Data Access Framework All Hands Community Meeting July 9, 2014

Meeting Etiquette Remember: If you are not speaking, keep your phone on mute Do not put your phone on hold – if you need to take a call, hang up and dial in again when finished with your other call – Hold = Elevator Music = very frustrated speakers and participants This meeting, like all of our meeting is being recorded – Another reason to keep your phone on mute when not speaking Feel free to use the “Chat” feature for questions, comments or any items you would like the moderator or participants to know. NOTE: This meeting is being recorded and will be posted on the DAF Wikipage, under “Materials”  “Past Meetings” From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute 2

Agenda TopicEstimated Time QED Overview and Application to DAF, Presented by Keith Boone 40 minutes Next Steps/Questions5 minutes 3

Create IG based on existing standards WP Comme nt Period Notional Project Timeline S&I Lifecycle (Discovery  Pilot & Evaluation) Today 7/9 August November September OctoberDecember DAF/IHE White Paper Published July 2014 Implementation (DAF/IHE Community) DAF IHE/ S&I Joint Work Group IHE Activities Document IG Consensus Implementation (S&I Community) Candidate Standards Analysis Finalize Actors + Transactions + Technology Stacks and Standards TWG 2: Data Element based access for LDAF & TDAF Creating Operation Plan for Pilot Testing Balloting Activities Pilots and Testing Pilots & Testing Create IG Creating Operation Plan for Pilot Testing Pilots & Testing Pilots and Testing Balloting Activities Data Element IG Consensus IHE Trial Implementation Meeting TWG 1: Document Metadata based access for LDAF & TDAF

5 QED Analysis and DAF Application provided by IHE PCC Technical Committee member, Keith Boone

6 Query for Existing Data Value Proposition Exchange of information between Data Repositories and Clinical Data Consumers for: –Drug Safety –Public Health, Biosurveillance and Disease Registries –Identifying Qualifying Patients Clinical Trials Disease Management –Quality Reporting –Claims Submission –Decision Support Systems Using a single standard for query Compatible with CCD vs HL7 V2.X $10-20K/Inteface HITSP TP21, Quality

Scope Problems and Allergies –Disease Registries, EHR Systems, CDS Vital Signs –Monitoring Systems, EHR Systems, CDS Diagnostic Results –Laboratory and Radiology Information Systems, EHR Systems, CDS Medications –Pharmacy, EHR Systems, CDS Immunizations –Immunization Registries, EHR Systems, CDS Professional Services –Practice Management, Scheduling Systems, Care Management, CDS

Key Technical Properties Support for Web Services and SOA Architecture Use of one standard for all queries Reuse of PCC Technical Framework Templates Compatibility with ASTM/HL7 CCD

QED Actors/Transactions 9

Data Elements (1) Common Observations Simple measurements or reported values that can be determined using simple measuring devices (e.g., Height, Weight), or which can be reported by the patient (e.g., date of last menstrual period). Diagnostic Results Observations made or performed using laboratory testing equipment, imaging procedures, vision examinations, et cetera. Problems and Allergies These are a collection of diagnoses, clinical findings, allergies, or other risk factors that are recorded for the patient. The information may be obtained from patient reports, or through clinical decision making. –Conditions: Disease conditions for the patient. –Intolerances: Allergies and other intolerances. –Risk Factors: Significant risk factors based on family history, social history, occupational exposures, et cetera. Medications Medications that a patient is or has been taking for treatment of one or more conditions. Immunizations Immunizations that have been given, or which are planned to be given to the patient. Professional Services Procedures and/or encounters which the patient has participated in, or is expected to participate in. 10

Data Elements (2) 11 Information CategoryCodeReturnsTemplate Id Vital Signs COBSCATAll Vital SignsVital Signs Observation Any Code from the Vital Signs Table below The vital sign identified by the codeVital Signs Observation Problems and Allergies MEDCCATAll problem entriesProblem Entry CONDLISTAll Concern EntriesConcern Entry PROBLISTAll Problem ConcernsProblem Concern INTOLISTAll Allergy ConcernsAllergy and Intolerance Concern RISKLISTAll Risks 1 Concern Entry Diagnostic Results LABCATAll Lab ResultsSimple Observations DICATAll Imaging ResultsSimple Observations Medications RXCATAll MedicationsMedications MEDLISTAll MedicationsMedications CURMEDLISTAll active medicationsMedications DISCHMEDLISTDischarge MedicationsMedications HISTMEDLISTAll Historical MedicationsMedications ImmunizationsIMMUCATAll ImmunizationsImmunizations Professional ServicesPSVCCATAll professional service entries Encounters Procedures Entry

Query Interaction 12

Query Syntax (1) 13

Query Syntax (2) 14

Query Results (1) 15

Query Results (2) 16

Adoption Two Published Integration Statements –Orion HealthOrion Health –IntercomponentWare AGIntercomponentWare AG –See Five Vendors Tested at IHE Connectathon – results.ihe.net/view_result.php?rows=company&columns=actor& title=integration_profile&integration_profile=QEDhttp://connectathon- results.ihe.net/view_result.php?rows=company&columns=actor& title=integration_profile&integration_profile=QED 17

Provenance/Security Metadata Provenance Author Verifier Responsible Party Patient/Subject Tags Confidentiality Can be Grouped with other Actors providing addition user metadata (e.g., XUA, IUA) 18

SWOT Strengths Nearly same XML as CCD/IHE XPHR Identical Constraints Supports Linkage to Document Weaknesses Needs update to Standard (based on DSTU) No Population Level Query Support No Pub/Sub Support Opportunities Some limitations removed with Standard RESTful/FHIR Update Threats FHIR Efforts More Interesting Limited Adoption 19

Questions 20

Data Access Framework Resources DAF Wiki Homepage – Become a Community Member – e e DAF Charter – mbers mbers DAF Standards, Harmonization and Implementation Activities – mentation mentation Standards and Interoperability(S&I) Framework – S & I Calendar of Events –

Initiative Support Leads For questions, please feel free to contact your support leads: – Initiative Coordinator: John Feikema – ONC Sponsors: Mera Choi – Support Team: Project Management: – Gayathri Jayawardena Technical Support: – Dragon (Nagesh) Bashyam Standards SME: – Ed Larsen Standards Support : – Angelique Cortez Vocabulary and Terminology Subject Matter Expert: – Mark Roche, MD 22