Data Access Framework (DAF) Kickoff 7/16/2013

1. Data Access Framework (DAF)Kickoff 7/16/2013 July 16th, 2013 Doug Fridsma, MD, PhD, FACP, FACMIChief Science Officer &Director, Office of Science & Technology John Feikema – Initiative Coordinator Mera Choi – ONC Lead

2. Meeting Etiquette • As a reminder all participants on this call are muted. If you want to ask questions or make comments please use the “Chat” feature on the web meeting • Send your “chat” to All Panelists in order to ensure the comments are addressed publically To find the chat feature look for the chat bubble at the top of the meeting window From S&I Framework to Participants: Could you please explain how the terminologies are used in this instance? All Panelists

3. Agenda • Opening Remarks - Doug Fridsma, MD, PhD Director, Office of Standards and Technology, ONC • The Standards & Interoperability Framework • Initiative Introduction • Data Access Framework Initiative • History • Importance • Scope • Expected Outcomes • Timeline • Next Steps/Call for Participation • Questions & Answers • Resources

4. Office of Science and Technology(OST) Promote compliance with validated information exchange standards, services and policies to assure interoperability between validated systems

5. S&I Framework Overview • Specific health interoperability initiatives guide the design and development of a fully integrated and connected health information system. • An S&I Initiative focuses on a single challenge with a set of value-creating goals and outcomes, and the development of content, technical specifications and reusable tools and services. • Call for Participation: The overall success of the S&I Framework is dependent upon volunteer experts from the healthcare industry and we welcome any interested party to get involved in S&I Framework Initiatives, participate in discussions and provide comments and feedback by joining the Wiki: http://wiki.siframework.org

6. S&I Framework Coordination FACAs • HIT Standards Committee • HIT Policy Committee • Tiger Team Community S&I Framework SDOs • Technology Vendors • System Integrators • Government Agencies • Industry Associations • Other Experts • HL7 • IHE • CDISC • NCPDP • ASC X12 • ASTM • WEDI • ISO/TC 215 • IHTSDO • NLM • NQF • Regenstrief • Other health IT standards related organizations ONC Programs & Grantees • State HIE Program & CoPs • SHARP Program • REC Program & CoPs • Beacon Program

7. ONC Standards and Interoperability (S&I) Framework Lifecycle • Our Missions • Promote a sustainable ecosystem that drives increasing interoperability and standards adoption • Create a collaborative, coordinated, incremental standards process that is led by the industry in solving real world problems • Leverage “government as a platform” – provide tools, coordination, and harmonization that will support interested parties as they develop solutions to interoperability and standards adoption. Pilot Demonstration Projects Standards Development Support Reference Implementation Harmonization ofCore Concepts Implementation Specifications Certificationand Testing Use Case Developmentand Functional Requirements Tools and Services Architecture Refinement and Management

8. S&I Framework Phases & Data Access Framework (DAF)Activities

9. A Brief History of the Data Access Framework (DAF) • BlueButton initiatives enabled patients to access to their own data • DAF is a similar concept, except it is focused on enabling providers to access their patient’s data both within and across organizations • Current industry standards are not modular enough to allow the different types of data access desired by Providers • NwHIN targeted and distributed queries • Multiple ONC initiatives Query Health, Innovation projects identified multiple data access challenges within and across organizations

10. Data Access FrameworkProblems to Solve • Data Portability • Patient moving from one provider to a new provider • Quality Improvement • A need for customized “small data analytics” for quality improvement • NwHIN/Targeted Query • Remote “chart pulls” • Public Health • Common framework needed

11. What is DAF • DAF will identify/create/modify standards to solve basic data access issues faced by providers • within their own organization and across organizations in a modular and substitutable fashion. • DAF is focused on enabling providers, their tools and applications to access their patient’s data • Through new or modified standards DAF will allow providers to use new and innovative applications • improve and fill gaps (such as medication tracking, long term care needs) in patient care

12. DAF - Example Real World Scenarios • A provider wants to access data about a particular population within his/her practice using quality measures • For example the provider wants to know all diabetic patients with HbA1c > 8% within their organization • A provider wants to access the complete medical history of a patient to improve care and use new tools and applications to improve care • Tools include predictive modeling, comparison with existing data sets etc. • Enable applications such as Medication Adherence and Tracking to be used by patients and care givers. • Enable social workers and other care givers to consume the patient information and determine the next steps in providing care. These may include determining what kind of long term care facility best suits the patient based on their demographics, diagnosis, medications etc. • Build an Extraction capability (such as an API) from EMRs

13. DAF – Challenge… • Data Access Framework has to support a wide variety of user stories (sample illustrated in table below)

14. DAF – Challenges Cont’d • To support the various user stories and access mechanisms there is a need to create a modular and substitutable framework that can be evolve with the industry over time • Modular framework can be best visualized as a stack of standards with multiple layers independent of each other • Substitutable standards will provide the ability to replace standards for a single layer and reuse standards from the other layers Data Model to support queries Information Models Result Vocabularies and Value Sets Query Results Result Structure Query Vocabularies and Value Sets Query Structure Query Structure Authentication/Authorization Security Layer Application Transport Protocols Transport Layer Basic Transport Protocols Data Access Framework

15. DAF – Modularity and Substitutability Challenge Data Model to support queries Information Models Result Vocabularies and Value Sets Query Results C-CDA HL7 v2.5.1 QRDA I, II, III Result Structure Query Vocabularies and Value Sets Query Structure ebRIM/ebRS HL7 FHIR HL7 HQMF Query Structure Authentication/Authorization TLS+SAML TLS+OAuth2 S/MIME Security Layer Application Transport Protocols MU2 ModSpec RTM SOAP (IHE SOAP) RESTful (IHE mHealth) Direct Transport Layer Basic Transport Protocols HTTP SMTP Data Access Framework Initial Candidate Standards

