query health: distributed population queries overview

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Query Health: Distributed Population Queries Overview

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Page 1: Query Health: Distributed Population Queries Overview

Query Health:Distributed Population Queries

Overview

Page 2: 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

Page 3: Query Health: Distributed Population Queries Overview

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.

Page 4: Query Health: Distributed Population Queries Overview

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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

Page 5: Query Health: Distributed Population Queries Overview

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

Page 6: Query Health: Distributed Population Queries Overview

Distributed queries unambiguously define a population from a larger set

Questions about disease outbreaks,

prevention activities, health research,

quality measures, etc.

Page 7: Query Health: Distributed Population Queries Overview

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

Page 8: Query Health: Distributed Population Queries Overview

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

Page 9: Query Health: Distributed Population Queries Overview

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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 ?

Page 10: Query Health: Distributed Population Queries Overview

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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

Page 11: Query Health: Distributed Population Queries Overview

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 EnvelopePrivacy Policy Enablement

hQuery

Concept Definitions and

Value Sets

Page 12: Query Health: Distributed Population Queries Overview

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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

Page 13: Query Health: Distributed Population Queries Overview

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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.

Page 14: Query Health: Distributed Population Queries Overview

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CEDD alignment with NQF’s QDM

Page 15: Query Health: Distributed Population Queries Overview

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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.

Page 16: Query Health: Distributed Population Queries Overview

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

16

Query Health Standards andRI Foundation Components

Components

The QuestionNew HQMF

Query EnvelopePrivacy Policy Enablement

hQuery

Concept Definitions and

Value Sets

Page 17: Query Health: Distributed Population Queries Overview

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

Page 18: Query Health: Distributed Population Queries Overview

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

Page 19: Query Health: Distributed Population Queries Overview

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

19

Query Health Standards andRI Foundation Components

Components

The QuestionNew HQMF

Query EnvelopePrivacy Policy Enablement

hQuery

Concept Definitions and

Value Sets

Page 20: Query Health: Distributed Population Queries Overview

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

Page 21: Query Health: Distributed Population Queries Overview

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 EnvelopePrivacy Policy Enablement

hQuery

Concept Definitions and

Value Sets

Page 22: Query Health: Distributed Population Queries Overview

The Query Envelope

• Query agnostic

• Content agnostic

• Metadata facilitates privacy guidance from HIT Policy Committee

• RESTful interface specification for the Existing RI component integration

Page 23: Query Health: Distributed Population Queries Overview

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Query Health Technical Approach -Putting it all together

Page 24: Query Health: Distributed Population Queries Overview

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

JavaScript

SQL

Native Formats

QRDA (Category III Report)

Query Envelope

Requesting Organization

Responding Organization

Page 25: Query Health: Distributed Population Queries Overview

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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

Page 26: Query Health: Distributed Population Queries Overview

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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

Page 27: Query Health: Distributed Population Queries Overview

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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

Page 28: Query Health: Distributed Population Queries Overview

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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

Page 29: Query Health: Distributed Population Queries Overview

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

Page 30: Query Health: Distributed Population Queries Overview

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

Page 31: Query Health: Distributed Population Queries Overview

Top Level Roadmap

Page 32: Query Health: Distributed Population Queries Overview

The Way Ahead for Query Health

Page 33: Query Health: Distributed Population Queries Overview

The path to critical mass

33

• 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

Page 34: Query Health: Distributed Population Queries Overview

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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

Page 35: Query Health: Distributed Population Queries Overview

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 EnvelopePrivacy Policy Enablement

hQuery

Concept Definitions and

Value Sets

www.queryhealth.org