Query Health Distributed Population Queries

Implementation Group Meeting

October 4, 2011

Participation Instructions for WebEx

Please Note: • This session will be recorded• Lines are open so please mute your line to avoid “Music on Hold”

1. Select the “Q&A” button in the WebEx toolbar.

2. Select “All Panelists” in the Q&A box.

3. Type your question and hit send.

4. We’ll call on you to state your comment / question

.

Agenda

• Summary of Last Meeting & Reminders• WG updates

• Clinical• Technical• Business

• Charter – Final Call for consensus• Discussion Forums• 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 HealthCalendar

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

Clinical Work Group Wednesdays 12pm-1pm EDT

Business Work GroupThursdays 11am-12pm EDT

Technical Work GroupNEW TIME Thursday 2:00 pm-3:00 pm EDT

First Face to Face MeetingOctober 18-19

Sign Up atQueryHealth.org

Download to your calendar at

QueryHealth.org

Current Query Health Workgroup Leads

Query HealthWho’s participating (As of 9/27)

100+ Participating Organizations– Public Health Agencies– Health IT Vendors– Health Information Exchanges– Academic Partners– Health Systems– Patient Advocacy Organizations

Recap of Last Meeting

• Reviewed Query Health Scope, Approach, Timeline, and Organization

• Reviewed activities of each working group• Clinical – Use Cases, User Stories, Clinical Information Models• Technical – Architectural principles, technical standards /

specifications, design of pilot implementations• Business – best practices for privacy, data use, network partner

coordination• Discussion on Implementation Workgroup activities

Action ItemsDescription Owner Status Due Date NotesReview changes to the charter and provide comments for consensus by 9/29/2011

Working Group Participants

Closed 9/29/2011 Consensus completed

Consensus voting on Generic User Story ENDS 10/4/2011

Working Group Participants

Open 10/4/2011 Consensus voting comments to be worked on at 10/4 meeting

Register and arrange for travel for the October Face to Face meeting

Working Group Participants

Open 10/7/2011 Registration extended an additional week

Choose leaders for each of the Work Groups

Working Group Participants

Closed 10/3/2011 Each WG now has volunteer leads in place

Clinical Working Group

Update from 9/21 Meeting

• Presented & Discussed Community User Story proposals– Inpatient & Outpatient– All Hazards User Story (Presented by Taha Kass-

Hout)• Reviewed updated Generic User Story (Presented by

Michael Buck)• The community was asked to provide feedback on the

Generic User Story last week

Key Topics Covered/Discussed

Key Topics Covered/Discussed

User Story Name Leads & Contributors Expected Presentation Date

Link

Example User Story – Case Control, Statin Efficacy

Working Group Participants 9/21/2011 Example User Story – Case Control, Vaccine Efficacy

Example User Story – Case Control, Vaccine Efficacy

Working Group Participants 9/21/2011 Example User Story – Case Control, Statin Efficacy

Expanded Analysis User Story Kim Nolen (Lead), Lindsay Hoggle 9/21/2011 Expanded Analysis User Story

Generic User Story Michael Buck, Susan Campbell 9/14/2011 Generic User Story

Consumer Perspective User Story Eva Powell 9/14/2011 Consumer Perspective User Story

All Hazards User Story Taha Kass-Hout 9/28/2011 All Hazards User Story

Hypothesis Generation User Story David McCallie 9/28/2011 Hypothesis Generation User Story

Hospital Inpatient Quality Reporting Program Myocardial Infarction CQM

Anne Kling Submitted via Email

Hospital Inpatient Quality Reporting Program Myocardial Infarction CQM

Trends in Use of Medical Products in the Inpatient Setting User Story

Jeff Brown 9/28/11 Trends in Use of Medical Products in the Inpatient Setting User Story

Outpatient Michael Brody 9/28/11 Outpatient User Story

User Story Recap

Decisions• Michael Buck was chosen as Working Group lead. A second

lead can be added in the future.• The Working Group members decided it would be best to

have the Generic User Story be included as part of the Use Case supplemented by 1-2 additional User Stories. 

Work Assignments/Next Steps• Query Health Clinical Working Group Call for Consensus

– Generic User Story– Ranking of User Stories– Deadline for submitting consensus vote is COB (8 PM ET)

October 4th (TODAY!!)

