Query Health Distributed Population Queries

Implementation Group Meeting

November 1, 2011

Agenda

• Where we are• Weekly Summary

• Clinical• Operations• Technical

• Upcoming Consensus and Important Dates• Open Discussion / Next Steps

Query HealthScope and Approach

Practice drives standards1. Rough consensus2. Running code (open source)3. Pilot4. Specifications5. Standards

Query Health – Distributed Population

Queries

Standards & Service

Public / Private

Partnership Project

Community Driven,

Consensus-based

EHRs & Other

Clinical Records

HIT Policy Committee:

Policy Guideposts

Query HealthWhere We are

Query Health Meeting Time Reminders

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

Clinical Work Group Wednesdays 12pm-1pm EDT

Operations Work GroupThursdays 11am-12pm EDT

(NOTE: one time meeting on Wednesday from 10-11 AM EDT))

Technical Work GroupThursday 2:00 pm-3:00 pm EDT

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Action Items

Description Owner Status Due Date NotesReview Query Matrix and Transport Matrix

Working Group Participants

Open 11/3/2011

Provide detail on Expanded Analysis User Story Operational Requirements

Working Group Participants

Open 11/2/2011

Review and Comment on Draft Query Health Use Case

Working Group Participants

Open 11/1/2011 All review comments should be received by the 8 PM ET on 11/1/2011

Clinical Working Group

November 1, 2011 Update

Clinical Working Group Update

• The working group made great progress developing the key sections of the Use Case during the last several weeks

• The DRAFT Query Health Use Case was compiled based on this work and posted to the wiki on October 28th

• All Query Health community participants were sent an email with the link to the Use Case and are invited to review and provide comments using the discussion tab

• REMINDER: If you provide any comments and/or revisions please plan on attending the 11/2 Clinical WG to discuss with the working group members

• Next Steps

o Reconcile comments, update Use Case and kick off consensus process

Please provide ALL comments on the Use Case by COB (8 PM ET) TODAY 11/1/2011

Operations Working Group

Week of November 2, 2011

• Finalized the ‘Operational Requirements for Query Health’ - a narrative description of the operational requirements that will govern the Generic User Story.

• The workgroup defined operational requirements that could be applied to any user story.  The result is a much shorter and more concise expression of operational considerations.

• The Support Team drafted specific Operational Requirements aligned with the Expanded Analysis User Story for the workgroup to provide comments on by the next meeting.

• The Support Team also drafted a supplement to the Expanded Analysis User Story that will outline the user story in a way that will be easier for non-clinicians to work with as they discuss the specific operational requirements.

Key Topics Covered/Discussed

Operations Workgroup Next Steps

• Next Steps– Our next meeting will take place on Wednesday, November

2 from 10:00 to 11:00 AM EDT.– Review the Expanded Analysis User Story Supplement and

Specific Operational Requirements drafted by the Support Team.– Review the specific user story (Expanded Analysis for Diabetic

Care in an Outpatient Setting) in preparation for a discussion of specific operational requirements our next meeting. The goal is to finalize the requirements during this meeting.

Technical Working Group

Week of November 2, 2011

Technical WG Update

• Recapped the F2F Summary for the WG• Started discussion of Queries that we have selected for

Query Analysis to determine the components of our technical foundation

• Query Analysis is focused on determining the type of Data Models and Formats to be used for Queries

• Candidates for Query Representations:• Code representations (e.g hQuery), • SQL based (e.g i2B2), • XML based representations• Standards based representations

Technical WG Update Cont’d

• Queries Selected:• Based on Clinical WG Expanded Diabetes Analysis

• Hba1c > 9.0% (NQF0059/MU Stage 1)• LDL Control < 100 mg/dl (NQF0064/MU Stage 1)

• The Hub Query Examples – QM18• Simple query which is used as a Quality Measure by the hub• Cholesterol Control:

• Male patients ≥ 35 years of age and female patients ≥ 45 years of age without Diabetes Mellitus or Ischemic Vascular Disease who have a total cholesterol < 240 or LDL < 160 measured in the past 5 years. The last 5 years is calculated from the most recent patient visit within the reporting period.

Technical WG Update Cont’d

Hypothesis Generation Query based on work from i2B2 as part of Epidemiology/Health Services Research:

http://care.diabetesjournals.org/content/33/3/526.full.pdf http://wiki.siframework.org/Query+Health+Hypothesis+Generation+User+Story+Proposal

Sample Query: The retrospective cohort analysis (n=34,253) included all patients aged 18 years identified by an ICD-9 code for Diabetes Mellitus (250.XX) or an A1C of 6.0% and at least one record of prescription of an oral diabetes medication as an outpatient or dispensation as an inpatient, between 1 January 2000 and 31 December 2006. Analyses focused on three classes of diabetic medications: sulfonylureas, the biguanide metformin, and the thiazolidinediones, rosiglitazone and pioglitazone. We excluded patients receiving either metformin or thiazolidinedione who had a diagnosis of polycystic ovaries but not diabetes. We used a cumulative temporal approach to ascertain the calendar date for earliest identifiable risk associated with rosiglitazone compared with that for other therapies. For each patient, duration of exposure to individual diabetes medications was assessed in 6-month increments during which only one of the four medications was prescribed. Patients receiving multiple medications under consideration were excluded. Events were associated with a particular medication only when the prescription or dispensation occurred within 6 months before the documented myocardial infarction. If a patient did not have any activity for a 6-month observation period but resumed activity in the following period, than the particular 6-month observation period with no activity was excluded from analysis

Technical WG Update Cont’d

Next Steps

• Technical Foundation: • Create Small sub-team with representation from the

three candidate implementations to examine the solutions further and report back.

• Query Analysis:• Continue to fill out the Query Analysis Matrix based on

the sample Queries across the different categories• Code Based• SQL Based • XML Based• Standards Based

Important Announcements

• Technical Working Group• Tentatively scheduled meeting for November 28-29 to review

technical foundation• Clinical Workgroup

• Formation of Clinical Information Model (CIM) Sub-Working Group starting later this week

• Formation of Clinical Concept Mapping Sub-Working Group starting next week