HLT - Healthcare Digital Solutions Skills

HLT - Healthcare Digital Solutions Skills

Service Line Overview

Code: HLT Full Name: Healthcare Digital Solutions Fee Modifier: 1.20 Description: Clinical workflow optimization, HIS implementation (HL7/FHIR), HIPAA compliance

---

Skills Index

#	Skill	Command	Purpose
1	Clinical Workflow Analysis	/hlt-workflow	Analyze and optimize clinical workflows
2	HIS Requirements	/hlt-his-req	Gather HIS implementation requirements
3	HL7/FHIR Mapping	/hlt-hl7-fhir	Map data to healthcare interoperability standards
4	HIPAA Gap Analysis	/hlt-hipaa-gap	HIPAA compliance gap analysis
5	Patient Journey Mapping	/hlt-patient-journey	Map patient journey touchpoints
6	Interoperability Assessment	/hlt-interop	Assess healthcare system interoperability
7	Clinical KPI Framework	/hlt-clinical-kpis	Define clinical performance metrics
8	Telehealth Readiness	/hlt-telehealth	Assess telehealth readiness

---

Skill 1: Clinical Workflow Analysis

Command: /hlt-workflow

Purpose

Analyze existing clinical workflows to identify inefficiencies, bottlenecks, and optimization opportunities while ensuring patient safety and care quality.

Inputs Required

organization_name: "Hospital/Clinic Name"
department: "Emergency|Inpatient|Outpatient|Surgery|Radiology|Lab|Pharmacy"
workflow_scope:
  - name: "Patient Registration"
  - name: "Triage Assessment"
  - name: "Physician Consultation"
current_state:
  paper_based: true|false
  ehr_system: "Epic|Cerner|Meditech|Other|None"
  integration_level: "none|partial|full"
pain_points:
  - "Long wait times"
  - "Documentation burden"
  - "Communication gaps"

Clinical Workflow Analysis Framework

Workflow Categories

Category	Examples	Key Metrics
Patient Flow	Registration, triage, discharge	Throughput, wait times
Clinical Documentation	Notes, orders, results	Time to document, completeness
Medication Management	Prescribing, dispensing, admin	Error rates, turnaround
Diagnostic Services	Lab, imaging, pathology	TAT, accuracy
Care Coordination	Referrals, handoffs, transitions	Communication delays

Analysis Dimensions

1. Time Analysis

   • Cycle time (total process time)
   • Value-added time vs wait time
   • Bottleneck identification
   • Peak load patterns

2. Quality Analysis

   • Error rates and types
   • Rework frequency
   • Compliance gaps
   • Patient safety events

3. Resource Analysis

   • Staff utilization
   • Equipment utilization
   • Space constraints
   • Technology gaps

4. Patient Experience

   • Wait times at each step
   • Communication touchpoints
   • Information gaps
   • Satisfaction drivers

Output: Clinical Workflow Assessment

# Clinical Workflow Analysis Report
## [Organization Name] - [Department]
### Assessment Date: [Date]

## Executive Summary
[High-level findings and key recommendations]

## Current State Analysis

### Workflow Map

[Process flow diagram] Patient Arrival → Registration → Triage → [Wait] → Consultation → [Wait] → Diagnostics → [Wait] → Treatment → Discharge

### Time Analysis
| Step | Avg Duration | Wait Time | Value-Added | Bottleneck |
|------|--------------|-----------|-------------|------------|
| Registration | 15 min | 5 min | 10 min | No |
| Triage | 10 min | 20 min | 10 min | Yes |

### Efficiency Metrics
| Metric | Current | Benchmark | Gap |
|--------|---------|-----------|-----|
| Door-to-Doctor | 45 min | 30 min | +50% |
| Length of Stay | 4.2 hrs | 3.0 hrs | +40% |
| Documentation Time | 35% | 25% | +10% |

## Pain Points Identified

| # | Pain Point | Impact | Root Cause | Priority |
|---|------------|--------|------------|----------|
| 1 | [Issue] | [Impact] | [Cause] | Critical |

## Recommendations

### Quick Wins (0-3 months)
| # | Recommendation | Expected Impact | Effort |
|---|----------------|-----------------|--------|
| 1 | [Recommendation] | [Impact] | Low |

### Process Redesign (3-6 months)
| # | Recommendation | Expected Impact | Effort |
|---|----------------|-----------------|--------|
| 1 | [Recommendation] | [Impact] | Medium |

### Technology Enablement (6-12 months)
| # | Recommendation | Expected Impact | Effort |
|---|----------------|-----------------|--------|
| 1 | [Recommendation] | [Impact] | High |

## Future State Workflow
[Optimized process flow diagram]

## Implementation Roadmap
[Phased approach with milestones]

---

Skill 2: HIS Requirements

Command: /hlt-his-req

Purpose

Gather and document comprehensive requirements for Hospital Information System (HIS) selection or implementation.

Inputs Required

organization_type: "hospital|clinic|health_system|specialty"
bed_count: 250
annual_patient_volume: 50000
current_systems:
  - name: "Current HIS"
    vendor: "Vendor"
    age_years: 10
    satisfaction: "low|medium|high"
departments_in_scope:
  - "Registration"
  - "Clinical"
  - "Billing"
  - "Pharmacy"
  - "Laboratory"
  - "Radiology"
integration_requirements:
  - "Lab Information System"
  - "PACS"
  - "Pharmacy System"

HIS Requirements Framework

Module Categories

Module	Sub-modules	Priority
Patient Management	ADT, Scheduling, Registration	Critical
Clinical	EMR, CPOE, Clinical Documentation	Critical
Revenue Cycle	Billing, Claims, Collections	Critical
Ancillary	Lab, Radiology, Pharmacy	High
Administrative	HR, Finance, Supply Chain	Medium
Analytics	Reporting, BI, Population Health	Medium

Functional Requirements Template

Req ID	Module	Requirement	Priority	MoSCoW
FR-001	ADT	Real-time bed management	Critical	Must
FR-002	EMR	Problem list with ICD-10	Critical	Must
FR-003	CPOE	Drug-drug interaction alerts	Critical	Must

Non-Functional Requirements

Category	Requirement	Target
Performance	Response time	< 2 seconds
Availability	Uptime	99.9%
Scalability	Concurrent users	500+
Security	Authentication	MFA required
Compliance	Standards	HIPAA, HL7, FHIR

