Draft Minutes February 23, 2006

Ø       Expenses for Intel in health care expense spurred the effort for Intel to move ahead in looking at PHRs
Ø       Development of a container for transfer and storage of health data
Ø       Intel structure – Personal Healthcare Platform, Enterprise, Standards and Policies, Personal Devices
Ø       Need: PDF/H – proposed standard to facilitate the creation, storage and sharing of electronic health information – bridge gaps between sharing of data between HC institutions, paper and digital records, health systems and consumers

Ø EMRs versus PHRs are not the issue, development of a container to share data regardless of the source of the data

Ø Cost effectiveness for establishing health records is beginning to gain support in multiple markets and demographic areas

Ø Types of information stored in PDF-H: electronic forms, claims, clinical, pharmacy and labs, document based info, scanned images, x-ray films, CAT, MRI, photographs, audio, video, ultrasound, family history, demographics, life chart (medications, medical issues, analytical history) any information that the consumer deems relevant to their health care record with the ability to create a searchable effort

Ø Most salient and critical data has not been determined to date – issue to discuss and understand privacy issues surrounding the data to be included in the system and/or record

Ø Transferring the access policy with the data to the container should be considered in the design
Ø Patient identification is a key issue – how is that done and should it reside with the consumer or patient? who is in control of what information? HIPPA issues – where do they apply and where do we comply – should not be an issue if the consumer/patient has control of the data

Ø CCR (Continuous Care Record) has attempted to address the issues of privacy and security in its design – control is managed by the patient with encryption and privacy based on the nature of the data

Ø Layers of security should be a consideration in the design of the PDF container – hardware, software and accessibility

Ø Health care equivalent of Quicken would be a proposed direction for PDF-H
Ø Research: health records could be managed more like financial records with the access and recording of data as well as education to the consumer to ascertain what the information tells the consumer and the accuracy of the data

Ø Electronic format/record should be focused on what I can do with the data and the services that might provide for the consumer

Ø Language neutral for PDF should be considered – who will be reading it, where and in what language
Ø Portable, searchable, personal, accessible, interoperability, secure, privacy are considerations for PHR – should be couched in an open “system” or framework

Ø Various fragmented efforts already in the market inclusive of HL7 which need to be considered as well as legacy systems in existence

Ø       PDF/H Proposed Phases
o       Phase 1 (12 months) – best practices document on how to capture data in PDF architecture
o       Phase 2 (12 – 36 months) – expand the best practices document into an ISO standard
o       Should there be a Phase 3? – includes the dynamics or implementations of the PDF standard which takes into considerations changes in requirements, priorities and changes in technologies

PDF demonstration – Carl Orthlieb - Adobe

Ø PDF- H’s role in the process is the format for the interchange of information for the internal system within the physician’s environment

Ø       PDF- H records results of the visit and stores it for future reference and is sent to others for review
Ø       Historical and updated information stored in data base
Ø       Demonstration is intended to provide a concept story board and provide a workflow with an electronic healthcare record application

Ø       Suggested workflow process needs to be addressed with the actual software and interception points for PDF
Ø       Electronic health care records are being used in the physicians offices today
Ø       AR: set up a demonstration of the EHR process and workflow for ambulatory care – David Kibbe/Carl Orthlieb
Ø       AR: set up a demonstration of the EHR process and workflow for hospital care – David Kibbe/Carl Orthlieb
Ø       Content standard is important to the implementation of a PHR…CCR bridge to PDF-H via XML would look like pages, metadata and search records for that data

Ø Intelligent PDF is the key to the direction for the container which could include the CCR, encryption, audit logs, etc as part of the file storage structure

Ø AR: Low hanging fruit might be EHRs with transforms to PDF and set up demonstration as example for transforms – XSLT transform already exists to transform XML to PDF

Ø CCR is a summary document with multiple sources with structured data – PDF provides means for that to happen in a structured, secure manner

Ø Kibbe: offering help to investigate how the CCR is a representation of data that has created a structure for the medical data

Ø Kibbe: key questions to answer - what data should be included and in what form? Myriads of data that is useful versus useless – determine the difference and include what is relevant and important

