Data Access Framework (DAF)

Data Access Framework (DAF) John Feikema ONC Initiative Coordinator

Data Access FrameworkUnderstanding the Challenge • Wide spread use of HealthIT systems (EHRs, Data Warehouses, etc.) has created opportunities for healthcare organizations and their teams to access and use the patient data that is already collected during clinical workflows. • However, Health IT systems may be limited in their ability to perform data queries, APIs, or services to access data sets. • Therefore, creating an industry standard access methods is needed: • To expand the ability of users to create value out of their data • To enable a provider to understand a patient’s overall health and the health of a provider’s collective patient population • To use the data to power innovative new applications and tools to take better care of patients and populations.

Data Access FrameworkAddressing the Challenge • Enable Local and Targeted data access using the various data access mechanisms (document based, data element based, quality measure based, etc.) • Identify privacy and other necessary metadata to enable the various data access mechanisms • Modularize the query stack into modular layers (transport, query structure, query results, authentication, etc.) and allow for substitutability at each layer of the query stack • Identify the set of modular components and industry standards that should be assembled together as valid combinations to promote interoperability for the various business requirements of the community.

Data Access FrameworkPurpose of DAF • To develop a framework that seeks to identify, create and/or modify standards to solve basic data access issues faced by providers • Within their own organization and across organizations in a modular and substitutable fashion • To enable providers, their tools and applications, to access their patient’s data • Allow providers to use new and innovative applications, through new or modified standards • Improving and filling gaps (e.g. medication tracking,long term care needs in patient care)

DAF Scope Focus Areas Data AccessFramework Local Access via Intra-Organization Query (Complete) Multiple Data Source Access via Distributed Query (Query Health) – Completed Initiative Targeted Access via Inter-Organization Query (Complete) • 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 Organization X Organization Y Data Source Data Source Data Source Organization X Query Request Query Response Standards based approach to enable access at all levels: Local, Targeted, and Distributed Note: An organization can be a hospital that is part of a larger organization and can also include HIEs, RIOs, other types of organizations etc.

Data Access FrameworkExample of a Real World Scenario • A provider wants to access data about a particular population within his/her practice using quality measures • E.g. the provider wants to know all diabetic patients over the age of 65 with HbA1c > 7% 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

Data Access FrameworkMechanisms

Data Access FrameworkDraft Query Stack • To address mechanisms, multiple standards across multiple layers must be present • Transport Layer: getting patient data from one place to another • Security Layer: ensuring data will only be accessible to authorized parties. • Query Structure: making sure the “question” being asked is phrased appropriately for the data to answer it. • Query Results: appropriately formatting the “answer” to the question posed. • Data Model to Support Queries: information models that define concepts used in clinical care.

Substitutability 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

Subway™ Condiment Layer Mayo Ranch Mustard Information Models Result Vocabularies and Value Sets Veggie Layer Lettuce Tomatoes Onions Result Structure Query Vocabularies and Value Sets Cheese Layer Swiss Cheddar Monterey Jack Query Structure Authentication/Authorization Ham Turkey Roast Beef Pastrami Meat Layer Application Transport Protocols Italian 9 Grain Wheat 9 Grain Honey Oat Bread Layer Basic Transport Protocols Italian Herbs and CHeese Build your own Sub

Notional Project Timeline S&I Lifecycle (Discovery  Pilot & Evaluation) July 2013 August September October November December UC 2 Kickoff (12/11) UC 1 Consensus (12/11) DAF Initiative Kickoff (7/16) Project Charter Consensus (8/28) UC 1 Kickoff (8/14) Discovery (Use Case 1) Pre-Discovery UC 1: Local Data Access: Intra-Organizational Query Define Use Case & Functional Requirements Development of Charter Sub-Work Group Sub-Work Group Discovery (Use Case 2) UC 2: Targeted Data Access: Inter-Organizational Query Define Use Case & Functional Requirements Implementation (DAF/IHE Community) DAF IHE/ S&I Joint Work Group IHE Activities Signifies milestone or deliverable

Data Access FrameworkStrategic Alignment • HITPC and HITSC guidance on queries • ONC Innovation community work • Meaningful Use Stage 2 standards where applicable • Industry work related to queries as appropriate • eHealth Exchange standards related to queries as appropriate. • "EHR|HIE Interoperability Workgroup" work related to queries as appropriate. • Existing standards from IHE and HL7

Data Access FrameworkCurrent Gaps

Data Access Framework Resources • To take part in our current Harmonization and Standards work activitiesvisit: http://wiki.siframework.org/DAF+Standards+Harmonization+and+Implementation • To join our weekly webinars, visit the DAF Wiki Homepage for the latest meeting information: http://wiki.siframework.org/Data+Access+Framework+Homepage • To subscribe to our mailing list, simply complete the “Join this Initiative” Form: http://wiki.siframework.org/Data+Access+Framework+Join+the+Initiative • To access current and archived meeting materials, visit the Project Meeting Artifacts section: http://wiki.siframework.org/Project+Meeting+Artifacts

Initiative Support Leads • Initiative Coordinator: John Feikema john.feikema@siframework.org • ONC Sponsor: Mera Choi mera.choi@hhs.gov • Support Team: • Project Management: • GayathriJayawardenagayathri.jayawardena@esacinc.com • Technical Support: • Dragon (Nagesh) Bashyam nagesh.bashyam@drajer.com • Use Case Development: • Presha Patel presha.patel@accenture.com • Hema Patel hema.patel@accenture.com • Standards Support: • Angelique Cortez angelique.j.cortez@accenture.com • Vocabulary and Terminology Subject Matter Expert: • Mark Roche, MD mrochemd@gmail.com

Data Access Framework (DAF)