Query Health: Distributed Population Queries

1. Query Health:Distributed Population Queries Overview

2. Session Objectives Provide an overview of how Query Health is progressing • How do the different parts of the Query Health solution fit togetherand their progress ? • Use Cases and Requirements • Standards and Specifications • Reference Implementation • Operational guidance and Pilots

3. Vision Enable a learning health system to understand population measures of health, performance, disease and quality, while respecting patient privacy, to improve patient and population health and reduce costs.

4. Distributed Query Outcomes • Identify/Develop standards, specifications and Implementation Guides for distributed queries • Deliver a robust, open source Reference Implementation that implement the standards and specifications • Create operational guidelines and templates for Query Health pilots • Pilot the Reference Implementation and provide feedback on standards and specifications

5. Why a Distributed Query ? Don’t wait for a pendulum swing here: Privacy is a healthcare constant • Data Sources maintain HIPAA-mandated contractual control of their PHI • Local content experts maintain a close relationship with the data • Data Sources have the best understanding of their data and its uses; valid use and interpretation of findings requires input from the Data Sources. • Easier to manage consent • Lessens scale of breach / risk exposure / competitive exposure • Accuracy, timeliness, flexibility, sustainability

6. Distributed queries unambiguously define a population from a larger set Questions about disease outbreaks, prevention activities, health research, quality measures, etc.

7. Distributed Query NetworksVoluntary, No Central Planning Community of participants that voluntarily agree to interact with each other. There will be many networks; requestors and responders may participate in multiple networks. Query Requestors Participating Responders

8. How would a distributed query work? Aggregated Data Patient Data Note: All patient level data stays behind the firewall. Data Source Information Requester Query & Results Reviewer 1. EHR / Clinical Record (Patient Data) Translate patient data 3. Distribute Query to Data Sources 2. Query Health Data Element Mapping 5. Sends Query Results to Information Requestor 4. Execute Query , format & return Results Responding Organization Firewall

9. What are we Standardizing ? • What data can be queried ? • How are queries represented ? • How are results represented ? • How are queries and results exchanged ?

10. Query Health Supporting Artifacts • Data Use Agreement Template for Pilots • Health IT Policy Committee and Tiger Team recommendations for ONC pilots • Reference Implementation Foundation Components

11. Query Health Standards andRI Foundation Components Components Develop modular, testable portfolio of Query Health standards and specifications that can adopted by the industry, and support key HITECH and government priorities Vocabulary & Code Sets SNOMED-CT LOINC ICD-10 RxNorm Content Structure Clinical Element Data Dictionary Concept Definitions and Value Sets The Question New HQMF The Results New QRDA 2 & 3 Queries & Responses Privacy & Security Query Envelope Privacy Policy Enablement RI Foundation: Distributed Query Solutions i2b2 PopMedNet hQuery

12. The DataClinical Element Data Dictionary (CEDD) • Advance Directive • Vital Signs • Physical Exam • Family History • Social History • Order • Result • Medical Equipment • Care Setting • Enrollment • Facility • Demographic • Patient Contact Information • Payer Information • Healthcare Provider • Allergies & Adverse Reactions • Encounter • Surgery • Diagnosis • Medication • Procedure • Immunization • ONC S&I Framework deliverable • Standards independent

13. CEDD Cont’d Data Element Definition: Data Element Implementation Guidance– i2B2

14. CEDD alignment with NQF’s QDM

15. CEDD and C2C Outputs • Healthcare Industry has a significant gap in creating, managing and publishing “Value Sets” mapped to common concepts. • Community recommends to the HITSC to work with organizations such as NLM, NQF and others to set up the above capability. • For Query Health, the suggestion was to start with NQF CQM based Value Sets and improve from there. • This is a very good source as evidenced by the community and Query Health will start from these value sets. • In order to share value sets in a standard way, Query Health will adopt the IHE SVS Restful web service approach and will pilot that using the NQF and i2B2 Value Sets. • The CEDD is a significant specification to promote common definitions of queries across multiple Data Sources • Enhance the CEDD to include the vocabulary mapping, value sets for elements where applicable and map to the reference implementation frameworks of i2B2, hQuery and PopMedNetto ensure completeness • Multiple tools and interfaces can be used for Query Composition, but simple intuitive ways are necessary and the concept hierarchy representation of i2B2 has been proven to work in the real world. • Adopt i2B2 approach and create the hierarchy for Query Health pilots.

16. Query Health Standards andRI Foundation Components Components Develop modular, testable portfolio of Query Health standards and specifications that can adopted by the industry, and support key HITECH and government priorities Vocabulary & Code Sets SNOMED-CT LOINC ICD-10 RxNorm Content Structure Clinical Element Data Dictionary Concept Definitions and Value Sets The Question New HQMF The Results New QRDA 2 & 3 Queries & Responses Privacy & Security Query Envelope Privacy Policy Enablement RI Foundation: Distributed Query Solutions i2b2 PopMedNet hQuery

17. The QueryNew HQMF • Health Quality Measure Format • HQMF newly modified to support the needs for dynamic population queries: • More executable • Simplified • Advantages for query • Avoids “yet another standard” • Secure (vs procedural approach) • Works across diverse platforms • Benefits – Speed and Cost

18. What are the major modifications • Addition of business names to criteria and section elements to translate HQMF to executable code • Inclusion of Variable definitions which allow for re-use of definitions within HQMF and also allow for easier translation to executable code • Addition of Precondition conjunctions • Complete List at http://wiki.siframework.org/Query+Health+-+Query+Format

