query health technical approach primer operations workgroup

Query Health Technical Approach PrimerOperations Workgroup

Table of Contents• Goal of the Query Health Technical Approach• Key Actors• The Query Lifecycle• Query Health Specifications & Standards• Query Envelope• HQMF• QRDA • OWG Focus • Glossary

• The goal of the technical approach document is to identify the technical requirements necessary at each step of the query process.

• Technical Approach must promote interoperability.• Requestors want the ability to make queries and receive results

in a standardized way.• Responders want the ability to use whatever technologies they

want and implement it in whatever they want.• Both must have a common understanding of data element

definitions (e.g., is sex expressed as ‘sex’ or ‘gender’?)

Goal of the Query Health Technical Approach

“Technical Approach” Actor

Description “Real World” Actor

Requesting Organization Initiates the Query Public Health Agency

Responding Organization Subscribes to the Query and generates results upon request

Provider/Provider Organization/HIE/RHIO

Key Actors

This document will focus on a query sent by a Requesting Organization (New York State Department of Health) and sent to a Responding Organization (Beth Israel Hospital).

Our Example

The Query Lifecycle

• The Query Health Technical Approach was created by the Query Health Technical Workgroup.

• The Technical Workgroup examined three of the best approaches from the Summer Concert Series. • hQuery• i2b2 • PoPMedNet

• The Technical Workgroup took the most relevant aspects from each of these three approaches to craft a custom Technical Approach for Query Health.

The following slides will explain the Technical Approach step by step. First, the step and the key actors will be highlighted on the graphic. Next, a slide will explain what happens during that step.

Origins of the Technical Approach

As we go through the Technical Approach, view it through the lens of a “Risk Assessment”:

• What is the privacy implication of this step?• What is a security risk association with this step?• What policies are in play here?

Lens through which to view the Technical Approach

Step 1: Create Query

Occurs within the Department of Health

The New York State Department of Health must create a query using one of three possible ‘Query Builders’:• hQuery• i2b2• HQMFThese builders were chosen so that requestors do not have to be technical experts to create a query. Instead, they can create queries using common clinical language in a user-friendly interface.

Step 1: Create Query


Step 2: Query is sent to PopMedNet Portal


The query is sent in the format of Modified HQMF* to the PopMedNet Portal. • PopMedNet has a user-friendly web-based portal, where queries

are submitted.

*HQMF is a standard for representing health quality measures as an electronic document. The Query Health initiative is making modifications to the standard to suit the needs of Query Health.

Step 2: Query is sent to PopMedNet Portal


Step 3: PMN Portal sends Query to PMN Data Client

Query Transported from Department of Health to Beth Israel

Hospital

The PopMedNet Portal sends the query, via Query Envelope, to the PopMedNet Data Client.• The Query Envelope is designed to be query and content agnostic

and ensure enforcement of privacy and security requirements.• The PopMedNet Data Client is the counterpart of the PopMedNet

Portal where queries are received by (Beth Israel Hospital).

Step 3: PMN Portal sends Query to PMN Data Client

Query Transported from Department of Health to Beth Israel

Hospital

Step 4: PMN Data Client sends Query to Procedural Translator

Occurs within Beth Israel Hospital

PMN Data Client sends the Query to the Procedural Translator which creates specific directions on how to run the query. The Procedural Translator takes the message in HQMF (declarative language) and translates it to JavaScript or SQL (procedural languages).

Step 4: PMN Data Client sends Query to Procedural Translator


Note: In this step, Responding Organizations, like Beth Israel, have the right to reject any query.

Declarative vs. Procedural Languages

Declarative “Make me a cake”

Procedural Mix 3 cups of flour, 2 ¼ cups of sugar, 2 tsp. of baking powder, 1 tsp. salt, 3 sticks of butter, ½ tsp. of vanilla extract, 1 cup milk, and 8 large egg whites. Bake at 350 for 40 minutes.