Output: HIS Requirements Specification

# HIS Requirements Specification
## [Organization Name]
### Version: 1.0 | Date: [Date]

## 1. Introduction

### 1.1 Purpose
[Purpose of this requirements document]

### 1.2 Scope
| Attribute | Value |
|-----------|-------|
| Organization Type | [Type] |
| Bed Count | [Count] |
| Annual Volume | [Volume] |
| Users | [Count] |

### 1.3 Departments In Scope
- [Department 1]
- [Department 2]

## 2. Current State Assessment

### 2.1 Existing Systems
| System | Vendor | Function | Replace/Integrate |
|--------|--------|----------|-------------------|
| [System] | [Vendor] | [Function] | [Decision] |

### 2.2 Pain Points
| # | Issue | Impact | Priority |
|---|-------|--------|----------|
| 1 | [Issue] | [Impact] | [Priority] |

## 3. Functional Requirements

### 3.1 Patient Management
| ID | Requirement | Priority | Notes |
|----|-------------|----------|-------|
| PM-001 | Patient registration with demographics | Must | |
| PM-002 | Insurance verification | Must | |
| PM-003 | Appointment scheduling | Must | |

### 3.2 Clinical Documentation
| ID | Requirement | Priority | Notes |
|----|-------------|----------|-------|
| CD-001 | Structured clinical notes | Must | |
| CD-002 | Voice recognition support | Should | |

### 3.3 Computerized Provider Order Entry (CPOE)
| ID | Requirement | Priority | Notes |
|----|-------------|----------|-------|
| CP-001 | Medication orders | Must | |
| CP-002 | Lab orders | Must | |
| CP-003 | Clinical decision support | Must | |

### 3.4 Pharmacy
| ID | Requirement | Priority | Notes |
|----|-------------|----------|-------|
| PH-001 | Drug dispensing workflow | Must | |
| PH-002 | Formulary management | Must | |

### 3.5 Laboratory
| ID | Requirement | Priority | Notes |
|----|-------------|----------|-------|
| LB-001 | Order management | Must | |
| LB-002 | Results reporting | Must | |

### 3.6 Radiology
| ID | Requirement | Priority | Notes |
|----|-------------|----------|-------|
| RD-001 | RIS functionality | Must | |
| RD-002 | PACS integration | Must | |

### 3.7 Revenue Cycle
| ID | Requirement | Priority | Notes |
|----|-------------|----------|-------|
| RC-001 | Charge capture | Must | |
| RC-002 | Claims management | Must | |

## 4. Non-Functional Requirements

### 4.1 Performance
| Requirement | Target |
|-------------|--------|
| Page load time | < 2 sec |
| Report generation | < 30 sec |
| Concurrent users | 500+ |

### 4.2 Security & Compliance
| Requirement | Target |
|-------------|--------|
| HIPAA compliance | Full |
| Access control | RBAC |
| Audit logging | Complete |
| Encryption | AES-256 |

### 4.3 Integration
| System | Protocol | Priority |
|--------|----------|----------|
| Lab System | HL7 2.x | Must |
| PACS | DICOM | Must |
| HIE | FHIR R4 | Should |

## 5. Vendor Evaluation Criteria

| Criterion | Weight | Description |
|-----------|--------|-------------|
| Functionality | 30% | Feature coverage |
| Usability | 20% | User experience |
| Integration | 15% | Interoperability |
| Vendor Stability | 15% | Market position |
| Cost | 20% | TCO |

## 6. Implementation Considerations

### 6.1 Timeline Expectations
| Phase | Duration |
|-------|----------|
| Selection | 3-4 months |
| Implementation | 12-18 months |
| Go-Live | Phased |

### 6.2 Resource Requirements
| Role | FTE | Duration |
|------|-----|----------|
| Project Manager | 1.0 | Full |
| Clinical Lead | 0.5 | Full |
| IT Lead | 1.0 | Full |

---

Skill 3: HL7/FHIR Mapping

Command: /hlt-hl7-fhir

Purpose

Map healthcare data to HL7 v2.x or FHIR R4 standards for interoperability between systems.

Inputs Required

mapping_direction: "source_to_hl7|source_to_fhir|hl7_to_fhir"
source_system:
  name: "Source System"
  data_format: "proprietary|hl7v2|fhir|csv|xml"
target_standard: "HL7v2.5|HL7v2.7|FHIR_R4"
data_domains:
  - "Patient Demographics"
  - "Encounters"
  - "Orders"
  - "Results"
  - "Medications"
  - "Allergies"
  - "Problems"
use_case: "ADT|ORM|ORU|MDM|SIU|Custom"

Healthcare Interoperability Standards

HL7 v2.x Message Types

Type	Name	Use Case
ADT	Admit/Discharge/Transfer	Patient movements
ORM	Order Message	Lab/Rad orders
ORU	Observation Result	Lab results
RDE	Pharmacy Encoded Order	Medication orders
MDM	Medical Document	Documents
SIU	Scheduling	Appointments
DFT	Detailed Financial	Charges

FHIR R4 Resources

Resource	HL7v2 Equivalent	Use Case
Patient	PID segment	Demographics
Encounter	PV1 segment	Visits
Observation	OBX segment	Results
MedicationRequest	RXE segment	Prescriptions
DiagnosticReport	ORU message	Reports
AllergyIntolerance	AL1 segment	Allergies
Condition	DG1 segment	Diagnoses

Output: Interface Specification

# Healthcare Interface Specification
## [Interface Name]
### Version: 1.0 | Date: [Date]

## 1. Interface Overview

| Attribute | Value |
|-----------|-------|
| Source System | [System Name] |
| Target System | [System Name] |
| Standard | [HL7v2.x / FHIR R4] |
| Direction | [Inbound/Outbound/Bidirectional] |
| Trigger | [Event/Scheduled/On-Demand] |

## 2. Message/Resource Scope

### Messages Supported
| Message Type | Event | Direction | Frequency |
|--------------|-------|-----------|-----------|
| ADT^A01 | Admit | Outbound | Real-time |
| ADT^A08 | Update | Outbound | Real-time |
| ORU^R01 | Results | Inbound | Real-time |

