proposition
NIEM
community
by
making
data
exchanges
discoverable,
understandable, accessible, and reusable by across our multiple
partners. At the heart of this, the interoperability of health data across the
health industry supports HHS’s objective of reaping the full economic
benefit of exchanging healthcare information with NIEM as the enabler.
This will position HHS to solve healthcare problems, aid in driving
innovation, while integrating technology into the workflow of the
healthcare
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to
transition
and
embrace
a
data
centric
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environment. At HHS, we firmly embrace and believe in the intrinsic and
direct value that can be gleaned from leveraging and establishing a
Health Domain founded on NIEM’s infrastructure, processes, &
procedures. In addition, a result of the PCAST report1 recommended the
use of granular healthcare types with metadata in order to create a
universal exchange language for healthcare.
Table 3 Domain Support Personnel
Domain Support
Domain Steward
Office of the National Coordinator (ONC)
Name:
Organization:
Domain POC
[email protected]
Office of the National Coordinator (ONC)
Office of the National Coordinator (ONC)
Name:
Organization:
Domain Committee Support Staff
[email protected]
Office of the National Coordinator (ONC)
TBD
Name:
Organization:
Domain Modeler
TBD
Office of the National Coordinator (ONC)
The individual(s) responsible for the development and
maintenance of the domain model.
Name:
Organization:
TBD
Office of the National Coordinator (ONC)
*NOTE: The roles of Domain POC, Committee Support Staff, and Modeler as they have been defined are
roles that may be assigned to one or to multiple individuals, depending on the size and structure of the
proposed domain.
DOMAIN DETAILS
The following section of the value proposition identifies the COI supported by the proposed domain. It
also provides a high-level summary of the types of data, potential information exchanges, and relevant
external standards to be used by the domain as well as areas of possible NIEM reuse.
1
http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-report.pdf
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Table 4 COI Entities
COI Entities: A group of federal, state, local, tribal and industry stakeholders with a common interest,
often to build and implement information exchanges within a given functional area or line of business
(E.g., Local enforcement, Border Protection, Family Services, etc.). The term COI is meant to be
inclusive and general, and to convey the breadth and depth of the community that a domain governance
group must adequately represent.
Actual organizations
1
Federal Government Agencies: HHS OpDivs (Health related CDC, FDA, NIH, CMS, HRSA,
SAMHSA, OIG, NCI, HIS, etc),
2
Healthcare Providers: Kaiser Permanente, Mayo Clinic, Cleveland Hospital, etc.
3
Universities: John Hopkins, University of Michigan, Duke, Indiana, Vanderbilt, Columbia, etc.
3
State and Local Government Agencies: Texas Department of Health and Human Services, New
York City Department of Health, etc.
4
Public Health Associations: NACHC, ASTHO, CSTE, APHL, and NAHDO.
5
Standards Development Organizations (SDOs): HL7, ASC, IHE, NLM, Regenstrief, etc.
Table 5 Domain Data by Subject Area
Sample Domain Data by Subject Area: Provide a high-level look at the types of domain data that will be
exchanged via the proposed domain. Please provide information at the component level, e.g. Defendant,
Patient, Activity, etc.
The following data sets and elements are intended to be representative of the elements necessary for
likely NIEM Health Domain transactions. They are not intended to be all inclusive and will be harmonized
with data elements available in other NIEM domains prior to creation within the NIEM Health Domain
Model.
1. Patient Demographics (Mother’s Maiden Name, Patient Date of Birth, Patient Gender, Patient
Identifiers, Patient Martial Status, Patient Name)
2. Patient Contact Information (Patient Direct-Enabled Address, Patient Home Address, Patient
Home Phone, Patient Home Phone Text Message Enabled, Patient Portal/PHR Available, Patient
Portal/PHR URL, Patient Work Phone, Patient Work Phone Text Message Enabled, Primary Email
Address, Secondary Email Address
3. Encounters (Class of Facility, Class of Patient, Date and Time of Arrival, Disposition at Discharge,
Encounter ID, Encounter Type, Encounter Attributes, Reason for Admission, Source of
Admission, Type of Admission)
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4. Admitting and Discharge Diagnoses (Diagnosis List ID, Diagnosis Name, Diagnosis Code, Patient
Conditions, Problem Observation)
Table 6 Anticipated Information Exchanges
Information Exchanges: Provide a list of the information exchange scenarios that would potentially be
developed and supported by the proposed domain. With each exchange, please identify the potential
exchange partners within that scenario. This information will assist identifying areas for cross-domain or
cross-agency information exchange.
#
Scenario
Exchange
1
The patient fills out an application for applying and qualifying
Health Insurance Plan
for benefits. The application information includes patient
Enrollment Exchange
gross income, status, health information, and other pertinent
data pertaining to benefits he/she is applying for. This data
can be exchanged with other partners for qualifying patients.
