Query Dispatch and Aggregate QDA Work Item ProposalOctober 2014

Vincent van Pelt (Nictiz)Mark Sinke (ForCare)Walco van Loon (ForCare)Albert-Jan Spruyt (Nictiz)

QDA - Business needs

Healthcare information is generated and stored in different systems. For the exchange of information, relevant selections have to be collected from these different

systems to create up-to-date summaries. These summaries contain information coming from a combination of live databases and/or

already existing documents. Within a healthcare organization, summary documents are currently generated by software that

queries the different systems using HL7 queries and/or proprietary connections, and then aggregates the results of these queries into a report, a discharge letter, a patient summary, a medication overview, et cetera.

But when cross-organizational information is needed, proprietary connections are not an option. This calls for a generic, standardized, sustainable and scalable mechanism that collects

information ‘building blocks’ from different sources (live databases or existing documents) and then aggregates them into a summary document.

Create a profile that formalizes multi-query dispatching creation and result aggregation

QDA - Use Cases On-Demand Medication Overview

Prescriptions Dispensations Allergies, contra-indications Relevant diagnoses Relevant lab results

On-Demand Patient Summary Up-to-date information from multiple systems: lab, diagnoses, allergies, medication, diagnostic studies,

medical history, ...

On-Demand Emergency Care Summary Combined information from emergency call center, ambulance, Emergency department, ICU

On-Demand Laboratory List Aggregated overview of laboratory results from different dates and locations, optionally in combination with

other relevant medical information

On-Demand Integrated Care Overview Combined information from PCP, dietician, physiotherapist, laboratory, …

QDAQuery Dispatch and Aggregate

• Generic profile for the on-demand creation of multi-source summaries and aggregated reports (ITI)

• Can be configured with a combination of a predefined master template, and several predefined query result templates and for the aggregation into one document (PCC)

Basic Process :

1. One report request simple parameters

2. starts a set of subqueries to multiple data sources [Actor: Query Distributor] sends out queries to multiple data sources (with different query methods) collects the pre-defined results (in a predefine format) from these sources stores the results in a submission set in the XDS environment

3. The resulting documents are then aggregated [Actor: Results Aggregator] parameters: master template document, and location of the submission set filling the master report template through XML-transformation Optional: reconciliation and re-ordering of information, signing, encryption

4. One report result Query Distributor returns the result in a predefined format (of the master

template)

XDS

Provide and Register Document Set (ITI-41)

Retrieve Document Set (ITI-43)

RegisterDocument Set (ITI-42)

Registry StoredQuery (ITI-18)

Document Registry

DocumentSource

DocumentRepository

DocumentConsumer

Register On-DemandDocument Entry (ITI-61)

XDS + ODD

Provide and Register Document Set (ITI-41)

Retrieve Document Set (ITI-43)

RegisterDocument Set (ITI-42)

Registry StoredQuery (ITI-18)

Document Registry

DocumentSource

DocumentRepository

DocumentConsumer

On-DemandDocument Source

Register On-DemandDocument Entry (ITI-61)

XDS + ODD (+ persistent storage)

Provide and Register Document Set (ITI-41)

Retrieve Document Set (ITI-43)

RegisterDocument Set (ITI-42)

Registry StoredQuery (ITI-18)

Document Registry

DocumentSource

DocumentRepository

DocumentConsumer

On-DemandDocument Source

Provide and Register Document Set (ITI-41)

Register On-DemandDocument Entry (ITI-61)

XDS + ODD + ?

Provide and Register Document Set (ITI-41)

Retrieve Document Set (ITI-43)

RegisterDocument Set (ITI-42)

Registry StoredQuery (ITI-18)

Document Registry

DocumentSource

DocumentRepository

DocumentConsumer

On-DemandDocument Source

Provide and Register Document Set (ITI-41)

Not defined how this profile creates the on-demand document

Register On-DemandDocument Entry (ITI-61)

QDA

Provide and Register Document Set (ITI-41)

Retrieve Document Set (ITI-43)

RegisterDocument Set (ITI-42)

Registry StoredQuery (ITI-18)

Document Registry

DocumentSource

DocumentRepository

DocumentConsumer

On-DemandDocument Source

QDA

Provide and Register Document Set (ITI-41)

EHR

Pharmacy

Laboratory

Radiology

Pathology

Nursing

1: Dispatch queries

2: Aggregate results

CDAresults

Create Multi-Source Summary (ITI-xx)

CDA Master template

QDA - Query Dispatch and Aggregate

Query DispatcherResults Aggregator

Remarks Some parts of the core functionality can be covered by existing profiles. However, some

functionality is missing:

Receiving one report request, and then sending a number of preconfigured subqueries

Configuration of multi-source query summaries

Transforming information from different sources into one document

QDA is the content-agnostic tool that can be used to create specific multi-source summaries, by using predefined sets of structured documents.

Questions It would be useful if a generic ODD document reference would be available for all patients. Generic

ODD documents would be possible for <any> patient that is selected in the EHR, without actually adding another record in the Registry for each and every patient.

Currently, all records in the Registry are linked to a specific patient. The template documents for the master template (but also for the creation of a new XDW document) could also be stored in the XDS Registry if these documents could be stored without the link to a patient. Is there a possibility to store documents that are not patient-specific?

Configuration

Report request: MedSumm 1

ReportID

Master templateID

Use RECON?

Use DEN?

Use DSG? Use MCV?

MedSumm 1 MedSumTempl1 Y N N N

MedSumm 2 MedSumTempl2 N N N N

PatientSumm 1 PatSumTempl1 N Y Y N

LabSumm 1 LabSumTempl1 N Y Y Y

Configuration

Report request: MedSumm 1

ReportID

QueryID

Query Method

Target OID Result Template OID

Query parameters

Query standard xx

MedSumm 1 MedPrescr HL7 Query

PCP A PRE …

MedSumm 1 MedPrescr HL7 Query

Hospital B PRE …

MedSumm 1 MedDisp HL7 V2 Pharmacy X DIS …

MedSumm 1 MedLabData QED Laboratory Y LAB-x …

MedSumm 1 MedDiagData

XDS EMR-Hospital Z DIAG-x …

PatientSumm 1

DiagData … … … …

PatientSumm 1

LabData … … … …

Query result 1

Query result 2

Query results ....

Report result: MedSumm 1 Aggregation

QDA parameters

• Report ID

• Requestor ID

• Patient ID

•Summaryformat• Collate• Reconcile

• From-datetime

• To-datetime

• ToFormat• HL7 CDA• HL7 V2 message• HL7 V3 Message• XML document

Request • Report ID

• Requestor ID

• Patient ID

• Query ID

• Target ID

• Query Method• XDS Retrieve Document Set• XCA Query and Retrieve• HL7 Care Record Query• QED• RESTful: FHIR, JSON, MHD• Web Service

• Required document template (OID)

Distribute • ‘Stitch’, collate to 1 doc

• Use RECON to reconciliate

• Message wrapper?

Aggregate

Your feedback?