19. Query Health Standards andRI Foundation Components Components Develop modular, testable portfolio of Query Health standards and specifications that can adopted by the industry, and support key HITECH and government priorities Vocabulary & Code Sets SNOMED-CT LOINC ICD-10 RxNorm Content Structure Clinical Element Data Dictionary Concept Definitions and Value Sets The Question New HQMF The Results New QRDA 2 & 3 Queries & Responses Privacy & Security Query Envelope Privacy Policy Enablement RI Foundation: Distributed Query Solutions i2b2 PopMedNet hQuery

20. The ResultsNew QRDA • Quality Reporting Document Architecture • Category I – Patient Level • Category II – Patient Populations • Category III – Population Measures • Query Health will use new definitions of Categories II and III • Not yet specified and balloted • Needs implementation guide • Needs to align with eMeasures

21. Query Health Standards andRI Foundation Components Components Develop modular, testable portfolio of Query Health standards and specifications that can adopted by the industry, and support key HITECH and government priorities Vocabulary & Code Sets SNOMED-CT LOINC ICD-10 RxNorm Content Structure Clinical Element Data Dictionary Concept Definitions and Value Sets The Question New HQMF The Results New QRDA 2 & 3 Queries & Responses Privacy & Security Query Envelope Privacy Policy Enablement RI Foundation: Distributed Query Solutions i2b2 PopMedNet hQuery

22. The Query Envelope • Query agnostic • Content agnostic • Metadata facilitates privacy guidance from HIT Policy Committee • RESTful interface specification for the Existing RI component integration

23. Query Health Technical Approach -Putting it all together

24. Query Health Technical Approach – Reference Implementation Components hQuery Query Builder UX i2B2 Query Builder UX Results Viewer HQMF Query Builder UX New HQMF PMN Portal Requesting Organization Policy Enablement Components Query Envelope PMN Data Client Responding Organization QRDA (Category III Report) HQMF to Procedural Translator Native to QRDA Translator SQL PopMedNet Components JavaScript hQuery Execution Engine i2B2 Execution Engine Query/Results Standards Components Native Formats i2B2 Components hQuery CIM (JSON) i2B2 CIM (STAR Schema) hQuery Components C32 or ETL C32 or ETL Data Sources

25. DemonstrationDistributed Query Execution • What you’ll see • Life cycle of a Distributed Query (1 requestor, 2 data providers) • Policy Enablement Layer (control of queries execution and results by data providers) – RESTful interface • Query Envelope metadata for work flow integration and policy enforcement • Integration of hQuery (Query execution) and PopMedNet (policy enablement) • Open source components • Presenting • Marc Hadley, MITRE Corporation • Rob Rosen, Lincoln Peak

26. DemonstrationQuery Language • What you’ll see • Query Composition using i2B2 query builder • Query representation of i2B2 using internal formats and ontologies • Translation of composed Query to new HQMF • Translation of new HQMF to Java script • Open source components • Presenting • Jeff Klann, Partners Healthcare • Marc Hadley, MITRE

27. Current Status of Standards , Specifications and Supporting Artifacts

28. Current Status of RI

29. New York City / New York State Pilot Information Requestors Data Sources Axolotl RHIO NYC PCIP Sends Query to Data Sources Distributes Query Results to Information Requestor Inter-systems RHIO NYS DOH Sends Query to Data Sources Distributes Query Results to Information Requestor eCWEHR

30. Mini-Sentinel/FDA Pilot 1- User creates and submits query (a computer program) 2- Data partners retrieve query 3- Data partners review and run query against their local data 4- Data partners review results 5- Data partners return results via secure network 6 Results are aggregated PopMedNet

31. Top Level Roadmap

32. The Way Ahead for Query Health

33. The path to critical mass • Today, distributed queries are generally limited to • Organizations with large IT & research budgets • Some exceptions (e.g., NYC PCIP, MDPHNet) • Missing: Primary Care, FQHCs, CAHs, HIEs, etc… In other words, most places where clinical care is delivered and recorded • Path to critical mass depends on • Query Health Standards • Health IT vendor participation Health IT vendors Allscripts Amazing Charts AZZLY Cerner dbMotionClinicalWorks Epic eRECORDS IBEZA InterSystems Medicity Microsoft National Health Data Systems NextGenRelayHealth Siemens Check back - more to come at QueryHealth.org

34. Agenda for Thursday / Friday

35. Query Health Recap • An ONC-sponsored S&I Framework open government initiative • Standards and specifications for distributed population queries. • “Send questions to the data” • Data sources including EHRs, HIEs, PHRs, payers’ clinical record or any other clinical record. • Voluntary collaborative networks • Declarative questions build on NQF / CMS work on population measures • Aggregate responses • Patient level information secure • Support questions related to disease outbreak, quality, CER, post-market surveillance, performance, utilization, public health, prevention, resource optimization and many others. Vocabulary & Code Sets SNOMED-CT LOINC ICD-10 RxNorm Content Structure Clinical Element Data Dictionary Concept Definitions and Value Sets The Question New HQMF The Results New QRDA 2 & 3 Queries & Responses Privacy & Security Query Envelope Privacy Policy Enablement RI Foundation: Distributed Query Solutions i2b2 PopMedNet hQuery www.queryhealth.org