Query Health Distributed Population Queries

Implementation Group Meeting

December 20, 2011

Agenda

• Where we are going• Weekly Summary

• Clinical• Operations• Technical

• Important Announcements• Open Discussion / Next Steps

Query HealthWhere We are

Query Health Meeting Time Reminders

Implementation GroupTuesdays 1:30pm-3:00pm EDT

Clinical Working Group Wednesdays 12pm-1pm EDT

Clinical Concept Mapping Sub-Working Group

Tuesday 3pm-4pm EDT

Operations Working GroupThursdays 11am-12pm EDT

Pilots Sub-Working GroupThursdays 3:30pm-4:30pm EDT

Technical Working GroupThursday 2pm-3 pm EDT

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Action Items

Description Owner Status Due Date NotesContinue review of Operations Working Group Sample Data Use Agreement Development

Operations Working Group

Open Prepare for Dec 22 meeting

Continue work on Query Health CEDD Crosswalk (focus on final review and examples)

Working Group Participants

Open Prepare for Dec 21 meeting

Volunteer for Query Health Pilots

Working Group Participants

Open Ongoing

Final vote on the Technical Approach Call for Consensus

Technical Working Group

Open Prepare for Dec 22 meeting

Attend Query Health Clinical Concept Mapping presentations

Working Group Participants

Open Ongoing

Clinical Working Group

December 20, 2011

Concept to Codes

• Meetings will occur every Tuesday from 3:00 – 4:00 PM EST– On January 3rd , 10th , and potentially 17th the meeting time will be extended to 2:30-

4:00pm to provide ample presentation time for our SMEs

• 12/13 Meeting Summary– Presentations from Andy Gregorowicz (hQuery) and Shawn Murphy (i2B2/SHRINE)– Reviewed Questions for Considerations and Proposed Outline for end deliverable to

help frame the presentations and the end deliverable summarizing presented standards, tools, and frameworks

• Next Steps– 12/20 – Continue presentations from our SMEs

• (Shawn Murphy (Cont. from this week), Stan Huff, Rick Biehl, and Oliver Bodenreider). Full schedule can be found here

– 12/27 - No Meeting– 1/4 and 1/10 - Additional presentation schedules being confirmed

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Query Health CEDD Timeline

• Query Health CEDD Crosswalk available for community input:

http://wiki.siframework.org/Clinical+Information+Model+Activity • Volunteers working through key sections of the crosswalk (THANK YOU!)

– Crosswalk available at the following URL:

https://docs.google.com/spreadsheet/ccc?key=0ApW4Ox66ml2IdEtYR0lwenlJVWl6RC1vVnZuaEppeWc

• Crosswalk updated with hQuery and SHRINE mappings, and additional clinically-focused notes from volunteers

• Our approach for this week:– Finalize data definitions– Define examples for specific elements– Final crosswalk review– Support team to begin developing supporting documentation (for review in

first week of January)

This Week’s Plan for the Query Health CEDD

Operations Working Group

December 20, 2011

• Discussed adding the following changes to the Draft Query Health Data Use Agreement:• Language to explain what happens to data once an agreement is terminated

• Indemnity clause

• Definitions or HIPPA references to certain terms

• Giving the right to terminate the agreement to both the Data Source and the Query Source

• Purpose statement

Key Topics Covered/Discussed

Operations Workgroup Next Steps

• Review second draft of Query Health DUA

• Regular SWG meeting held on Thursday 12/15– 8 attendees, excluding ONC staff.  – Discussed three pilot projects: NYC/PCIP, NYS, Azzly– ONC Support offered assistance to SWG attendees in

completing pilot project profiles.

Pilots SWG Meeting update

• Received and reviewed preliminary PCIP pilot project profile from the New York City Department of Health and Mental Hygiene. – Dr. Mark Buck submitted, but was unable to attend the

meeting.– Primary Care Information Project (PCIP) would run the

pilot.– The NYCDHMH already has a distributed query

network built on eClinicalWorks (“the Hub”).– The pilot would be self-sufficient as to partners,

development resources, etc.