16. DAF – Overall Context Data AccessFramework Local Access via Intra-Organization Query Multiple Data Source Access via Distributed Query (Query Health) – Completed Initiative Targeted Access via Inter-Organization Query • Create and disseminate queries to external • organization • Query Structure Layer • Transport Layer • Authentication/Authorization Layer • Receive standardized responses from external orgs • Query Results Layer • Create and disseminate queries to multiple orgs • Governed by a network • Receive aggregated or de-identified responses • Focus on Information Model for the network and • leverage standards from earlier phases. • Create and disseminate queries internal to • organization • Query Structure Layer • APIs • Receive standardized responses • Query Results Layer X Hospital System Y Hospital System Data Source Data Source Data Source X Hospital System Query Request Query Response Standards based approach to enable access at all levels: Local, Targeted, and Distributed

17. DAF - Scope • The work of this initiative will be done in 2 phases: • Phase 1 is focused on Local Access via Intra Organization Query • Phase 2 is focused on Targeted Access via Inter Organization Query • The following capabilities are In-Scope: • Define the modular layers for Data Access Framework to support identified business and functional requirements. • Identify the existing standards that can be used for each layer of the Data Access Framework including guidance for substitutability of standards for both Local Access and Targeted Access. • Define Implementation Guides leveraging existing standards where necessary to structure queries and query results for identified business and functional requirements. • Identify standardized APIs that allow applications to query data in a consistent manner across EHRs. • We will work with FACA and OPP to coordinate policy issues

18. DAF - Local Data Access Workstream via Intra-Organizational Query Scenario Example: Information Requester sends a data query to his/her Internal Information System requesting information about one or more patient(s). The Internal Information System returns the requested patient data or document to the Information Requester. Organization Entity A Internal Information System Information Requester Sends: Data Query Receives: Patient(s) Data or Document 18

19. DAF - Targeted Data Access Workstream via Inter-Organizational Query Scenario Example: Originating Request System from Org A sends a data query to a known external organization requesting information for a known patient to Data Source System from Org B. The Data Source System from Org B returns the requested patient data or document to the Originating Request System in Org A. Organization Entity A Organization Entity B Data Source System Originating Request System Sends: Data Query Firewall Receives: Patient(s) Data or Document

20. Notional Project Timeline S&I Lifecycle (Discovery  Pilot & Evaluation) Jan 2014 July 2013 Sept Nov Pre-Discovery, Call for Participation Kick-off (7/16) Use Case 1 Consented 10/22 Technical Project Outline (11/14) UC 1: Local Data Access: Intra-Organizational Query Discovery Implementation Harmonized Specifications Standards Gap Analysis Define Use Case & Functional Requirements Charter Review & Consensus Technology Evaluations Use Case 2 Consented 11/29 UC 2: Targeted Data Access: Inter-Organizational Query Implementation Discovery Define Use Case & Functional Requirements Standards Gap Analysis

21. Logistics • We will be meeting as a community every week on Wednesdays • This will be a 60 minute meeting • Community Meeting Time • Wednesdays 12:00-1:00 EST • All Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Use Case, Project Charter and General Data Access Framework information will be posted on the Data Access Framework Wiki page • Join us for our next meeting July 24th, 2013 • See the wiki page for the meeting updates http://wiki.siframework.org/Data+Access+Framework+Homepage

22. Data Access Framework Wiki Page http://wiki.siframework.org/Data+Access+Framework+Homepage Data Access Framework Wiki Page

23. Next Steps – Sign Up • The ONC Data Access Framework Initiative is open for anyone to join. • This community will meet frequently by webinar and teleconference • We use Wiki pages to facilitate discussion. • Information on how to join the Community can be found on the Data Access Framework Sign Up Wiki: http://wiki.siframework.org/Data+Access+Framework+Join+the+Initiative • In order to ensure the success of our initiative and the subsequent pilot, we encourage broad and diverse participation from the community. • This is your chance to have an impact on the creation and implementation of a pilot program in this important area of health IT development.

24. Next Steps – Getting Started • Details on the Data Access Framework launch including this presentation are posted on the wiki: http://wiki.siframework.org/Data+Access+Framework+Homepage • Please feel to review and comment on the Proposed Project Charter • To review the Data Access Framework Project Charter go to the Charter wiki page: http://wiki.siframework.org/Data+Access+Framework+Charter+and+Members • Complete the Data Access Framework Project Charter Comment Form: http://wiki.siframework.org/Data+Access+Framework+Charter+and+Members(you will need to select the “Click Here to Provide Comments” in the Project Charter Comments Section) • Join us for our next meeting July 24th, 2013 from 12-1 pm EST • All meeting updates, call in number and web meeting details can be found here: http://wiki.siframework.org/Data+Access+Framework+Homepage

25. Resources and Questions • Please feel free to reach out to any member of the Data Access Framework Initiative team: • Initiative Coordinator: • John Feikema: john.feikema@siframework.org • ONC Sponsors • Mera Choi: mera.choi@hhs.gov • Support Team: • Project Management: Jamie Parker jamie.parker@esacinc.com and Gayathri Jayawardena gayathri.jayawardena@esacinc.com • Technical Support: Dragon (Nagesh) Bashyam nagesh.bashyam@drajer.com • Use Case Development: Presha Patel presha.patel@accenture.com • Vocabulary and Terminology Subject Matter Expert: Mark Roche mrochemd@gmail.com