Ø AR: Provide access to schema for CCR to committee – Tom Eberle

Standards Development Process – AIIM – Betsy Fanning

Ø       AIIM Overview – Assoc for Imaging and Information Management (AIIM)
o       Leading industry representing professionals working in Enterprise Content Management (ECM)
o       Membership programs – market education; professional development; peer networking; industry advocacy
o       ANSI accredited
o       Tow secretaries at the ISO level and US TAG (technical advisory group)
o       ISO Fast Track practice
o       Mission: leading, global authority for enterprise content management (ECM)
o       PDF efforts include PDF/A, PDF/E and PDF/UA
Ø       Standards Program Overview
o       Project proposal
o       Project approval and assignment to committee
o       Committee drafts
o       Draft standard approval
o       Publication
o       Education
o       Adoption – for the PDF-H supporters
Ø       Membership for end users – no fees; resource commitment; participation in balloting
Ø       Best Practice Program – relatively new program offering from AIIM
o       Deliverable: Document of the PDF-H creation practice and distribute for free
o       Develop in parallel for ANSI and/or ISL standard
o       Face to face and conference calls
o       Approval for publication would be granted by the group
o       PDF-A was executed on two month face to face meetings
o       Building the requirements for the standard as the best practice is developed – pseudo “implementation guide” for the standard once developed

o       Create formal alliances with the appropriate industry players such as HL7, ANSI, etc.
o       Web tools provided to foster and encourage communication for the group
o       Solution center in place for healthcare and electronic records management

Notes:

Recommendation: to move ahead with the PDF work effort in combination with CCR by Steve Waldren, AAFP

AR: Investigate resources available to assist in the development of the PDF structure and technical specification – Rick Peters/Carl Orthlieb/Melonie Warfel

AR: Contact of key companies/organizations to invite to the project – coordinated by Melonie Warfel/Omid Moghadam/Rick Peters/Rick Benoit/Betsy Fanning

Two step process: begin definition of container; then look at contents to house as step 2

Suggest the development of a demo that could be used as a exemplary model for the best practice document – detailed use case might prove to be a good example of what and how the standard could evolve over time

Pursuit of both paths to include development of the practice and the implementation of that practice

Key issue of awareness – government could take control of managing the standard development but may actually prefers that private sector take lead role in this area

AR: Investigate meeting on EMR providers in TEPR Conference - Baltimore in May 20 – 24, 2006 – could use this as a venue that would provide use case examples for patient to physician; physician to physician; patient to physician, etc. – Rick Peters/Carl OrthliebAR: Investigate for AHIC conference may prove to be another venue for demonstrating use cases – Omid Moghadam/Rick Peters

Vendors have demanded implementation guides for standards are being demanded to accompany the standard

AR: Distribute teleconference info to be discuss EHR and CDC environments – documents included in distribution – use case potential example – IHE (Integrating the Health Care Enterprise) – meeting scheduled for 2:00 – 3:00 PM EST Dial in number: 18779724011 PC:435800 Host: Landen Baine - Dana Stone/Melonie Warfel

HL7 has floundered at times due to structure and complexity of implementation

May want to view the project as a referenced implementation through open source distribution

Security issues for any sample implementation must be considered with encryption and security

Brainstorming issues:

Who is missing from the group? – medical device manufacturers (Siemens, GE Medical); medical clinics (Mayo); service providers (Kaiser Permanente); insurance providers (BlueCross/BlueShield); EMR solution providers; SVOs; security providers; any others?

Motion: Recommendation by Melonie Warfel to utilize AIIM for developing of best practices with PDF standard to be pursued in parallel – approved

Key discussion of economics for AIIM members – zero dollar commitment at this time as associate member and AIIM adheres to ANSI policies – commitment to participate – cleanliness in management of intellectual property should be managed appropriately

AR: Set up communication web tools via AIIM offerings – Betsy Fanning

AR: Distribution of project proposal – Melonie Warfel

Meeting schedules:

AIIM meeting May 16 -18 in Philadelphia – next meeting for other PDF activities

Biweekly meetings – 2:00 PM EST

Monday March 13, 2006

Next face to face meeting – Thursday - March 30, 2006

Location – Adobe location in Seattle, WA

May 16 and/or 17, 2006

Location – Philadelphia, PA – AIIM Expo

PDF Standards

A Service of AIIM and the PDF Technology Community

Draft Minutes February 23, 2006