1. Data Access Framework (DAF) S&I Initiative Update June 19 th, 2014 1

2. Overview (Recap) BlueButton initiatives enabled patients to access to their own data DAF is similar, except it is focused on enabling providers to access their patient’s data using modular and substitutable standards –Within their own Local Organization (Local DAF) –From another Targeted Organization (Targeted DAF) –Between multiple Organizations (Federated DAF – Future phases) 2

3. Challenges to Address Data Access Complexities include: –Ability to access data within and across organizations using standards –Ability to access patient’s data using document metadata paradigm Get latest Lab Report for a Patient so that I can check her HBA1C levels Get CCD’s for the last 3 years for a patient Get the last History and Physical Note for the patient –Ability to access patient’s data based on discrete data elements captured within a patient record Get latest lab report for a patient where HBA1C > 7% Get me all patients < 5 years who are due for an immunization Get me all patients > 75 years with HBA1C > 7% –Enable both Patient level (Local and Targeted ) and Population level data (Data about multiple patients – only for Local) 3

4. Out Of Scope DAF does not address the following: –Trust establishment between organizations for Targeted Query Could leverage all the trust work happening in Direct –Discovery of End Points for Targeted Query –Patient Matching rules and algorithms that organizations may implement –Policies that allow/dis-allow disclosure of patient data 4

5. Current State S&I/IHE PCC DAF White Paper –Describes how to use existing IHE profiles to meet DAF needs and identifies gaps that need to be filled (Both new profiles and change proposals) –Gaps being prioritized to inform upcoming IHE Planning Cycle. –Currently under Public Comment period http://www.ihe.net/Public_Comment/#pcc http://www.ihe.net/Public_Comment/#pcc S&I Document Metadata Based Access Work Group –Allows ability to access patient data using document metadata paradigm –Finished Candidate standards analysis –Creating an Implementation Guide around the standards S&I Data Element Based Access Work Group –Currently performing standards analysis –Completed FHIR, working on others identified by the community (HL7v2, QED, HQMF etc) S&I DAF Direct Transport WG (Community/Volunteer driven WG) –Working on a solution using all the content models from Document and Data Element Based Access Work Groups but changing the Transport from SOAP/HTTP to Direct/SMTP. 5

6. Create IG based on existing standards WP Comment Period Notional Project Timeline S&I Lifecycle (Discovery  Pilot & Evaluation) August November September OctoberDecember DAF/IHE White Paper Published July Implementation (DAF/IHE Community) DAF IHE/ S&I Joint Work Group IHE Activities Document IG Consensus Implementation (S&I Community) TWG 1: Document Metadata based access for LDAF & TDAF 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

7. IHE/S&I Joint White Paper 7

8. Document Metadata Based Access Overview 8 Query Requestor Query Responder Query Query Results Query Stacks Required SOAP and RESTful Query Stacks Required SOAP or RESTful DAF Queries Find Document(s) based on Patient Identifiers Find Document(s) based on Patient Demographics Get Document(s) based on Patient Identifiers Get Document(s) based on Patient Demographics Get Document(s) based on Document Identifiers Get Document(s) for multiple patients based on patient identifiers Find Patient Identifiers based on Patient Demographics Find Patient Demographics based on Patient Identifiers DAF Supporting Capabilities Provide message integrity and confidentiality of queries and results exchanged between the Query Requestor and the Query Responder Ability to provide user and system identities as necessary for authentication and authorization Ability to tag the queries and the query results with security metadata that will enable policy enforcement for query execution and data disclosure

9. Document Metadata Based Access Query Stacks 9 Query Stack ComponentSOAP Query StackRESTful Query Stack Transport ProtocolsHTTP Message Packaging EnvelopeSOAP 1.2HTTP Message Structure Message IntegrityTLS ConfidentialityTLS System AuthenticationMutual TLS Access Controls/Authorization *XUA (Targeted only) *IHE IUA (Based on OAuth2) + FHIR Tags * Consent and Security metadata *DS4P + XDS Metadata (Targeted only) *DS4P + FHIR Tags * AuditingATNAATNA + FHIR Security Event Query StructureXCA, XCPD – Patient Level MPQ – Population Level IHE MHD v2 (Being Aligned to FHIR Document Resources) ** Result StructureCCDACCDA expressed via FHIR Document Resources API’sXCA/XCPD/MPQ WSDLIHE MHD v2 ** * - Specifying profiles for Targeted DAF only, Local DAF choices left to the organization ** - IHE working on finalizing IHE MHDv2 which aligns with FHIR this summer – DAF will reanalyze once it is published

10. Data Element Based Access 10 Query Requestor Query Responder Query Query Results Query Stacks Required Under Analysis FHIR - Initial Analysis performed Query Stacks Required Under Analysis FHIR - Initial Analysis performed Data Elements for Constructing Queries and Query Results Started from MU Stage 2 ToC/VDT data elements + community input Current Data Element Spreadsheet

11. Data Element Based Access (Potential FHIR Query Stack) 11 Query Stack ComponentRESTful Query Stack Transport ProtocolsHTTP Message Packaging EnvelopeHTTP Message Structure Message IntegrityTLS ConfidentialityTLS System AuthenticationMutual TLS Access Controls/Authorization *IHE IUA (Based on OAuth2) + FHIR Tags Consent and Security metadata *DS4P + FHIR Tags AuditingATNA + FHIR Security Event Query StructureFHIR Queries based on RESTful resources (FHIR Query Resource May be used along with resources) Result StructureFHIR Resources API’sFHIR API’s Note: Query Stack Components for Document Metadata based Access and Data Element based Access share same components except for Query Structure and Query Results.

12. Questions 12

13. Useful Links DAF Homepage – http://wiki.siframework.org/Data+Access+Framework+Homepage http://wiki.siframework.org/Data+Access+Framework+Homepage DAF Initiative Signup – http://wiki.siframework.org/Data+Access+Framework+Join+the+Initiative http://wiki.siframework.org/Data+Access+Framework+Join+the+Initiative DAF Charter – http://wiki.siframework.org/Data+Access+Framework+Charter+and+Members http://wiki.siframework.org/Data+Access+Framework+Charter+and+Members DAF Standards, Harmonization and Implementation Activities – http://wiki.siframework.org/DAF+Standards+Harmonization+and+Implementa tion http://wiki.siframework.org/DAF+Standards+Harmonization+and+Implementa tion 13

14. Initiative Support Leads For questions, please feel free to contact your support leads: – Initiative Coordinator: John Feikema john.feikema@siframework.orgjohn.feikema@siframework.org – ONC Sponsors: Mera Choi mera.choi@hhs.govmera.choi@hhs.gov – Support Team: Project Management: – Gayathri Jayawardena gayathri.jayawardena@esacinc.comgayathri.jayawardena@esacinc.com Technical Support: – Dragon (Nagesh) Bashyam nagesh.bashyam@drajer.comnagesh.bashyam@drajer.com Standards SME: – Ed Larsen ed_larsen@comcast.neted_larsen@comcast.net Standards Support : – Angelique Cortez angelique.j.cortez@accenture.comangelique.j.cortez@accenture.com Vocabulary and Terminology Subject Matter Expert: – Mark Roche, MD mrochemd@gmail.commrochemd@gmail.com 14