New York City DHM Pilot

• The New York State Department of Health stated its intention to prepare a pilot project profile very shortly.– Dr. Linh Le, Director of Informatics, Bureau of

Healthcom Network Systems Management is taking the lead.

– Dr. Le and colleagues are discussing the particulars of their proposal and will initiate a pilot project profile soon.

New York State DoH Pilot

• Azzly is a Web-based EHR vendor and provider with a number of clients.– Mr. Jeff Ice, Azzly CTO, stated his intention to complete a

pilot project profile shortly.– The pilot would run in a test environment using test data

that Azzly has already developed for training purposes.– Azzly would adapt their software to conform to the Query

Health requirements.– Azzly would offer the distributed query network software

as a service to its clients after the pilot project.

Azzly Pilot

• Approached the Kentucky HIE to solicit interest in a pilot project; no response yet.

• Approached Dr. Michael Klompas of the Harvard Pilgrim Health Care Institute regarding his interest in conducting a pilot.  Dr. Klompas is on vacation, so no response yet.

• Met with Dr. Aneel Advani, Associate Director for Medical Informatics at the Indian Health Service, to discuss IHS conducting a pilot project.  Dr. Advani was optimistic that he’d be able to do so, and that discussion will continue.

• Completed initial list of organizations and people to be contacted to solicit pilot project participation, merging information from the initial list of 2 to 3 months ago, recent contacts from the SWG, and personal contacts from the support team.

Pilot Outreach

Technical Working Group

December 20, 2011

Technical Approach Consensus Update

• Technical Approach document.

• Directional document detailing the decisions made so far in the Technical WG with respect to specifications, standards and the Reference Implementation

• Approach documents the activities that will be pursued by the Technical WG to create specifications, standards and the Reference Implementation

• Call for Consensus on the Technical Approach Completed• http://wiki.siframework.org/Query+Health+Technical+Approach• http://wiki.siframework.org/Query+Health+Technical+Approach+-+

Consensus+Page • Two “No” Votes to be resolved by updating the wording, no change in

direction. This is not yet done, but the coordination to resolve this is ongoing.

Vendor Advisory Meeting Update

EMR and HIE Vendors Advisory Meeting• Purpose: To get feedback on best way to integrate with the data sources and

provide them an update on Query Health

• Summary:• Vendors expressed their driving force to be their customers and regulation but

definitely validated the technical approach and see value in using it • Data Warehouses and external data marts are definitely encouraging • Data Content

• Focus on the C32 element sub-sets which are more widely implemented across EMR vendors as reliable data quality mechanisms

• C32 / CCD’s are the ones which are most widely available across implementations• Data for all sections is not all structured, so the data analysis with different C32/CCD’s is important

• Vocabularies and Code Sets: • Alignment with MU Stage 1 and Stage 2 will help a lot as we go forward• Vendors have not implemented standard code sets for many reasons

• Concept to Code Mapping• Use and Leverage ontology capabilities such as i2B2 • Local mappings will be essential

TWG Activities Moving Forward

Reference Implementation• Wiki’s for Reference Implementation up and running

• http://wiki.siframework.org/Query+Health+Reference+Implementation • Google Code Repository created

Specifications and Standards • Wiki for Specification and Standards created

• http://wiki.siframework.org/Query+Health+Specifications+and+Standards

Reference Implementation Code Repository Contents• Code Repository will have only the source code that will be written to

enhance and integrate the existing reference implementations

• In other words PopMedNet, hQuery, and i2B2 will reside in their current locations

• Plug-In Code that will be required for their integration for the purposes of Query Health will be added to the Query Health Code Repository

• Will Contain test data and other data samples like C32

• Architecture and Design Documents relevant to the Query Health and its components

Reference Implementation Code Repository Structure• Query Health Root

• /src• PopMedNet

• Binaries• Hquery

• Binaries• Libraries• Plug-ins• Standards Translators

• i2B2• Binaries • Libraries• Plug-ins• Standards Translators

• /Reference Data Sources• C32 Samples

• /Reference Queries• MU Queries

Reference Implementation TasksTasks Owner Status Date Dependencies

Reference Implementation Wiki Dragon Complete

Reference Implementation Code Repository Dragon In-Progress

C32 Repository Dragon Not started

PopMedNet Plug-in Design Document PMN (Mike Sullivan) In-Progress

i2B2 Plugin Interface to PMN Shawn Murphy Not started PMN Plug-in Design Document

hQuery Plugin interface to PMN Marc Hadley Not started PMN Plug-in Design Document