2
A scientist/research at HHS gathers and studies obesity
Obesity Exchange Package
information for a selected population based on his
hypothesis. This information can be exchanged/shared with
John Hopkins University that is working with partners to map
obesity data using heat maps (via Google maps) to study the
correlation between a fast food restaurant and the impacts
on neighborhoods. The question attempted to answer is
‘should congress limit the number of fast food restaurants
within a certain radius if one can prove that a neighborhood
with a fast food restaurant is more likely to results in an
increase in obesity rates vs a neighborhood that has a fast
food restaurant at a radius of 5 miles?
3
A commercial laboratory has performed studies on a patient
Laboratory Results Interface
at the request of a healthcare provider. The completed
Exchange
laboratory report includes the patient’s demographics,
relevant diagnoses, the tests performed, the relevant results,
and normal values for that test in that commercial laboratory.
The data is then exchanged electronically with the primary
care provider, as well as relevant government agencies as
required by law.
4
A patient was admitted to a hospital, where care was
Transition of Care Exchange
provided for some time. On discharge, a summary of the
patient’s care plan is sent to the patient’s primary care
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physician for continuity of care. This discharge summary
contains the patient’s demographic information, relevant
medical history prior to admission including medications and
allergies, the patient’s presentation and reason for
admission, the hospital course, a discharge diagnosis, a
disposition on discharge, any modifications made to the
patient’s routine medications, and a suggested plan of action
for treating the patient. The discharge summary is also
shared with relevant commercial and government agencies
as required by law or as necessary to facilitate the provision
of care.
5
A patient is moving their primary residence and needs to
Provider Directory Exchange
identify a new healthcare provider. The patient queries a
directory of healthcare providers, which is a distributed
network maintained by various stakeholders. The patient is
able to select criteria to narrow their search such as the
provider’s location, licensure status, and availability. The
patient then makes the new provider known to their previous
provider. The previous provider then queries the directory for
the electronic services supported by the new provider for
direct electronic data exchange. In this instance, the directory
also makes available the relevant certificates necessary to
secure the transaction. The previous provider then utilizes
the described cryptographic and transport methods to
securely communicate the patient’s wishes and deliver the
necessary medical information.
6
In the process of routine healthcare provision, an electronic
Public Health Incident Reporting
medical record system (EMR) determines that a patient’s
Exchange
information meets criteria for being reported to the local
public health department as required by law. The EMR
guides the healthcare provider through the collection of
additional information as required for the report. The EMR
then electronically delivers the completed public health
incident report to the local public health department’s system.
This public health incident report generally contains the
patient’s demographics, public health exposure history, the
data element that qualified the patient for being reported, and
the provider’s contact information.
7
At scheduled intervals, a healthcare provider’s electronic
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medical record system (EMR) contacts local public health
Exchange
servers to download the latest data elements and values for
those elements that would determine the need for a patient
to be reported to the public health department. These
elements may include particular diagnoses (such as active
tuberculosis), laboratory test results (such as a positive
screen for syphilis), or other data elements. These elements
are then incorporated into the EMR, which screens the
patient data being stored within it for meeting public health
reporting criteria.
Table 7 Relevant External Standards
Relevant External Standards: Provide a list of any external standards to NIEM that are used by the
proposed domain’s COI and how those external standards will integrate with NIEM. For example,
Emergency Data Exchange Language (EDXL) for the Emergency Management Domain, Geography
Markup Language (GML) for the Geospatial components found within NIEM core, etc.
#
Data Standard
Integration with NIEM Standard
1
HL7 version 3.0
The integration with NIEM will be explored.
2
ICD-10 (current version is ICD-9)
The integration with NIEM is in discovery mode.
3
CEN ENV12612
The integration with NIEM will be explored.
4
CVX
The integration with NIEM will be explored.
5
HL7 version 2.X
The integration with NIEM will be explored.
6
IHE Profiles (such as SVS)
Integration with NIEM will be explored as specific data
exchanges require the exploration.
7
ASC X12 Standards (such as N274)
Integration with NIEM will be explored as specific data
exchanges require the exploration.
8
Vocabulary, Code Set, and Value Set
The integration with NIEM will be explored.
Standards as named in the HITSP
Code Set Transmittal Memo dated 815-11 (link)
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Table 8 POAM
1 Fiscal Year Plan of Actions and Milestones: Provide a notional 1 fiscal year timeline of planned
actions and milestones for the development of the proposed domain.
#
Action /Milestone
Quarter/Fiscal Year
1
Develop Domain Charter
1st Quarter 2012
2
Develop Communication Plan and Buy-In from Leadership to
2nd and 3rd Quarter 2012
Promote the Use of NIEM
3
Develop, Manage, and Govern Domain Data Models
4th Quarter of 2012 through the
1st Quarter 2013
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