Research Network Query Interoperation

James R. CampbellUniversity of Nebraska

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Requirements of Networked Query Semantic Interoperation

1. Standardized (agreed) formalism for query language

2. Shared (standardized) information modela) Top level ontology (data classes and attributes)b) Terminology model (domain ontology)

3. Domain data archetypes (data type specification)

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Query Interoperationi2b2 GPC 2014

Query formalism

Shared SQL Shared SQL

Top level ontology

ONTOLOGY metadata (MODIFIER_CD)

GPC metadata(BABEL)

Terminology model

CONCEPT_CD GPC ICD-9-CM

Data type specification

Metadataxml(MODIFIER_CD)

---

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EHR Healthcare Data InteroperationONC S&I Framework

EHR vendor Epic 2012 MU Stage 2(2012 )

Epic 2015

Query formalism

EDI (business) EDI HL7 QUERYEDI

HL7 HIE EDI Patient-CCDA

Top level ontology

Proprietary information model

Clarity tables HL7 RIMCCDA

CCDA

Terminology model

ICD-9-CMCPTHCPCS

ICD-9-CMCPTHCPCS

ICD-*-CMCPTHCPCSSNOMED CTLOINCRXNORM NDCMVX CVX

ICD-*-CMCPTHCPCSSNOMED CTLOINCRXNORM NDCMVX CVX

Data type specification

Site specific (Model system)Site specific

(Model system)Site specific

COGITO / i2b2 data specs

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UNMC Goals Implementing i2b2

• Deploy KU extracts updated to Clarity v2012 (now 2014)

• Take advantage of standard terminology that had appeared in Epic since KU started their project

• Develop Ontology metadata for MU domain ontologies to:– Meet PCORI requirements for network query management– Share and standardize for GPC network queries– Provide consistent data management interface to UNMC

research/public health communities

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GPC-Epic Research Standards Transformation Architecture

Meaningful UseMaps Clarity ETL Maps

i2b2 Ontology Metadata

Demographics LOINCLOINC(site)SNOMED CT

Problem ListSNOMED CT(IMO) SNOMED CT

Encounter diagnosesBilling diagnoses

ICD-9-CM(IMO) ICD-(*)-CM

Social historyLOINC

SNOMED CT

Laboratory results LOINC(site) LOINC

Clinical findingsLOINC(site)SNOMED CT

LOINC

Medication ordersPrescriptions

RxNORM(FDB) RxNORM

Medications AdministeredMedications Dispensed

NDC (Surescripts) RXNORMNDC

ProceduresCPT

ICD-9-PCSHCPCS

CPTICD-9-PCS

HCPCS(Colorado)

ImmunizationsCVX

MVX(site)

DocumentsLOINC(site)

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Issues within GPC re/interoperation

• Our sites have heterogeneous data resources and control/management of source data

• Sites are at different stages (?) of MU compliance within their EHR

• Problems with i2b2 metadata build for MU ontologies

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Problems of i2b2 metadata build for support of top level ontology

• Complex polyhierarchies like SNOMED CT require large metadata sets

• ‘LIKE’ string match queries for aggregation are prone to errors of metadata deployment

• Run-time aggregation queries are less efficient in polyhierarchy ‘tangles’

• Transitive closure tables improved run-time efficiency and provided an understandable formalism for distributing i2b2 ONTOLOGY metadata

• PATH-based queries were accurate but run-time varied substantially based upon PATH chosen

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Composed i2b2 SQL

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Metadata Structural DifferencesPATH vs TC

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UNMC Enterprise Research Information Models 2015

CHRONICLES

(Cache)

CLARITY

(SQL)

COGITOData

warehouse i2b2(SQL)

i2b2

(SQLStar

Schema)

PCORI

CDMv3

Popmednet SAS programs

SQL ODBC

Shared SQL ETLsStandards mapping

Meaningful Use Mapped

Standards

I2b2 OntologyMetadata

CDM V2SQL

SAS

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Query Interoperationi2b2 GPC 2014 UNMC 2014

Data CharacterztnGPC CDM V3

Query formalism Shared SQL Shared SQL Shared SQL SAS code

Top level ontology

ONTOLOGY metadata (MODIFIER_CD)

GPC metadata(BABEL)

ONC metadata (GPC metadata)CDM V2

CDM V3 SAS Datasets

Terminology model

CONCEPT_CD GPC CONCEPT_CDs

ICD-*-CMCPTHCPCSSNOMED CTLOINCRXNORM NDC

CDM V3 mixed subset ONC

Data type specification

Metadataxml --- Metadataxml (ONC datatypes)

CDM V3

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What UNMC can offer GPC colleagues today

• Metadata software for SNOMED CT, RxNORM, NDC incl some metadataxml

• Clarity extracts: Problems, Encounter dx, PMH, DRG, FS:Vital signs/exam/PRO/monitoring, Encounters, Procedures, Surgical history, Enrollment, Dispensing, Lab results, Outpt prescriptions,

• CDM SQL build: all V1, Dispensing, Conditions, Prescribing, (Lab_result_CM)

Questions?