Each of the S&I Initiatives will follow a phased approach to achieve the key outcomes outlined for the Initiative. The phasing approach provides the ability to fail-fast, re-prioritize initiatives, and better understand the interoperability challenge. Learn more about the S&I Framework Processes & Guidelines and S&I Initiative Overview, Phases and Outputs.
Charter (Pre-Discovery)
An Initiative is defined in an Initiative Charter. The Initiative Charter includes:
- The Challenge Statement: a statement of how a standards and interoperability challenge currently limits the achievement of a national health goal
- The Initiative Goal and Scope: a statement of the value the Initiative will create, in specific, measurable, attainable, relevant, and time-bound terms
- The overall staff resource allocation for the Initiative (for Staff Assigned Initiatives)
- The key Initiative Deliverables
- Key timelines, including the timeline for the Call for Participation
- Key risks for the Initiative
- Key stakeholders for the Initiative
- Alignment with Meaningful Use
The Initiative Charters should be updated based on lessons learned during Initiative execution. All updates to the Initiative Charter will be reviewed and accepted by the S&I Steering Team or, for Community Assigned Initiatives, by the Initiative Community of Interest.
For more information about S&I Charters, click here.
Provider Profiles Authentication
Objective: Define the business requirements related to the registration process, compliant with CMS policies and FISMA guidelines, and determine how to securely send medical document request letters to registered providers. In addition to addressing requirements, this workgroup will also analyze and harmonize standards to support secure electronic sending of medical document request letters. Business requirements and standards will have a key focus on the needs of CMS and the CMS post-payment Review Contractors, while also considering options to enable re-use of the processes and standards by other Payers and Medicare partners.
Visit the following page to access the charter: Provider Profiles Authentication
eMDR and Structured Content
Objective: Define the business requirements related to the medical documentation request letters process, and analyze and harmonize standards that can be used to electronically send standards-based medical document request letters. Business requirements and standards will have a key focus on the needs of CMS and the CMS post-payment Review Contractors, while also considering options to enable re-use by other Payers and Medicare partners.
Visit the following page to access the charter: eMDR and Structured Content
Author of Record
Objective: The workgroup will conduct an environmental scan to understand what viable standards and practices are currently in place to support proof of authorship and digital signatures. With the knowledge obtained from the environmental scan, the workgroup will discuss and document requirements relevant to CMS and other Payers regarding signatures for submitted medical documentation. This will include consideration and vendor input with regards to what EHR systems can realistically support, and also include input from healthcare Providers to ensure the solution is not overly burdensome to healthcare Providers and healthcare Provider organizations. Additionally, the Provider Profiles Authentication and Structured Content/Secure Transport of the eMDR use cases will be supported in this workgroup by the following:
- Cryptographic (or equivalent) verification of all participants (Providers, intermediaries and Payers)
- Prevention of tampering
- Encryption of Patient Health Information (PHI) contained in the eMDR
This workgroup will define the Use Case and Functional Requirements, Analyze and Harmonize standards relevant to author-level signatures that support pilot implementations of the solutions, while taking into account the two Use Cases developed as part of the S&I esMD initiative. Business requirements and standards will focus on the needs of CMS and the CMS Review Contractors, while also considering options to enable re-use by other Payers.
Visit the following page to access the charter: Author of Record
Use Case(s) (Discovery)
The Use Case is the foundation for identifying and specifying the standards required to support the data exchange, reference implementations and tools to ensure consistent and reliable adoption of the data exchange standards. It gives the contextual background of why the Initiative is necessary, in a narrative format, and explains the benefits it will provide upon completion. The Use Case describes detailed Scenarios and User Stories, which serve as examples of how the enhanced technical capabilities will improve the task at hand. The scenarios are accompanied by various diagrams, providing pictorial representations of the processes, and displaying the actors involved as well as the sequence of the information exchange.
For more information about S&I Use Cases, click here.
Workgroups
UC 1 - Provider Registration with Payer
The specific purpose of the PPA workgroup is to evaluate solutions to:
- Register providers with CMS and other payers to receive eMDRs and
- Support CMS and other payers in securely sending eMDRs to Agents and Providers
Visit the following page to access the Use Case: UC 1 - Provider Registration with Payer
UC 2 - eMDR and Structured Content
The esMD Use Case 2 is focused on the sending of the electronic Medical Documentation Request (eMDR) from a Payer or Payer contractor to a registered Provider or Provider Organization. It also includes the requirements for the structured content of the eMDR itself along with the transport requirements to send the eMDR.
Visit the following page to access the Use Case: UC 2 - eMDR and Structured Content
Harmonization and Standards (Implementation)
Harmonization
Standards Harmonization is the activities within the S&I Framework that analyze candidate standards and implementation guides. The Standards Harmonization process begins by reviewing the candidate standard list developed during Standards Identification and evaluating the candidate standards against harmonization criteria to select a standard for further harmonization. Additional work products from this phase may include an implementation guide, or proposed improvements, or extensions to a standard. The harmonized standard and accompanying work products are further analyzed and revised through the Reference Implementations and Pilots phases, which results in a harmonized standard for recommendation.
PPA Harmonization of UC 1
Harmonization will focus on developing a data model, conducting standards analysis, and developing implementation guidance for the Provider Profiles Authentication (PPA) Use Case 1 of the esMD Initiative.
Visit the following page to access the Harmonization page: PPA Harmonization of UC 1
eMDR Harmonization of UC 2
Harmonization will focus on developing a data model, conducting standards analysis, and developing implementation guidance for the PPA Use Case 2 (eMDR and Structured Content) of the esMD Initiative.
Visit the following page to access the Harmonization page: eMDR Harmonization of UC 2
Standards
During the Pre-Discovery and Discovery phases of an initiative, it is important to identify and document which standards are being considered as part of that initiative’s solution. TheCandidate Standards List is an artifact designed to foster this activity.
The Candidate Standards List is generated by performing a full environmental scan and collecting input from the community members of the initiative while the use case and functional requirement efforts are going on in parallel. Once a standard is identified and gained community consensus as to its potential relevance, the corresponding SDO should be immediately engaged. This list should continue to grow as business requirements are defined and refined, and should hit its peak by the time the use case and requirements reach consensus and at this point the list in its entirety should go through a verbal consensus. However, the Candidate Standards List may be added to after this point if, for instance, there is a change in scope, change in requirements, or if a previously unidentified standard comes to light.
For more information on harmonization and standards, click here.
Workgroups
Pilots
To date, many S&I Framework Initiatives have included a Pilots Workgroup (see S&I Framework Functions) throughout the lifecycle. The Pilots Workgroup (WG) organizes and guides the deployment of Pilot projects that will test the suitability of the Initiative specifications, standards, and technology in real-world settings. The types of members that have participated in Pilots Workgroups include EHR vendors, provider groups, HIT Integrators, etc. The Pilots WG will form Pilot Teams to deploy instances of the Initiative use case and establish the feasibility of implementing the Initiative’s outputs in real-world, production-grade environments.
For more information about S&I Pilots, click here.
Evaluation
The reference implementation activity creates a fully instantiated software solution that is verified to be compliant with the standards and serves as a “reference” to other software developers of what an interoperable solution looks like. The reference implementation will be accessible as a public resource with compiled code, source code, and supporting documentation.
A reference implementation provides value to the community through a thorough assessment of the technology, support for established standards, and vetting within the S&I Framework.
For more information about S&I Evaluation and Reference Implementation, click here.