1. Query Health Distributed Population Queries Implementation Group Meeting December 20, 2011

2. Agenda Where we are going Weekly Summary Clinical Operations Technical Important Announcements Open Discussion / Next Steps

3. Query Health Where We are

4. Query Health Meeting Time Reminders Implementation Group Tuesdays 1:30pm-3:00pm EDT Clinical Working Group Wednesdays 12pm-1pm EDT Clinical Concept Mapping Sub-Working Group Tuesday 3pm-4pm EDT Operations Working Group Thursdays 11am-12pm EDT Pilots Sub-Working Group Thursdays 3:30pm-4:30pm EDT Technical Working Group Thursday 2pm-3 pm EDT

5. Action Items DescriptionOwnerStatusDue DateNotes Continue review of Operations Working Group Sample Data Use Agreement Development Operations Working Group OpenPrepare for Dec 22 meeting Continue work on Query Health CEDD Crosswalk (focus on final review and examples) Working Group Participants OpenPrepare for Dec 21 meeting Volunteer for Query Health Pilots Working Group Participants OpenOngoing Final vote on the Technical Approach Call for Consensus Technical Working Group OpenPrepare for Dec 22 meeting Attend Query Health Clinical Concept Mapping presentations Working Group Participants OpenOngoing

6. Clinical Working Group December 20, 2011

7. Concept to Codes Meetings will occur every Tuesday from 3:00 – 4:00 PM EST –On January 3 rd, 10 th, and potentially 17 th 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 frameworksQuestions for Considerations and Proposed Outline 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 herehere –12/27 - No Meeting –1/4 and 1/10 - Additional presentation schedules being confirmed 7

8. Query Health CEDD Timeline

9. 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=0ApW4Ox66ml2IdEtYR 0lwenlJVWl6RC1vVnZuaEppeWc 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

10. Operations Working Group December 20, 2011

11. 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

12. Operations Workgroup Next Steps Review second draft of Query Health DUA

13. 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

14. 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

15. 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

16. 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

17. 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

18. Technical Working Group December 20, 2011

19. 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+Pagehttp://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.

20. 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

21. 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

22. 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

23. 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

24. Reference Implementation Tasks TasksOwnerStatusDateDependencies Reference Implementation WikiDragonComplete Reference Implementation Code RepositoryDragonIn-Progress C32 RepositoryDragonNot started PopMedNet Plug-in Design DocumentPMN (Mike Sullivan)In-Progress i2B2 Plugin Interface to PMNShawn MurphyNot startedPMN Plug-in Design Document hQuery Plugin interface to PMNMarc HadleyNot startedPMN Plug-in Design Document HQMF Translators POCKeith Boone / Marc Hadley In-Progress QRDA Translators POCNot started i2B2- HQMF Standards PluginNot startedHQMF Standards Translation guidance hQuery – HQMF Standards PluginNot startedHQMF Standards Translation guidance i2B2 Results TranslatorNot startedQRDA Standards Translation guidance hQuery Results TranslatorNot startedQRDA Standards Translation guidance i2B2 Data Model ChangesNot startedClinical WG identifying the data changes hQuery Data Model ChangesNot startedClinical WG identifying the data changes

25. Reference Implementation Tasks Cont’d TasksOwnerStatusDateDependencies Data Source Integration TasksDragonVendor Advisory Meeting C32 Importer ?Vendor Advisory Meeting ETL Process ?Vendor Advisory Meeting Handing of queries to EMR / HIE vendorsVendor Advisory Meeting

26. Envelope Specification Tasks TasksOwnerStatusDateDependencies 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

27. Query Format Specification Tasks TasksOwnerStatusDateDependencies 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

28. 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

29. Results Format Specification Tasks TasksOwnerStatusDateDependencies 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

30. CEDD Specification Tasks TasksOwnerStatusDateDependencies 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

31. 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

32. Important Announcements Enjoy the holidays! Meetings cancelled next week unless otherwise noted: NOTE: Clinical Concept Mapping SWG will be MEETING!