HQMF Translators POC Keith Boone / Marc Hadley

In-Progress

QRDA Translators POC Not started

i2B2- HQMF Standards Plugin Not started HQMF Standards Translation guidance

hQuery – HQMF Standards Plugin Not started HQMF Standards Translation guidance

i2B2 Results Translator Not started QRDA Standards Translation guidance

hQuery Results Translator Not started QRDA Standards Translation guidance

i2B2 Data Model Changes Not started Clinical WG identifying the data changes

hQuery Data Model Changes Not started Clinical WG identifying the data changes

Reference Implementation Tasks Cont’d

Tasks Owner Status Date Dependencies

Data Source Integration Tasks Dragon Vendor Advisory Meeting

C32 Importer ? Vendor Advisory Meeting

ETL Process ? Vendor Advisory Meeting

Handing of queries to EMR / HIE vendors Vendor Advisory Meeting

Envelope Specification TasksTasks Owner Status Date Dependencies

Identify Starting Reference Material

Mike Sullivan / Rob Rosen

PMN Architecture Document + System Design Document

Document Envelope Structure

Document Envelope Query Request / Results Identification data

Document purpose and usage of each Query Request / Results data elements

Document Envelope Security data elements

Document Envelope Security data element purpose and usage

Query / Results Payload elements

Query / Results Payload data elements purpose and usage

Query Format Specification TasksTasks Owner Status Date Dependencies

Identify current state of HQMF

Represent Sample Queries using current HQMF and identify areas for simplification and improvement (XML Changes, conventions, business names)

Marc H/ Keith B

Create Implementation guidance

Represent Sample Queries using Improved HQMF and identify areas for simplification and improvement

Marc/Keith B

Create final implementation guidance and modifications to current standard

Follow up with SDO Representatives, NQF, CMS and other stakeholders to review proposed changes

Query Format - Activities Update• Met with Keith Boone / Marc Hadley to discuss activities to focus on developing the

next version of HQMF

• Greening HQMF is a priority

• Identifying Expressions for Measure Logic as the first starting step

• Create appropriate classes in the model to represent key concepts

• Keith presented initial concepts to HL7 SDWG

• HL7 interested in getting involved to understand the changes

• Initial discussions with NQF started

• NQF looking forward to get involved, determining the best approach to get them involved

• Continuing discussions with the various stakeholders – followup meeting to discuss options

Results Format Specification TasksTasks Owner Status Date Dependencies

Identify current state of QRDA

Represent Sample Results using current QRDA and identify areas for simplification and improvement (XML Changes, conventions, business names)

Create Implementation guidance

Represent Sample Results using Improved QRDA and identify areas for simplification and improvement

Create final implementation guidance and modifications to current standard

Follow up with SDO Representatives, NQF, CMS and other stakeholders to review proposed changes

CEDD Specification TasksTasks Owner Status Date Dependencies

Identify Data Elements needed for Query Health

Identify Vocabularies for Query Health CEDD Implementation

Identify Value Sets for Query Health CEDD

Identify Concept – Code Maps for Query Health CEDD

Create CEDD Specification for Query Health Pilot purposes

Create UML Representation of CEDD

Obtain Feedback from Vendor Advisory committee on Data Element Specifications

Next Steps

• Reference Implementation work stream • Volunteer to register for the reference implementation work.• http://wiki.siframework.org/Query+Health+Reference+Implementation

• Specifications and Standards documentation work stream• Proof of Concepts will continue on the Reference Implementation work stream• Volunteer to take the lead in documenting the specifications and standards• http://wiki.siframework.org/Query+Health+Specifications+and+Standards

Important Announcements

• Enjoy the holidays!• Meetings cancelled next week unless otherwise noted:

• NOTE: Clinical Concept Mapping SWG will be MEETING!