Data Access Framework (DAF) John Feikema ONC Initiative Coordinator

2 Wide spread use of HealthIT systems (EHRs, Data Warehouses, etc.) has created opportunities for healthcare organizations and their teams to access and use the patient data that is already collected during clinical workflows. However, Health IT systems may be limited in their ability to perform data queries, APIs, or services to access data sets. Therefore, creating an industry standard access methods is needed: – To expand the ability of users to create value out of their data – To enable a provider to understand a patient’s overall health and the health of a provider’s collective patient population – To use the data to power innovative new applications and tools to take better care of patients and populations. Data Access Framework Understanding the Challenge

3 Enable Local and Targeted data access using the various data access mechanisms (document based, data element based, quality measure based, etc.) Identify privacy and other necessary metadata to enable the various data access mechanisms Modularize the query stack into modular layers (transport, query structure, query results, authentication, etc.) and allow for substitutability at each layer of the query stack Identify the set of modular components and industry standards that should be assembled together as valid combinations to promote interoperability for the various business requirements of the community. Data Access Framework Addressing the Challenge

4 To develop a framework that seeks to identify, create and/or modify standards to solve basic data access issues faced by providers – Within their own organization and across organizations in a modular and substitutable fashion To enable providers, their tools and applications, to access their patient’s data Allow providers to use new and innovative applications, through new or modified standards – Improving and filling gaps (e.g. medication tracking, long term care needs in patient care) Data Access Framework Purpose of DAF

Data Access Framework Local Access via Intra-Organization Query (Complete) Local Access via Intra-Organization Query (Complete) Targeted Access via Inter-Organization Query ( Complete ) Targeted Access via Inter-Organization Query ( Complete ) Multiple Data Source Access via Distributed Query (Query Health) – Completed Initiative Standards based approach to enable access at all levels: Local, Targeted, and Distributed Create and disseminate queries internal to organization Query Structure Layer APIs Receive standardized responses Query Results Layer Create and disseminate queries internal to organization Query Structure Layer APIs Receive standardized responses Query Results Layer Create and disseminate queries to external organization Query Structure Layer Transport Layer Authentication/Authorization Layer Receive standardized responses from external orgs Query Results Layer Create and disseminate queries to external organization Query Structure Layer Transport Layer Authentication/Authorization Layer Receive standardized responses from external orgs Query Results Layer Create and disseminate queries to multiple orgs Governed by a network Receive aggregated or de-identified responses Focus on Information Model for the network and leverage standards from earlier phases. Create and disseminate queries to multiple orgs Governed by a network Receive aggregated or de-identified responses Focus on Information Model for the network and leverage standards from earlier phases. Data Source Data Source Data Source Query Request Query Response Organization X Organization Y 5 DAF Scope Focus Areas Note: An organization can be a hospital that is part of a larger organization and can also include HIEs, RIOs, other types of organizations etc.

6 A provider wants to access data about a particular population within his/her practice using quality measures – E.g. the provider wants to know all diabetic patients over the age of 65 with HbA1c > 7% within their organization A provider wants to access the complete medical history of a patient to improve care and use new tools and applications to improve care – Tools include predictive modeling, comparison with existing data sets etc. – Enable applications such as Medication Adherence and Tracking to be used by patients and care givers. – Enable social workers and other care givers to consume the patient information and determine the next steps in providing care. These may include determining what kind of long term care facility best suits the patient based on their demographics, diagnosis, medications etc. Build an extraction capability (such as an API) from EMRs Data Access Framework Example of a Real World Scenario

7 Data Access Framework Mechanisms

8 Data Access Framework Draft Query Stack To address mechanisms, multiple standards across multiple layers must be present – Transport Layer: getting patient data from one place to another – Security Layer: ensuring data will only be accessible to authorized parties. – Query Structure: making sure the “question” being asked is phrased appropriately for the data to answer it. – Query Results: appropriately formatting the “answer” to the question posed. – Data Model to Support Queries: information models that define concepts used in clinical care.

Notional Project Timeline DAF Initiative Kickoff (7/16) Discovery (Use Case 1) S&I Lifecycle (Discovery  Pilot & Evaluation) August November Define Use Case & Functional Requirements Define Use Case & Functional Requirements Sub-Work Group Signifies milestone or deliverable July 2013 September OctoberDecember UC 1 Kickoff (8/14) Project Charter Consensus (8/28) UC 2 Kickoff (12/11) UC 1 Consensus (12/11) UC 1: Local Data Access: Intra- Organizational Query Pre-Discovery Development of Charter Define Use Case & Functional Requirements Define Use Case & Functional Requirements Implementation (DAF/IHE Community) Discovery (Use Case 2) UC 2: Targeted Data Access: Inter- Organizational Query Sub-Work Group DAF IHE/ S&I Joint Work Group IHE Activities

Notional Project Timeline CONTINUED S&I Lifecycle (Discovery  Pilot & Evaluation) Today 3/18 February May Signifies milestone or deliverable March AprilJune Define Use Case & Functional Requirements Define Use Case & Functional Requirements Discovery (Use Case 2) UC 2 Consensus (2/5) Draft DAF/IHE White Paper Complete (2/28) DAF/IHE White Paper Published January 2014 UC 2: Targeted Data Access: Inter- Organizational Query Implementation (DAF/IHE Community) DAF IHE/ S&I Joint Work Group IHE Activities Publish DAF/IHE White Paper IG Consensus Implementation (S&I Community) Candidate Standards Analysis TWG 1: Document Metadata based access for LDAF & TDAF Finalize Actors + Transactions + Technology Stacks and Standards Create IG’s based on existing standards Create SWG to modify/add standards as necessary Update IG’s based on SWG output Candidate Standards Analysis Finalize Actors + Transactions + Technology Stacks and Standards Create SWG to profile standards for data element access TWG 2: Data Element based access for LDAF & TDAF White Paper Comment Period

11 HITPC and HITSC guidance on queries ONC Innovation community work Meaningful Use Stage 2 standards where applicable Industry work related to queries as appropriate eHealth Exchange standards related to queries as appropriate. "EHR|HIE Interoperability Workgroup" work related to queries as appropriate. Existing standards from IHE and HL7 Data Access Framework Strategic Alignment

12 Data Access Framework Relevant Stakeholders Individual ProvidersProvider OrganizationsQuery Thought Leaders Government AgenciesStandards OrganizationsHIE/HIO HIT Vendors- EHR/EMR/PHR Other Healthcare Vendors Privacy and Security Experts PatientsPatient AdvocatesBeacon Communities Federal AgenciesPublic Health Agencies 3rd Party Clinical Application Vendors Healthcare Organizations

13 Data Access Framework Resources To take part in our current Harmonization and Standards work activities visit: +Implementation +Implementation To join our weekly webinars, visit the DAF Wiki Homepage for the latest meeting information: To subscribe to our mailing list, simply complete the “Join this Initiative” Form: To access current and archived meeting materials, visit the Project Meeting Artifacts section:

Questions 14

Initiative Support Leads Initiative Coordinator: John Feikema ONC Sponsor: Mera Choi Support Team: – Project Management: Gayathri Jayawardena – Technical Support: Dragon (Nagesh) Bashyam – Use Case Development: Presha Patel Hema Patel – Standards Support: Angelique Cortez – Vocabulary and Terminology Subject Matter Expert: Mark Roche, MD 15