## 3. Detailed Mapping

### ADT^A01 - Patient Admit

#### MSH Segment (Message Header)
| Field | Element | Source Field | Transform | Example |
|-------|---------|--------------|-----------|---------|
| MSH-3 | Sending App | Config | Static | "HIS" |
| MSH-4 | Sending Facility | Config | Static | "FACILITY1" |
| MSH-7 | Message DateTime | System | yyyyMMddHHmmss | "20260202120000" |
| MSH-9 | Message Type | Config | Static | "ADT^A01" |
| MSH-10 | Control ID | System | UUID | "MSG123456" |

#### PID Segment (Patient Identification)
| Field | Element | Source Field | Transform | Example |
|-------|---------|--------------|-----------|---------|
| PID-3 | Patient ID | patient.mrn | Direct | "MRN12345" |
| PID-5 | Patient Name | patient.name | XPN format | "DOE^JOHN^M" |
| PID-7 | DOB | patient.dob | yyyyMMdd | "19800115" |
| PID-8 | Sex | patient.gender | Lookup | "M" |
| PID-11 | Address | patient.address | XAD format | "123 MAIN ST^^CITY^ST^12345" |

#### PV1 Segment (Patient Visit)
| Field | Element | Source Field | Transform | Example |
|-------|---------|--------------|-----------|---------|
| PV1-2 | Patient Class | visit.type | Lookup | "I" (Inpatient) |
| PV1-3 | Location | visit.location | PL format | "UNIT1^ROOM101^BED-A" |
| PV1-7 | Attending Dr | visit.physician | XCN format | "12345^SMITH^JOHN^MD" |
| PV1-44 | Admit DateTime | visit.admit_dt | yyyyMMddHHmmss | "20260202120000" |

### FHIR Alternative: Patient Resource

```json
{
  "resourceType": "Patient",
  "id": "[patient.id]",
  "identifier": [{
    "system": "urn:oid:2.16.840.1.113883.19.5",
    "value": "[patient.mrn]"
  }],
  "name": [{
    "family": "[patient.lastName]",
    "given": ["[patient.firstName]", "[patient.middleName]"]
  }],
  "gender": "[patient.gender -> male|female|other|unknown]",
  "birthDate": "[patient.dob -> YYYY-MM-DD]",
  "address": [{
    "line": ["[patient.address.street]"],
    "city": "[patient.address.city]",
    "state": "[patient.address.state]",
    "postalCode": "[patient.address.zip]"
  }]
}

4. Code Mappings (Lookup Tables)

Gender Mapping

Source	HL7	FHIR	Description
Male	M	male	Male
Female	F	female	Female
Unknown	U	unknown	Unknown

Patient Class Mapping

Source	HL7 PV1-2	Description
Inpatient	I	Inpatient
Outpatient	O	Outpatient
Emergency	E	Emergency

5. Validation Rules

Rule ID	Field	Validation	Action
VAL-001	PID-3	Required, non-empty	Reject
VAL-002	PID-5	Required, valid XPN	Reject
VAL-003	PID-7	Valid date format	Default

6. Error Handling

Error Code	Description	Action
AE	Application Error	Log, retry
AR	Application Reject	Log, alert
CR	Commit Reject	Log, escalate

7. Testing Scenarios

#	Scenario	Input	Expected
1	Valid admit	Complete ADT^A01	ACK^A01 AA
2	Missing MRN	ADT^A01 no PID-3	ACK^A01 AE

---

## Skill 4: HIPAA Gap Analysis

### Command: `/hlt-hipaa-gap`

### Purpose
Assess compliance with HIPAA Privacy Rule, Security Rule, and Breach Notification Rule requirements.

### Inputs Required
```yaml
organization_type: "covered_entity|business_associate|hybrid"
organization_size: "small|medium|large"
assessment_scope: "full|privacy|security|breach"
current_state:
  risk_assessment_date: "2025-01-15"
  policies_last_updated: "2024-06-01"
  training_completed: true
  incidents_last_year: 2
  baa_inventory: true
ephi_locations:
  - "EHR System"
  - "Email"
  - "Mobile Devices"
  - "Paper Records"

HIPAA Assessment Framework

HIPAA Rule Structure

Rule	Focus	Key Requirements
Privacy Rule	PHI Use/Disclosure	Notice, Authorization, Minimum Necessary
Security Rule	ePHI Safeguards	Administrative, Physical, Technical
Breach Notification	Incident Response	Notification timelines, documentation

Security Rule Safeguards

Administrative Safeguards (§164.308)

Standard	Implementation Specifications
Security Management	Risk analysis, Risk management, Sanctions, Review
Assigned Responsibility	Security official designation
Workforce Security	Authorization, Clearance, Termination
Information Access	Access authorization, Access management
Security Awareness	Training, Login monitoring, Password management
Security Incidents	Response procedures
Contingency Plan	Data backup, Disaster recovery, Emergency mode
Evaluation	Periodic evaluation
BAA	Business associate contracts

Physical Safeguards (§164.310)

Standard	Implementation Specifications
Facility Access	Contingency operations, Facility security, Access control
Workstation Use	Workstation use policies
Workstation Security	Physical safeguards
Device Controls	Disposal, Media re-use, Accountability, Backup

Technical Safeguards (§164.312)

Standard	Implementation Specifications
Access Control	Unique user ID, Emergency access, Auto logoff, Encryption
Audit Controls	Audit logs and examination
Integrity	Mechanism to authenticate ePHI
Authentication	Person or entity authentication
Transmission Security	Integrity controls, Encryption

Output: HIPAA Gap Analysis Report

# HIPAA Compliance Gap Analysis
## [Organization Name]
### Assessment Date: [Date]

## Executive Summary

**Overall Compliance Score:** [X]%
**Risk Level:** [High|Medium|Low]
**Critical Gaps:** [Count]
**High Priority Gaps:** [Count]

### Compliance by Rule
| Rule | Score | Status |
|------|-------|--------|
| Privacy Rule | [X]% | [Status] |
| Security Rule | [X]% | [Status] |
| Breach Notification | [X]% | [Status] |

## Assessment Scope

| Attribute | Value |
|-----------|-------|
| Organization Type | [Type] |
| Assessment Date | [Date] |
| Last Risk Assessment | [Date] |
| ePHI Locations | [Count] |

