query health: distributed population queries
DESCRIPTION
Query Health: Distributed Population Queries. Overview. Session Objectives. Provide an overview of how Query Health is progressing How do the different parts of the Query Health solution fit together and their progress ? Use Cases and Requirements Standards and Specifications - PowerPoint PPT PresentationTRANSCRIPT
Query Health:Distributed Population Queries
Overview
Provide an overview of how Query Health is progressing
• How do the different parts of the Query Health solution fit together and their progress ?
• Use Cases and Requirements
• Standards and Specifications
• Reference Implementation• Operational guidance and
Pilots
Session Objectives
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.
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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
Why a Distributed Query ?
• 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
Don’t wait for a
pendulum swing
here: Privacy is a
healthcare
constant
Distributed queries unambiguously define a population from a larger set
Questions about disease outbreaks,
prevention activities, health research,
quality measures, etc.
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.
Requestors ParticipatingResponders
Query
Aggregated Data Patient Data
Query & Results Reviewer
Data Source
How would a distributed query work?
Information Requester
5. Sends Query Results to Information Requestor
Firewall
3. Distribute Query to Data Sources
1. EHR / Clinical Record
(Patient Data)
2. Query Health Data Element
Mapping
Note: All patient level data stays behind the firewall.
Translate patient data
4. Execute Query , format
& return Results
Responding Organization
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What are we Standardizing ?
• What data can be queried ?
• How are queries represented ?
• How are results represented ?
• How are queries and results exchanged ?
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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
Vocabulary & Code Sets
Develop modular, testable portfolio of Query Health standards and specifications that can adopted by the industry, and support key HITECH and government priorities
Content Structure
Queries & Responses
Privacy & Security
RI Foundation: Distributed
Query Solutions
SNOMED-CT
Clinical Element Data Dictionary
i2b2
The ResultsNew QRDA 2 & 3
PopMedNet
LOINC ICD-10 RxNorm
11
Query Health Standards andRI Foundation Components
Components
The QuestionNew HQMF
Query Envelope Privacy Policy Enablement
hQuery
Concept Definitions and
Value Sets
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The DataClinical Element Data Dictionary (CEDD)
– Demographic– Patient Contact Information– Payer Information– Healthcare Provider – Allergies & Adverse Reactions
– Encounter – Surgery – Diagnosis – Medication – Procedure – Immunization
– Advance Directive – Vital Signs – Physical Exam – Family History – Social History – Order – Result – Medical Equipment– Care Setting– Enrollment– Facility
• ONC S&I Framework deliverable• Standards independent
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CEDD Cont’d
Data Element Name
Data Element Definition Data Element Format
Expected Values/Cardinality
Expected Vocabulary
Guidelines
Diagnosis NameThe name of the diagnosis. Can also be
used to capture a local code if the standard code is not mapped
Text Required
Diagnosis Flag Principal diagnosis flag Text Diagnosis Type Describes the type Coded Value Required SNOMED-CT Diagnosis Date Captures the date of the diagnosis Date Diagnosis Code Used to capture a specific diagnosis code Coded Value Required SNOMED-CT
Data Element Definition:
Data Element Implementation Guidance – i2B2S&I CEDD Defined Object S&I CEDD Data Elements i2b2 CRC Dimension i2b2 Dimension Data
ElementImplementation Guidelines
Diagnosis
Diagnosis Code Observation Fact concept_cd Diagnosis is represented in i2b2 using the ICD-9 CM ontology The diagnosis concept code is used to join to other information, such as diagnoses, procedures, and medications, which also use concept codes.
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CEDD alignment with NQF’s QDM
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CEDD and C2C Outputs
1. 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.
2. 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.
3. 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.
4. 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 PopMedNet to ensure completeness
5. 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.
Vocabulary & Code Sets
Develop modular, testable portfolio of Query Health standards and specifications that can adopted by the industry, and support key HITECH and government priorities
Content Structure
Queries & Responses
Privacy & Security
RI Foundation: Distributed
Query Solutions
SNOMED-CT
Clinical Element Data Dictionary
i2b2
The ResultsNew QRDA 2 & 3
PopMedNet
LOINC ICD-10 RxNorm
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Query Health Standards andRI Foundation Components
Components
The QuestionNew HQMF
Query Envelope Privacy Policy Enablement
hQuery
Concept Definitions and
Value Sets
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
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
Vocabulary & Code Sets
Develop modular, testable portfolio of Query Health standards and specifications that can adopted by the industry, and support key HITECH and government priorities
Content Structure
Queries & Responses
Privacy & Security
RI Foundation: Distributed
Query Solutions
SNOMED-CT
Clinical Element Data Dictionary
i2b2
The ResultsNew QRDA 2 & 3
PopMedNet
LOINC ICD-10 RxNorm
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Query Health Standards andRI Foundation Components
Components
The QuestionNew HQMF
Query Envelope Privacy Policy Enablement
hQuery
Concept Definitions and
Value Sets
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
Vocabulary & Code Sets
Develop modular, testable portfolio of Query Health standards and specifications that can adopted by the industry, and support key HITECH and government priorities