Step 5: Procedural Translator sends Query to Execution Engines


The Procedural Translator sends the query to the Execution Engines.• They query is now in JavaScript or SQL (procedural languages)• The Execution Engines run the queries while matching the concepts (e.g.

“diabetes” and/or codes (e.g. an ICD 9 code) to the Data Sources using the CIM(CEDD).– Clinical Information Model (CIM)/Clinical Elements Data Dictionary (CEDD) is

a dictionary that is an ‘overlay’ on the Data Source. It is a translation tool. – Example: A query may ask for the number of people taking a particular

medication. The system will use the CIM/CEDD as a reference to identify the number of patients who have that medication listed in their ‘active medications list.’

• All of this occurs behind Beth Israel’s firewall, thus maintaining patient privacy and security of data.

E

Step 5: Procedural Translator sends Query to Execution Engines


Step 6: Execution Engines send results to QRDA Translator


The Execution Engines take the results, which are still in JavaScript or SQL and send them to the QRDA Translator, to be changed to QRDA.• QRDA is a document format that will provide a standard structure with which to

report results. • Remember: The Department of Health does not necessarily understand the

coding language of Beth Israel Hospital (JavaScrip or SQL).• Therefore results must be translated in a standard way before they can be sent

back to the Department of Health.• The standard selected by the Technical Workgroup for expressing query results

is QRDA Category III*.

*QRDA Category III was selected because it allows for returning aggregate or summary level results.

Step 6: Execution Engines send results to QRDA Translator


Step 7: QRDA Translator sends results back to PMN Data Client


The QRDA Translator sends the results back to the PopMedNet Data Client, which routes them back to the PopMedNet Portal. • The PopMedNet Data Client is the last stop at Beth Israel before the

results are sent back to the Department of Health.

Step 7: QRDA Translator sends results back to PMN Data Client


Step 8: PMN Data Client sends results back to PMN Portal

Query Transported from Beth Israel

Hospital to Department of Health

The PopMedNet Data Client sends the results, now in QRDA, back to the Department of Health through the PopMedNet Portal using the Query Envelope.• The Query results are now in the hands of the Department of Health. • Reminder: The Query Envelope is designed to be query and content

agnostic and ensure enforcement of privacy and security requirements.

Step 8: PMN Data Client sends results back to PMN Portal

Query Transported from Beth Israel

Hospital to Department of Health

Step 9: PMN Portal sends the results to the Results Viewer


The PopMedNet Portal now sends the results to the Results Viewer, a specific interface designed for reviewing query results. Now an individual at the Department of Health can review the results.

Step 9: PMN Portal sends the results to the Results Viewer


The lifecycle of the query is now complete.

Specification Definition Standard

Query Envelope A means to package the query and results along with security/privacy requirements, as well as other instructions

PopMedNet Query Envelope

Query Format The way in which a query is constructed, its code, vocabulary etc.

HQMF- Health Quality Measures Format

Results Format The way in which a result is reported, its code, vocabulary etc.

QRDA- Quality Reporting Document Architecture

Summary: Query Health Specifications and Standards

Query Health must standardize how queries are asked, how they are returned, and how the information travels between parties.

PopMedNet Query Envelope – essentially wraps metadata around data and protects it with a data/security layer

• Metadata is essentially data that describes data• It offers integration among different systems; designed to have

some flexibility • Designed to be query and content agnostic

Query Envelope

What does the Query Envelop mean to the Operations WG?• The Query Envelope contains supporting metadata that ensures

enforcement of privacy and security requirements defined in the Query Health Policy Sandbox (e.g., Small Cells, Author, Verifier)

• What metadata needs to be a part of the package? • Author? • Reviewer?• Time for completion?• Instructions?• Encryption?• What else?

• What security implications do you see during the data exchange?

• Under HHS direction, NQF was tasked with retooling 113 endorsed quality measures from a paper-based format to an eMeasure format.

• HQMF is a standard for representing health quality measures as an electronic document that is machine readable.