## Detailed Findings

### Privacy Rule Compliance

#### Notice of Privacy Practices
| Requirement | Status | Gap | Priority |
|-------------|--------|-----|----------|
| NPP available to patients | [Met/Gap] | [Description] | [H/M/L] |
| NPP acknowledgment documented | [Met/Gap] | [Description] | [H/M/L] |

#### Authorization Requirements
| Requirement | Status | Gap | Priority |
|-------------|--------|-----|----------|
| Valid authorization elements | [Met/Gap] | [Description] | [H/M/L] |
| Authorization tracking | [Met/Gap] | [Description] | [H/M/L] |

### Security Rule Compliance

#### Administrative Safeguards
| Standard | Requirement | Status | Gap | Priority |
|----------|-------------|--------|-----|----------|
| §164.308(a)(1) | Risk Analysis | [Met/Gap] | [Desc] | [H/M/L] |
| §164.308(a)(1) | Risk Management | [Met/Gap] | [Desc] | [H/M/L] |
| §164.308(a)(2) | Security Official | [Met/Gap] | [Desc] | [H/M/L] |
| §164.308(a)(3) | Workforce Security | [Met/Gap] | [Desc] | [H/M/L] |
| §164.308(a)(4) | Access Management | [Met/Gap] | [Desc] | [H/M/L] |
| §164.308(a)(5) | Security Training | [Met/Gap] | [Desc] | [H/M/L] |
| §164.308(a)(6) | Incident Procedures | [Met/Gap] | [Desc] | [H/M/L] |
| §164.308(a)(7) | Contingency Plan | [Met/Gap] | [Desc] | [H/M/L] |
| §164.308(a)(8) | Evaluation | [Met/Gap] | [Desc] | [H/M/L] |
| §164.308(b)(1) | BAA Contracts | [Met/Gap] | [Desc] | [H/M/L] |

#### Physical Safeguards
| Standard | Requirement | Status | Gap | Priority |
|----------|-------------|--------|-----|----------|
| §164.310(a)(1) | Facility Access | [Met/Gap] | [Desc] | [H/M/L] |
| §164.310(b) | Workstation Use | [Met/Gap] | [Desc] | [H/M/L] |
| §164.310(c) | Workstation Security | [Met/Gap] | [Desc] | [H/M/L] |
| §164.310(d)(1) | Device Controls | [Met/Gap] | [Desc] | [H/M/L] |

#### Technical Safeguards
| Standard | Requirement | Status | Gap | Priority |
|----------|-------------|--------|-----|----------|
| §164.312(a)(1) | Access Control | [Met/Gap] | [Desc] | [H/M/L] |
| §164.312(b) | Audit Controls | [Met/Gap] | [Desc] | [H/M/L] |
| §164.312(c)(1) | Integrity | [Met/Gap] | [Desc] | [H/M/L] |
| §164.312(d) | Authentication | [Met/Gap] | [Desc] | [H/M/L] |
| §164.312(e)(1) | Transmission Security | [Met/Gap] | [Desc] | [H/M/L] |

### Breach Notification Compliance

| Requirement | Status | Gap | Priority |
|-------------|--------|-----|----------|
| Breach detection procedures | [Met/Gap] | [Desc] | [H/M/L] |
| Risk assessment process | [Met/Gap] | [Desc] | [H/M/L] |
| Individual notification (60 days) | [Met/Gap] | [Desc] | [H/M/L] |
| HHS notification | [Met/Gap] | [Desc] | [H/M/L] |
| Media notification (>500) | [Met/Gap] | [Desc] | [H/M/L] |

## Remediation Plan

### Critical Priority (0-30 days)
| # | Gap | Remediation | Owner | Due Date |
|---|-----|-------------|-------|----------|
| 1 | [Gap] | [Action] | [Owner] | [Date] |

### High Priority (30-90 days)
| # | Gap | Remediation | Owner | Due Date |
|---|-----|-------------|-------|----------|
| 1 | [Gap] | [Action] | [Owner] | [Date] |

### Medium Priority (90-180 days)
| # | Gap | Remediation | Owner | Due Date |
|---|-----|-------------|-------|----------|
| 1 | [Gap] | [Action] | [Owner] | [Date] |

## Risk Register

| Risk | Likelihood | Impact | Score | Mitigation |
|------|------------|--------|-------|------------|
| [Risk] | [H/M/L] | [H/M/L] | [Score] | [Action] |

## Appendix: Evidence Checklist

| Item | Required | Provided | Status |
|------|----------|----------|--------|
| Risk Assessment Report | Yes | [Y/N] | [Status] |
| Policies & Procedures | Yes | [Y/N] | [Status] |
| Training Records | Yes | [Y/N] | [Status] |
| BAA Inventory | Yes | [Y/N] | [Status] |
| Incident Log | Yes | [Y/N] | [Status] |

---

Skill 5: Patient Journey Mapping

Command: /hlt-patient-journey

Purpose

Map the complete patient journey across touchpoints to identify experience gaps and improvement opportunities.

Inputs Required

journey_type: "emergency|elective|chronic|preventive"
patient_persona:
  name: "Persona Name"
  age: 45
  condition: "Cardiac"
  tech_savvy: "low|medium|high"
journey_scope:
  start: "Symptom onset"
  end: "Follow-up care"
touchpoints_included:
  - "Pre-visit"
  - "Arrival"
  - "Registration"
  - "Clinical care"
  - "Discharge"
  - "Post-visit"
data_sources:
  - "Patient surveys"
  - "Process observations"
  - "Staff interviews"

Patient Journey Framework

Journey Stages

Stage	Description	Key Touchpoints
Awareness	Recognition of need	Symptoms, research
Access	Finding care	Scheduling, referral
Arrival	Facility entry	Parking, wayfinding
Intake	Registration	Forms, verification
Care Delivery	Clinical services	Exams, procedures
Transition	Moving between	Handoffs, transfers
Departure	Leaving facility	Discharge, instructions
Follow-up	Ongoing care	Results, appointments

Experience Dimensions

Dimension	Description	Metrics
Functional	Getting the job done	Wait times, outcomes
Emotional	How patients feel	Anxiety, confidence
Accessibility	Ease of access	Availability, barriers
Communication	Information exchange	Clarity, timeliness