Key Decisions & Next Steps

Business Working Group

Update from 9/28 Meeting

• Defined Goals of Business Working Group

• Documented and Detailed the Operations Requirements (was Business Requirements) for User Stories and inclusion in the Use Case and Requirements document being prepared by Clinical Working Group;

• Ensure linkage between the Query Health Initiative and the guidance received from the Health IT Policy Committee (HITPC) and the Privacy and Security Tiger Team, and;

• Preparation of guidance documents (as prioritized by the work group), such as those related to:

• Adherence to privacy and security requirements and considerations;

• Evaluation of transaction cost / time to implement distributed queries;

• Other operational guidance (or feedback to other responsible groups)

• Merideth Vida, Support Team Lead for the Clinical Working Group, presented an overview of the Query Health Generic User Story and invited the Business Workgroup members to review and provide feedback.

Key Topics Covered/Discussed

Business Working Group Key Decisions and Next Steps

• Decisions• Alice Leiter chosen as Working Group lead.

– Work Assignments/Next Steps– Review and populate the Operations Requirements Matrix

spreadsheet (columns D and E)• Focus on Generic User Story

– Review the Query Health Operations Requirements-Narrative document for context on business requirements

– Review Generic User Story for any privacy/security implications that need documentation

– Workgroup focused on providing Business Requirements for each user story and documenting additional requirements needed for distributed queries

Technical Working Group

Update from 9/28 Meeting

• The WG Lead is requesting a change in the meeting time to support a broader base of potential participants

• Currently Wednesday 3-4pm ET or Thursday 2-3 pm ET are open and can be used with minimum conflicts with other initiatives.

• Group will be polled for preferences and notice will be sent out

Technical Workgroup Meeting Time Adjustment

Technical WG Update

• Discussed the Abstract Model in detail

• Addressed the various discussion posts and followed up with others

• Refined the abstract model based on the discussion

• Refined the Query Life Cycle and added/clarified terminology

Discussion Items from Posts and Resolutions Incorporated

Discussion Post Resolution

Separation of Authorization and Trust(Arien M/David M/John M/Jeff B)

Clarified that the Gateway will have an authorization layer different from the Trust establishment layer

Support for Intermediate conversations between Agent and Gateway (Rob Rosen)

Accommodated by Submitting queries , obtaining results and refining queries based on results and resubmitting queries

Support for Intermediaries or Trusted Third Parties (Rob Rosen)

Clarify that the Agent can act as a Smart Agent and can meet the needs of Intermediaries. In the abstract model, split out the Agent and Aggregator into it's own box (Instead of having it as part of the Requestor) and rename composer to Query UX and put it in its own box.

Composer / Agent / Aggregator relationship (Rob Rosen/Marc H)

In the abstract model, split out the Agent and Aggregator into it's own box (Instead of having it as part of the Requestor) and rename composer to Query UX and put that in its own box.

Query Envelope and Security/Trust Information (Marc H/Rob R)

The envelope will contain sufficient security information to allow the gateway to make the identity/trust and authorization decisions. The details of the exact security information will be worked out as the Technical WG proceeds further.

Support for Multiple Query Types (Marc H) Goal is to support two types in pilots; one very simple and one more complex to support the clinical workgroup user stories.

Periodic Time based Queries (Publish/Subscribe) – Mike Buck

Added Orchestrator to mange the necessary state and other relevant information related to time based or publish/subscribe type of queries.

Notes on Abstract Model – Bobby Lee Follow up with Bobby.

Query Lifecycle

1. Requestor optionally uses a query builder user interface to create a query and submits it to their dedicated orchestrator.

2. The orchestrator determines at what time and frequency the query should run (one time, monthly, etc.) and submits the query when appropriate to its agent.

3. Agent submits the query over the Internet to each participating responder’s gateway and awaits responses. Gateways may provide a number of services: additional authorization, manual review, etc.

4. The standard gateway passes accepted requests to a site-specific adapter.

5. The adapter calculates site results for their site and returns them to the gateway.

6. The gateway returns site results to the appropriate agent.

7. The agent returns site results to the aggregator that combines site results into combined results

8. The aggregator makes interim and final results available to the requestor.

Agent

Gateway Gateway

Adapter Adapter

QueryBuilder UX

Aggregator

ClinicalData

ClinicalData

AuthorizedRequestor

1a

1b

45

63

8

Responder “1” Responder “N”…

Orchestrator2 7

Next Steps and Actions

• Posted the Abstract Model for Technical WG consensus• Don’t forget to review and vote by October 5, 2011

• Will be discussing the outcome of Abstract model consensus

• Validate Abstract Model using User Stories from Clinical WG

Charter Voice Vote Approval?

• All comments from the Initiative members have been received and dispositioned• Consistent and rigorous focus on access to clinical data

sources for queries• Timeline driven by community as the workgroups evolve• Identification, not definition, of standards• Leverage and consideration of existing standards and

technologies• Work has been done to ensure outreach to any

individuals/organizations with NO votes

• How would the Implementation Workgroup like to proceed?