Content Structure
Queries & Responses
Privacy & Security
RI Foundation: Distributed
Query Solutions
SNOMED-CT
Clinical Element Data Dictionary
i2b2
The ResultsNew QRDA 2 & 3
PopMedNet
LOINC ICD-10 RxNorm
21
Query Health Standards andRI Foundation Components
Components
The QuestionNew HQMF
Query Envelope Privacy Policy Enablement
hQuery
Concept Definitions and
Value Sets
The Query Envelope
• Query agnostic
• Content agnostic
• Metadata facilitates privacy guidance from HIT Policy Committee
• RESTful interface specification for the Existing RI component integration
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Query Health Technical Approach -Putting it all together
Query Health Technical Approach – Reference Implementation Components
PopMedNet Components
Query/Results StandardsComponents
i2B2 Components
hQuery Components
hQuery Query Builder UX
HQMF Query Builder UX
PMN Portal
PMN Data Client
HQMF to Procedural Translator
hQuery Execution Engine i2B2 Execution Engine
Data Sources
Native to QRDA Translator
i2B2 Query Builder UX Results Viewer
hQuery CIM (JSON) i2B2 CIM (STAR Schema)
C32 or ETLC32 or ETL
Policy Enablement Components
New HQMF
JavaScriptSQL
Native Formats
QRDA (Category III Report)
Query Envelope
Requesting Organization
Responding Organization
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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
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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
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Current Status of Standards , Specifications and Supporting Artifacts
Artifact Current Status Link
CEDD Specification Consensus Approved http://wiki.siframework.org/file/view/Query+Health+CEDD_Version+1+0.docx/312800596/Query%20Health%20CEDD_Version%201%200.docx
Query Envelope First Round of Consensus voting completed - Resolving Consensus votes
http://wiki.siframework.org/Query+Health+-+Query+Envelope
Query Format (HQMF Implementation Guide)
HQMF Schema Changes completed.Implementation Guide under review and comments
Schema Location: http://code.google.com/p/query-health
IG: http://wiki.siframework.org/Query+Health+-+Query+Format
Query Results (QRDA Category II and III Implementation Guide)
QRDA proposed changes under review and comments
IG: http://wiki.siframework.org/Query+Health+-+Results+Format
DUA Template Consensus Approved http://wiki.siframework.org/file/view/Query%20Health%20DUA%20-%20Final%20for%20Consensus%20-%20Updated%20031212.doc
Concept to Code WG Recommendations
Consensus Approved http://wiki.siframework.org/file/view/SIFramework_QH_ConcepttoCodes_V1.0.ppt
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Current Status of RIArtifact Current Status Link
Base PopMedNet 3.0 Platform Completed http://www.popmednet.org
PopMedNet Plug-in RESTful Interfaces Completed. http://www.popmednet.org
Base i2B2 Platform Existing Platform https://www.i2b2.org
i2B2 XML to HQMF Translator First Version Completed (Able to create HQMF queries for encounters, meds, labs, problems, diagnosis, demographics etc)
http://code.google.com/p/query-health
i2B2 HQMF to Native Translator In-Progress
i2B2 – PopMedNet Integration In-Progress
hQuery Base Platform Completed http://github.com/hquery
HQMF to Java Script Translator First Version Completed(Able to translate i2B2 and sample HQMF queries.)
https://github.com/hadleynet/hqmf2js/tree/query-health-dev
hQuery Composer to HQMF Not started
hQuery – PopMedNet Integration First Version Completed http://github.com/hquery
HQMF to SQL Translator (PopMedNet, CDC and other Vendors)
Initial Prototype. http://code.google.com/p/query-health
QRDA Translators Not started
Implement C2C Recommendations In-Progress
PopMedNet Enhancements for Query Envelope
Not started
NYS DOH
NYC PCIP
Information Requestors Data Sources
Axolotl RHIO
Inter-systems
RHIO
eCWEHR
Sends Query to Data Sources
Distributes Query Results to Information Requestor
New York City / New York StatePilot
Sends Query to Data Sources
Distributes Query Results to Information Requestor
Mini-Sentinel/FDA Pilot1- 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
Top Level Roadmap
The Way Ahead for Query Health
The path to critical mass
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• 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 vendorsAllscripts Amazing ChartsAZZLY CernerdbMotion ClinicalWorksEpic eRECORDSIBEZA InterSystemsMedicity MicrosoftNational Health Data SystemsNextGen RelayHealthSiemens
Check back - more to come at QueryHealth.org
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Agenda for Thursday / Friday
Session Track 1 Track 2Thursday Morning (8am – 10am)
RI Coding and Enhancements(HQMF Translators, Value Sets, NY DOH Pilot – i2B2 ontology mapping)
HQMF Sample Representation(Need to have XML Spy or Oxygen or some eclipse editor)(Samples/Schemas from Google Code Repository)
Thursday Morning (10:30am – 12) RI Coding and Enhancements(HQMF Translators, Value Sets, NY DOH Pilot – i2B2 ontology mapping)
QRDA Sample Representation(Need to have XML Spy or Oxygen or some eclipse editor)(Samples/Schemas from Google Code Repository)
Thursday Afternoon (1:30 – 3:30 pm)
HQMF IG Review(Discuss pending issues)
CEDD Specification Review and Mapping activities(IG cleanup, Implementation Guidance)
Thursday Afternoon (4 – 6pm)
HQMF IG Review(Discuss IG)
CEDD Specification Review and Mapping activities(IG cleanup, Implementation Guidance)
Friday Morning(8-9am)
RI Round Table(Ask the RI team questions about the RI components)
QRDA IG Review
Friday Morning(9 – 10:30 am)
Pilots Discussion(NY and FDA Pilot next steps planning session, timelines)
QRDA IG Review
Friday Morning(11 – 12 noon)
Wrap Up
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
Content Structure
Queries & Responses
Privacy & Security
RI Foundation: Distributed
Query Solutions
SNOMED-CT
Clinical Element Data Dictionary
i2b2
The ResultsNew QRDA 2 &
3
PopMedNet
LOINC ICD-10 RxNorm
The QuestionNew HQMF
Query Envelope Privacy Policy Enablement
hQuery
Concept Definitions and
Value Sets
www.queryhealth.org