Output: Patient Journey Map

# Patient Journey Map
## [Journey Name]: [Patient Type]
### Date: [Date]

## Journey Overview

**Journey Type:** [Type]
**Duration:** [Start] to [End]
**Key Pain Points:** [Count]
**Opportunities:** [Count]

## Patient Persona

| Attribute | Value |
|-----------|-------|
| Name | [Persona Name] |
| Age | [Age] |
| Condition | [Condition] |
| Tech Comfort | [Level] |
| Goals | [What patient wants to achieve] |
| Concerns | [What patient worries about] |

## Journey Map

### Stage 1: Awareness & Research

Timeline: [Duration] Touchpoints: Website, Dr. Google, Phone

| Touchpoint | Action | Thinking | Feeling | Pain Points | Opportunities |
|------------|--------|----------|---------|-------------|---------------|
| Symptom onset | Notices symptoms | "What's wrong?" | Worried | Uncertainty | Symptom checker |
| Online search | Researches condition | "Is this serious?" | Anxious | Conflicting info | Trusted content |

### Stage 2: Access & Scheduling

| Touchpoint | Action | Thinking | Feeling | Pain Points | Opportunities |
|------------|--------|----------|---------|-------------|---------------|
| Phone call | Calls for appointment | "How soon can I be seen?" | Impatient | Long hold times | Online scheduling |
| Scheduling | Books appointment | "Will this time work?" | Relieved | Limited availability | Self-service portal |

### Stage 3: Arrival & Registration

| Touchpoint | Action | Thinking | Feeling | Pain Points | Opportunities |
|------------|--------|----------|---------|-------------|---------------|
| Parking | Finds parking | "Where do I go?" | Frustrated | Confusing signage | Mobile wayfinding |
| Registration | Checks in | "Not this again" | Annoyed | Redundant forms | Pre-registration |

### Stage 4: Clinical Care

| Touchpoint | Action | Thinking | Feeling | Pain Points | Opportunities |
|------------|--------|----------|---------|-------------|---------------|
| Waiting room | Waits | "How much longer?" | Anxious | No updates | Wait time display |
| Exam room | Sees provider | "Will they listen?" | Hopeful | Rushed feeling | Extended time slots |
| Testing | Gets tests | "What are they looking for?" | Nervous | No explanation | Real-time education |

### Stage 5: Discharge & Follow-up

| Touchpoint | Action | Thinking | Feeling | Pain Points | Opportunities |
|------------|--------|----------|---------|-------------|---------------|
| Discharge | Receives instructions | "What do I do next?" | Overwhelmed | Information overload | Digital instructions |
| Results | Gets results | "What does this mean?" | Anxious | Delay in communication | Patient portal alerts |

## Emotional Journey Curve

 High  |                    *

Emotion | * /
| / \ / \ * | / \ / \ /
| * / \ / _/ ___ Low |*__/_________________ Awareness Arrival Care Discharge Follow-up

## Pain Point Analysis

| # | Pain Point | Stage | Severity | Impact | Root Cause |
|---|------------|-------|----------|--------|------------|
| 1 | Long wait without updates | Care | High | Anxiety | No system |
| 2 | Redundant paperwork | Arrival | Medium | Frustration | No integration |

## Opportunities

| # | Opportunity | Stage | Effort | Impact | Quick Win |
|---|-------------|-------|--------|--------|-----------|
| 1 | Digital check-in | Arrival | Medium | High | No |
| 2 | Wait time display | Care | Low | High | Yes |

## Recommendations

### Immediate (0-3 months)
1. [Recommendation]

### Short-term (3-6 months)
1. [Recommendation]

### Long-term (6-12 months)
1. [Recommendation]

## Metrics to Track

| Metric | Current | Target | Frequency |
|--------|---------|--------|-----------|
| Patient Satisfaction | [Score] | [Target] | Monthly |
| Net Promoter Score | [Score] | [Target] | Quarterly |
| Wait Time (avg) | [Time] | [Target] | Weekly |

---

Skill 6: Interoperability Assessment

Command: /hlt-interop

Purpose

Assess healthcare organization's interoperability capabilities and readiness for health information exchange.

Inputs Required

organization_name: "Organization Name"
systems_inventory:
  - name: "System Name"
    type: "EHR|LIS|RIS|PIS|ADT"
    vendor: "Vendor"
    hl7_capable: true|false
    fhir_capable: true|false
current_exchanges:
  - partner: "Partner Name"
    type: "HIE|Direct|Custom"
    direction: "bidirectional|send|receive"
regulatory_requirements:
  - "CMS Interoperability"
  - "Information Blocking"
  - "TEFCA"

Interoperability Maturity Model

Level	Name	Characteristics
1	Foundational	Non-electronic, fax/mail
2	Structural	Standard formats (HL7 2.x)
3	Semantic	Coded data, common vocabularies
4	Organizational	Governance, trust frameworks
5	Optimized	Real-time, patient-mediated

Assessment Dimensions

Dimension	Focus Areas
Technical	Standards support, APIs, connectivity
Semantic	Vocabularies, code sets, data quality
Process	Workflows, governance, monitoring
Policy	Consent, privacy, data sharing agreements

Output: Interoperability Assessment Report

# Healthcare Interoperability Assessment
## [Organization Name]
### Assessment Date: [Date]

## Executive Summary

**Interoperability Maturity Level:** [1-5] - [Name]
**Overall Readiness Score:** [X/100]
**Critical Gaps:** [Count]

## Current State Analysis

### System Inventory
| System | Type | Vendor | HL7 v2 | FHIR | APIs |
|--------|------|--------|--------|------|------|
| [Name] | [Type] | [Vendor] | [Y/N] | [Y/N] | [Y/N] |

### Current Exchanges
| Partner | Type | Direction | Standards | Volume |
|---------|------|-----------|-----------|--------|
| [Name] | [HIE/Direct] | [Dir] | [HL7/FHIR] | [/day] |

## Maturity Assessment

### Technical Interoperability
| Criterion | Score | Evidence |
|-----------|-------|----------|
| HL7 v2 messaging | [X/10] | [Details] |
| FHIR R4 capability | [X/10] | [Details] |
| API availability | [X/10] | [Details] |
| Security protocols | [X/10] | [Details] |