• A health quality measure encoded in the HQMF format is referred to as an “eMeasure”.• eMeasures may be understood by providers to guide optimal care, and to guide

collection of Electronic Health Record (EHR) and other data, which is then assembled into quality reports

• HQMF Targets the following groups:• Healthcare Providers• EHR Vendors• Physicians and Clinicians• Quality Improvement Reporting Agencies

HQMF – Health Quality Measures Format

• Query Format• Best Practice research regarding the most applicable eMeasures to

Query Health • Best Practice research focused on how quality measures are captured

by responding organizations• Oversight of the types of queries submitted as well as determined usage

of query results• Who can submit queries?• What kinds of queries are out of bounds?

• What health insurance questions cannot be asked?• What private sensitive information cannot be queried?• Are there groups or vulnerable populations that have cultural, religious

restrictions regarding data exchange?• What about the exchange of highly sensitive information, such as someone’s HIV

status?

What does HQMF mean to the OWG?

• Quality Reporting Document Architecture (QRDA) is a document format that will provide a standard structure with which to report quality measures.

• Conforms to the requirements of the Health Level Seven (HL7) Clinical Document Architecture Release 2.0 (CDA).

• Emerging Standard but not widely implemented• If a result cannot be expressed in QRDA, the Reference

Implementation will provide other options based on MIME Types• MIME: Multi-purpose Internet Mail Extensions- a specification for

sending messages over the internet

QRDA – Quality Reporting Document Architecture

• Results Format• Policy and Security implications focused on de-identification of

results• Who can review results?• Could the OWG define the needed Governance body? • How can organizations enforce the principle that all data is de-

identified? • What quality checks are in place as query results are produced to

verify the queries are correct and meet the determined security and privacy guidelines?

What does QRDA mean to the OWG?

The focus of the Operations Workgroup should be on a Risk Analysis• What stands out to you as a risk with this technical approach?

Examples:• What would be a problem when trying to implement this on a large

scale?• Where do we need policies in place?

Operations Workgroup Focus

Glossary

Term DefinitionCIM/CEDD The Clinical Information Model/Clinical Elements Data Dictionary describes the

data elements, the relationships of these data elements, possible datatypes for the elements, and how they are used in support of a specific query.

Data Source The actual location of the data within the responding organization.

Declarative Language

Technical language that specifies what SHOULD be in an outcome without specifying how to arrive at that outcome.

Execution Engine

The processor that actually performs the query.

HQMF Health Quality Measures Format is a standard for representing health quality measures as an electronic document. It is the format in which queries are submitted.

HQMF to Procedural Translator

Translates the query from HQMF into a procedural language like JavaScript of SQL.

Metadata Information that describes data; it is packaged along with the query in the query envelope for security & policy enforcement.

Native to QRDA Translator

Translates the query results from the responding organization’s native language (e.g., JavaScript or SQL) to QRDA so it can be sent back to the requesting organization.

Glossary

Term DefinitionPopMedNet Data Client

The web-based location where the responding organization can view incoming query requests.

PopMedNet Portal

The web-based location where a requesting organization can submit a query.

Procedural Language

Technical language which prescribes the step-by-step procedures for executing a query.

QRDA Quality Reporting Document Architecture is a document format that will provide a standard structure with which to report quality measures. It is the format in which query results are captured.

Query Builder A Graphical User Interface (GUI) that facilitates the creation of queries (e.g. Microsoft Office is a GUI that facilitates the creation of a Word document).

Query Envelope A means to package the query and results along with security/privacy requirements, as well as other instructions.

Query Format The way in which a query is constructed, its code, vocabulary etc.

Glossary

Term DefinitionRequesting Organization

An organization which submits a query.

Results Format The way in which a result is reported, its code, vocabulary etc.

Responding Organization

An organization that responds to a query.

Results Viewer An interface which enables the requesting organization to view the query results.

Note: In some cases, the terms listed in the Glossary may have more than one meaning. These definitions are intended to provide context solely for the Technical Approach Primer.

query health technical approach primer operations workgroup

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