Query Health Distributed Population Queries Implementation Group Meeting

1. Query Health Distributed Population QueriesImplementation Group Meeting November 1, 2011

2. Agenda • Where we are • Weekly Summary • Clinical • Operations • Technical • Upcoming Consensus and Important Dates • Open Discussion / Next Steps

3. Query HealthScope and Approach HIT Policy Committee: Policy Guideposts Practice drives standards Rough consensus Running code (open source) Pilot Specifications Standards

4. Query HealthWhere We are

5. Query Health Meeting Time Reminders Implementation Group Tuesdays 1:30pm-3:00pm EDT Clinical Work Group Wednesdays 12pm-1pm EDT Operations Work Group Thursdays 11am-12pm EDT (NOTE: one time meeting on Wednesday from 10-11 AM EDT)) Technical Work Group Thursday 2:00 pm-3:00 pm EDT Sign Up at QueryHealth.org Download to your calendar at QueryHealth.org

6. Action Items

7. Clinical Working Group November 1, 2011 Update

8. Clinical Working Group Update • The working group made great progress developing the key sections of the Use Case during the last several weeks • The DRAFT Query Health Use Case was compiled based on this work and posted to the wiki on October 28th • All Query Health community participants were sent an email with the link to the Use Case and are invited to review and provide comments using the discussion tab • REMINDER: If you provide any comments and/or revisions please plan on attending the 11/2 Clinical WG to discuss with the working group members • Next Steps • Reconcile comments, update Use Case and kick off consensus process Please provide ALL comments on the Use Case by COB (8 PM ET) TODAY 11/1/2011

9. Operations Working Group Week of November 2, 2011

10. Key Topics Covered/Discussed • Finalized the ‘Operational Requirements for Query Health’ - a narrative description of the operational requirements that will govern the Generic User Story. • The workgroup defined operational requirements that could be applied to any user story.  The result is a much shorter and more concise expression of operational considerations. • The Support Team drafted specific Operational Requirements aligned with the Expanded Analysis User Story for the workgroup to provide comments on by the next meeting. • The Support Team also drafted a supplement to the Expanded Analysis User Story that will outline the user story in a way that will be easier for non-clinicians to work with as they discuss the specific operational requirements.

11. Operations Workgroup Next Steps • Next Steps • Our next meeting will take place on Wednesday, November 2 from 10:00 to 11:00 AM EDT. • Review the Expanded Analysis User Story Supplement and Specific Operational Requirements drafted by the Support Team. • Review the specific user story (Expanded Analysis for Diabetic Care in an Outpatient Setting) in preparation for a discussion of specific operational requirements our next meeting. The goal is to finalize the requirements during this meeting.

12. Technical Working Group Week of November 2, 2011

13. Technical WG Update • Recapped the F2F Summary for the WG • Started discussion of Queries that we have selected for Query Analysis to determine the components of our technical foundation • Query Analysis is focused on determining the type of Data Models and Formats to be used for Queries • Candidates for Query Representations: • Code representations (e.ghQuery), • SQL based (e.g i2B2), • XML based representations • Standards based representations

14. Technical WG Update Cont’d • Queries Selected: • Based on Clinical WG Expanded Diabetes Analysis • Hba1c > 9.0% (NQF0059/MU Stage 1) • LDL Control < 100 mg/dl (NQF0064/MU Stage 1) • The Hub Query Examples – QM18 • Simple query which is used as a Quality Measure by the hub • Cholesterol Control: • Male patients ≥ 35 years of age and female patients ≥ 45 years of age without Diabetes Mellitus or Ischemic Vascular Disease who have a total cholesterol < 240 or LDL < 160 measured in the past 5 years. The last 5 years is calculated from the most recent patient visit within the reporting period.

15. Technical WG Update Cont’d • Hypothesis Generation Query based on work from i2B2 as part of Epidemiology/Health Services Research: • http://care.diabetesjournals.org/content/33/3/526.full.pdf • http://wiki.siframework.org/Query+Health+Hypothesis+Generation+User+Story+Proposal • Sample Query: • The retrospective cohort analysis (n=34,253) included all patients aged 18 years identified by an ICD-9 code for Diabetes Mellitus (250.XX) or an A1C of 6.0% and at least one record of prescription of an oral diabetes medication as an outpatient or dispensation as an inpatient, between 1 January 2000 and 31 December 2006. Analyses focused on three classes of diabetic medications: sulfonylureas, the biguanide metformin, and the thiazolidinediones, rosiglitazone and pioglitazone. We excluded patients receiving either metformin or thiazolidinedione who had a diagnosis of polycystic ovaries but not diabetes. We used a cumulative temporal approach to ascertain the calendar date for earliest identifiable risk associated with rosiglitazone compared with that for other therapies. For each patient, duration of exposure to individual diabetes medications was assessed in 6-month increments during which only one of the four medications was prescribed. Patients receiving multiple medications under consideration were excluded. Events were associated with a particular medication only when the prescription or dispensation occurred within 6 months before the documented myocardial infarction. If a patient did not have any activity for a 6-month observation period but resumed activity in the following period, than the particular 6-month observation period with no activity was excluded from analysis

16. Technical WG Update Cont’d • Next Steps • Technical Foundation: • Create Small sub-team with representation from the three candidate implementations to examine the solutions further and report back. • Query Analysis: • Continue to fill out the Query Analysis Matrix based on the sample Queries across the different categories • Code Based • SQL Based • XML Based • Standards Based

17. Important Announcements • Technical Working Group • Tentatively scheduled meeting for November 28-29 to review technical foundation • Clinical Workgroup • Formation of Clinical Information Model (CIM) Sub-Working Group starting later this week • Formation of Clinical Concept Mapping Sub-Working Group starting next week