### Semantic Interoperability
| Criterion | Score | Evidence |
|-----------|-------|----------|
| ICD-10 adoption | [X/10] | [Details] |
| SNOMED CT usage | [X/10] | [Details] |
| LOINC for labs | [X/10] | [Details] |
| RxNorm for meds | [X/10] | [Details] |

### Process Interoperability
| Criterion | Score | Evidence |
|-----------|-------|----------|
| Data governance | [X/10] | [Details] |
| Interface monitoring | [X/10] | [Details] |
| Error handling | [X/10] | [Details] |
| Change management | [X/10] | [Details] |

## Regulatory Compliance

### CMS Interoperability Rule
| Requirement | Status | Gap |
|-------------|--------|-----|
| Patient access API | [Met/Gap] | [Details] |
| Provider directory API | [Met/Gap] | [Details] |
| Payer-to-payer exchange | [Met/Gap] | [Details] |

### Information Blocking
| Exception | Applicable | Documented |
|-----------|------------|------------|
| Preventing harm | [Y/N] | [Y/N] |
| Privacy | [Y/N] | [Y/N] |
| Security | [Y/N] | [Y/N] |
| Infeasibility | [Y/N] | [Y/N] |

### TEFCA Readiness
| Requirement | Status | Gap |
|-------------|--------|-----|
| QHIN connectivity | [Status] | [Gap] |
| Common Agreement | [Status] | [Gap] |

## Gap Analysis

| # | Gap | Category | Impact | Priority |
|---|-----|----------|--------|----------|
| 1 | [Gap] | [Technical/Semantic/Process] | [Impact] | [H/M/L] |

## Roadmap

### Phase 1: Foundation (0-6 months)
- [ ] [Action item]

### Phase 2: Enhancement (6-12 months)
- [ ] [Action item]

### Phase 3: Optimization (12-18 months)
- [ ] [Action item]

---

Skill 7: Clinical KPI Framework

Command: /hlt-clinical-kpis

Purpose

Design a comprehensive clinical KPI framework covering quality, safety, efficiency, and patient experience.

Inputs Required

organization_type: "hospital|clinic|health_system"
focus_areas:
  - "Quality"
  - "Safety"
  - "Efficiency"
  - "Patient Experience"
  - "Financial"
departments:
  - "Emergency"
  - "Inpatient"
  - "Surgery"
  - "Outpatient"
regulatory_programs:
  - "CMS Quality Programs"
  - "Joint Commission"
  - "Leapfrog"
current_reporting:
  dashboards: true|false
  frequency: "daily|weekly|monthly"

Clinical KPI Categories

Category	Focus	Example Metrics
Quality	Clinical outcomes	Mortality, readmissions, complications
Safety	Patient harm prevention	Falls, infections, medication errors
Efficiency	Resource utilization	LOS, throughput, OR utilization
Experience	Patient satisfaction	HCAHPS, NPS, complaints
Access	Care availability	Wait times, appointment availability
Financial	Cost management	Cost per case, revenue cycle

Output: Clinical KPI Framework

# Clinical KPI Framework
## [Organization Name]
### Version: 1.0 | Date: [Date]

## Framework Overview

### Balanced Scorecard Approach
| Perspective | Focus | Weight |
|-------------|-------|--------|
| Quality & Safety | Clinical outcomes, patient harm | 35% |
| Patient Experience | Satisfaction, engagement | 25% |
| Efficiency | Operations, throughput | 25% |
| Financial | Sustainability | 15% |

## KPI Catalog

### Quality Metrics

| KPI | Definition | Formula | Target | Frequency |
|-----|------------|---------|--------|-----------|
| 30-Day Readmission Rate | % patients readmitted within 30 days | (Readmissions / Discharges) x 100 | < 15% | Monthly |
| Mortality Rate | Deaths per 1000 discharges | (Deaths / Discharges) x 1000 | < Benchmark | Monthly |
| Surgical Site Infection | SSI per 100 procedures | (SSI / Procedures) x 100 | < 1% | Monthly |
| Sepsis Bundle Compliance | % sepsis patients with bundle | (Compliant / Total Sepsis) x 100 | > 95% | Monthly |

### Safety Metrics

| KPI | Definition | Formula | Target | Frequency |
|-----|------------|---------|--------|-----------|
| Patient Falls | Falls per 1000 patient days | (Falls / Patient Days) x 1000 | < 3.0 | Monthly |
| Falls with Injury | Injury falls per 1000 patient days | (Injury Falls / Patient Days) x 1000 | < 0.5 | Monthly |
| CLABSI Rate | Central line infections per 1000 line days | (CLABSI / Line Days) x 1000 | 0 | Monthly |
| CAUTI Rate | Catheter infections per 1000 catheter days | (CAUTI / Cath Days) x 1000 | 0 | Monthly |
| Medication Errors | Errors per 1000 doses | (Errors / Doses) x 1000 | < 1.0 | Monthly |

### Efficiency Metrics

| KPI | Definition | Formula | Target | Frequency |
|-----|------------|---------|--------|-----------|
| Average Length of Stay | Mean inpatient days | Total Days / Discharges | < Benchmark | Weekly |
| ED Throughput | Time from arrival to disposition | Median minutes | < 180 min | Daily |
| OR Utilization | % of scheduled OR time used | (Actual / Scheduled) x 100 | > 80% | Weekly |
| Bed Turnover | Discharges per bed | Discharges / Beds | > 4.0/mo | Monthly |
| Door-to-Balloon | STEMI treatment time | Median minutes | < 90 min | Monthly |

### Patient Experience Metrics

| KPI | Definition | Formula | Target | Frequency |
|-----|------------|---------|--------|-----------|
| Overall Rating | HCAHPS 9/10 rating | % Top Box | > 75% | Quarterly |
| Recommend Hospital | HCAHPS definitely recommend | % Top Box | > 75% | Quarterly |
| Communication - Nurses | HCAHPS nurse communication | % Top Box | > 80% | Quarterly |
| Communication - Doctors | HCAHPS doctor communication | % Top Box | > 80% | Quarterly |
| Pain Management | HCAHPS pain well controlled | % Top Box | > 70% | Quarterly |
| Net Promoter Score | Likelihood to recommend | (Promoters - Detractors) | > 50 | Monthly |

### Access Metrics

| KPI | Definition | Formula | Target | Frequency |
|-----|------------|---------|--------|-----------|
| ED Wait Time | Arrival to provider | Median minutes | < 30 min | Daily |
| Appointment Availability | Days to next available | Median days | < 7 days | Weekly |
| No-Show Rate | Missed appointments | (No-shows / Scheduled) x 100 | < 10% | Weekly |

### Financial Metrics

| KPI | Definition | Formula | Target | Frequency |
|-----|------------|---------|--------|-----------|
| Cost per Case | Average cost per discharge | Total Cost / Discharges | < Budget | Monthly |
| Revenue per Adjusted Discharge | Revenue per case mix adjusted discharge | Revenue / Adj Discharges | > Budget | Monthly |
| Days in AR | Average collection time | AR / (Revenue/365) | < 45 days | Monthly |

## Department-Specific KPIs

### Emergency Department
| KPI | Target | Frequency |
|-----|--------|-----------|
| Door-to-Doctor | < 30 min | Daily |
| Left Without Being Seen | < 2% | Daily |
| ED Boarding Hours | < 2 hrs | Daily |

### Surgical Services
| KPI | Target | Frequency |
|-----|--------|-----------|
| Case Cancellation Rate | < 5% | Weekly |
| First Case On-Time Start | > 90% | Daily |
| Surgical Site Infection | < 1% | Monthly |

## Dashboard Design

### Executive Dashboard (Monthly)
- Quality composite score
- Safety event trends
- Financial performance
- Patient experience trends

### Operational Dashboard (Daily/Weekly)
- ED throughput metrics
- Bed availability
- OR utilization
- Staffing levels

### Quality Dashboard (Monthly)
- Core measure performance
- Infection rates
- Readmission rates
- Mortality indices

## Data Sources & Governance

| Metric Category | Primary Source | Secondary Source | Owner |
|-----------------|----------------|------------------|-------|
| Quality | EHR/Clinical | Claims | CMO |
| Safety | Incident System | EHR | CNO |
| Efficiency | ADT/Operations | EHR | COO |
| Experience | Survey Vendor | Complaints | CNO |
| Financial | Revenue Cycle | GL | CFO |

## Implementation Roadmap

### Phase 1: Foundation (Months 1-3)
- [ ] Validate data sources
- [ ] Build core dashboards
- [ ] Train leadership

### Phase 2: Expansion (Months 4-6)
- [ ] Department-level KPIs
- [ ] Automated reporting
- [ ] Benchmark integration

### Phase 3: Optimization (Months 7-12)
- [ ] Predictive analytics
- [ ] Real-time alerts
- [ ] Performance improvement integration

---

Skill 8: Telehealth Readiness

Command: /hlt-telehealth

Purpose

Assess organizational readiness for telehealth services including technology, workflow, regulatory, and patient engagement.

Inputs Required

organization_name: "Organization Name"
current_state:
  telehealth_active: true|false
  platforms_used: ["Platform1"]
  visit_types: ["Urgent", "Follow-up"]
  volume_monthly: 500
planned_expansion:
  - "Behavioral health"
  - "Chronic care"
  - "Specialty consults"
patient_population:
  avg_age: 55
  rural_percentage: 30
  tech_literacy: "low|medium|high"

Telehealth Readiness Dimensions

Dimension	Focus Areas	Weight
Technology	Platform, devices, connectivity	25%
Clinical	Workflows, protocols, appropriateness	25%
Operational	Scheduling, billing, support	20%
Regulatory	Licensing, privacy, consent	15%
Patient	Access, engagement, digital literacy	15%

Output: Telehealth Readiness Assessment

# Telehealth Readiness Assessment
## [Organization Name]
### Assessment Date: [Date]

## Executive Summary

**Overall Readiness Score:** [X/100]
**Readiness Level:** [Emerging|Developing|Established|Optimized]
**Key Gaps:** [Count]
**Priority Actions:** [Count]

## Readiness Scores by Dimension

| Dimension | Score | Status |
|-----------|-------|--------|
| Technology | [X/100] | [Status] |
| Clinical | [X/100] | [Status] |
| Operational | [X/100] | [Status] |
| Regulatory | [X/100] | [Status] |
| Patient | [X/100] | [Status] |

## Current State Analysis

### Telehealth Program Status
| Attribute | Value |
|-----------|-------|
| Program Active | [Yes/No] |
| Monthly Volume | [Volume] |
| Visit Types | [Types] |
| Platform(s) | [Names] |
| Provider Participation | [%] |

## Detailed Assessment

### Technology Readiness
| Criterion | Score | Evidence | Gap |
|-----------|-------|----------|-----|
| Video platform | [X/10] | [Details] | [Gap] |
| EHR integration | [X/10] | [Details] | [Gap] |
| Device availability | [X/10] | [Details] | [Gap] |
| Bandwidth/connectivity | [X/10] | [Details] | [Gap] |
| Technical support | [X/10] | [Details] | [Gap] |

### Clinical Readiness
| Criterion | Score | Evidence | Gap |
|-----------|-------|----------|-----|
| Clinical protocols | [X/10] | [Details] | [Gap] |
| Visit appropriateness criteria | [X/10] | [Details] | [Gap] |
| Provider training | [X/10] | [Details] | [Gap] |
| Quality monitoring | [X/10] | [Details] | [Gap] |
| Care coordination | [X/10] | [Details] | [Gap] |

### Operational Readiness
| Criterion | Score | Evidence | Gap |
|-----------|-------|----------|-----|
| Scheduling workflow | [X/10] | [Details] | [Gap] |
| Patient intake | [X/10] | [Details] | [Gap] |
| Billing/coding | [X/10] | [Details] | [Gap] |
| Staff training | [X/10] | [Details] | [Gap] |
| Performance metrics | [X/10] | [Details] | [Gap] |

### Regulatory Readiness
| Criterion | Score | Evidence | Gap |
|-----------|-------|----------|-----|
| State licensure | [X/10] | [Details] | [Gap] |
| HIPAA compliance | [X/10] | [Details] | [Gap] |
| Informed consent | [X/10] | [Details] | [Gap] |
| Prescribing policies | [X/10] | [Details] | [Gap] |
| Documentation standards | [X/10] | [Details] | [Gap] |

### Patient Readiness
| Criterion | Score | Evidence | Gap |
|-----------|-------|----------|-----|
| Digital literacy | [X/10] | [Details] | [Gap] |
| Device access | [X/10] | [Details] | [Gap] |
| Broadband access | [X/10] | [Details] | [Gap] |
| Patient education | [X/10] | [Details] | [Gap] |
| Digital divide solutions | [X/10] | [Details] | [Gap] |

## Gap Analysis

| # | Gap | Dimension | Impact | Priority | Effort |
|---|-----|-----------|--------|----------|--------|
| 1 | [Gap] | [Dim] | [H/M/L] | [H/M/L] | [H/M/L] |

## Recommendations

### Quick Wins (0-30 days)
| # | Recommendation | Owner | Impact |
|---|----------------|-------|--------|
| 1 | [Recommendation] | [Owner] | [Impact] |

### Short-term (1-3 months)
| # | Recommendation | Owner | Impact |
|---|----------------|-------|--------|
| 1 | [Recommendation] | [Owner] | [Impact] |

### Long-term (3-12 months)
| # | Recommendation | Owner | Impact |
|---|----------------|-------|--------|
| 1 | [Recommendation] | [Owner] | [Impact] |

## Implementation Roadmap

### Phase 1: Foundation
- Platform optimization
- Core protocol development
- Provider training

### Phase 2: Expansion
- New visit types
- Specialty programs
- Patient outreach

### Phase 3: Optimization
- Advanced analytics
- AI-assisted triage
- Remote monitoring integration

## Success Metrics

| Metric | Baseline | Target | Timeline |
|--------|----------|--------|----------|
| Monthly visits | [Current] | [Target] | [Date] |
| Provider adoption | [Current] | [Target] | [Date] |
| Patient satisfaction | [Current] | [Target] | [Date] |
| No-show rate | [Current] | [Target] | [Date] |

---

Service Line Integration

Fee Modifier

HLT Base Modifier: 1.20 (applied to standard rates)

Typical Engagement Phases

Phase	Duration	Deliverables
Assessment	3-4 weeks	Workflow analysis, gap assessments
Design	4-6 weeks	Requirements, journey maps, KPI frameworks
Implementation	Variable	System configuration, integration
Optimization	Ongoing	Performance monitoring, continuous improvement

Cross-Skill Workflows

HIS Implementation:
/hlt-workflow → /hlt-his-req → /hlt-hl7-fhir →
/hlt-interop → /esi-migration → /esi-cutover

HIPAA Compliance Program:
/hlt-hipaa-gap → /iso-gap (27001) → /iso-doc-control →
/hlt-workflow → Training

Patient Experience Initiative:
/hlt-patient-journey → /hlt-workflow → /coe-kpi →
/coe-dashboard → /hlt-telehealth

Clinical Quality Program:
/hlt-clinical-kpis → /coe-dashboard → /hlt-workflow →
Quality improvement cycles

Integration with Other Service Lines

Service Line	Integration Point
ESI	HIS implementation, HL7/FHIR integration
ISO	ISO 27001 for healthcare security
COE	Clinical dashboards, KPI frameworks
DIG	Healthcare digital transformation
AIG	AI in clinical decision support

---

Regulatory Reference

Key Healthcare Regulations

Regulation	Focus	Applicability
HIPAA	Privacy & Security	All covered entities
HITECH	EHR adoption, breach notification	All covered entities
21st Century Cures	Interoperability, information blocking	All providers
CMS CoP	Conditions of Participation	Medicare providers
Joint Commission	Accreditation standards	Accredited facilities
State regulations	Licensing, telehealth, consent	Varies by state

Healthcare Vocabulary Standards

Standard	Use Case
ICD-10-CM	Diagnosis coding
ICD-10-PCS	Procedure coding (inpatient)
CPT	Procedure coding (outpatient)
SNOMED CT	Clinical terminology
LOINC	Lab and clinical observations
RxNorm	Medication terminology
NDC	Drug identification

---

Templates & Artifacts

All HLT deliverables should use standard CPS branding via:

• /doc-gen for document generation
• assets/cps-branding.json for styling
• scripts/cps-document-generator.js for automation

Standard Artifacts by Skill

Skill	Primary Artifact	Format
/hlt-workflow	Clinical Workflow Report	DOCX/PDF
/hlt-his-req	HIS Requirements Spec	DOCX
/hlt-hl7-fhir	Interface Specification	DOCX/PDF
/hlt-hipaa-gap	HIPAA Gap Analysis	DOCX/PDF
/hlt-patient-journey	Patient Journey Map	PPTX/PDF
/hlt-interop	Interoperability Assessment	DOCX/PDF
/hlt-clinical-kpis	KPI Framework	XLSX/DOCX
/hlt-telehealth	Telehealth Assessment	DOCX/PDF

---

Additional Skill: population-health

Command: /cps-skills:population-health (v4.2.1)

Purpose

Design population health management program: stratification, care management, social determinants.

Inputs required

client:
  name: "Client Name"
context:
  scope: "in-scope description"
  constraints: ["regulatory / commercial constraints"]

Methodology

1. Frame the request against Healthcare Strategy domain conventions.
2. Pull required inputs from engagement brain and external sources.
3. Apply the population-health method using the relevant subagent.
4. Synthesize into deliverable with recommendations + risks.
5. Validate via /cps:verify-quality.

Output shape

CPS-branded population-health deliverable in 05_Deliverables_Final/.

Quality checklist

• Pyramid Principle structure
• Source citations on all data
• Quantified impact where the analysis supports it

---

Additional Skill: value-based-care

Command: /cps-skills:value-based-care (v4.2.1)

Purpose

Transition from fee-for-service to value-based-care: contracts, attribution, risk adjustment.

Inputs required

client:
  name: "Client Name"
context:
  scope: "in-scope description"
  constraints: ["regulatory / commercial constraints"]

Methodology

1. Frame the request against Healthcare Strategy domain conventions.
2. Pull required inputs from engagement brain and external sources.
3. Apply the value-based-care method using the relevant subagent.
4. Synthesize into deliverable with recommendations + risks.
5. Validate via /cps:verify-quality.

Output shape

CPS-branded value-based-care deliverable in 05_Deliverables_Final/.

Quality checklist

• Pyramid Principle structure
• Source citations on all data
• Quantified impact where the analysis supports it