1. Data Access Framework (DAF) IHE September 30, 2013 John Feikema Coordinator, Standards & Interoperability Framework Office of the National Coordinator for Health IT 1

2. Data Access Framework Problems to Solve Data Portability –Patient moving from one provider to a new provider Quality Improvement –A need for customized “small data analytics” for quality improvement –NwHIN/Targeted Query Remote “chart pulls” Public Health –Common framework needed 2

3. Background to Data Access Framework (DAF) BlueButton initiatives enabled patients to access to their own data DAF is a similar concept, except it is focused on enabling providers to access their patient’s data both within and across organizations –Current industry standards are not modular enough to allow the different types of data access desired by Providers. We need to be able to support: document and data element based access patient and population level based access data access based on quality measures multiple transport protocols etc. depending on the user story 3

4. DAF – Challenges Data Access Framework has to support a wide variety of user stories (samples illustrated below) 4 Data Access Mechanism (Query) Formats Document based access Data element based access Data Access using quality measures Granularity of Data being accessed Patient Level Data Get me the latest lab report for a patient so that I can check if their HbA1c > 7% Retrieve lab information for a patient for the past year where HbA1c > 7% Use a Quality Measure such as NQF 0059 to retrieve patient data for diabetic patients with HbA1c > 7% Population Level Data Retrieve population level information about patients who had a surgical procedure within the last 3 days to prepare for their care transition. Retrieve population level information about patients with age >=65 and HbA1c>7% stratified by ethnicity and preferred language to determine planning needs for the population. Use Quality Measure such as NQF0059 to retrieve population level information about diabetic patients with HbA1c>7%.

5. DAF will identify/create/modify standards to solve basic data access issues faced by providers within their own organization and across organizations in a modular and substitutable fashion. DAF is focused on enabling providers, their tools and applications to access their patient’s data Through new or modified standards DAF will allow providers to use new and innovative applications improve and fill gaps (such as medication tracking, long term care needs) in patient care What is DAF? 5

6. DAF – Modularity To support the various user stories and access mechanisms there is a need to create a modular and substitutable framework that can evolve with the industry over time: –Modular framework can be best visualized as a stack of standards with multiple layers independent of each other –Substitutable standards will provide the ability to replace standards for a single layer and reuse standards from the other layers Basic Transport Protocols Application Transport Protocols Query Structure Query Vocabularies and Value Sets Authentication/Autho rization Result Structure Result Vocabularies and Value Sets Information Models Transport Layer Security Layer Query Structure Query Results Data Model to support queries Data Access Framework 6

7. Basic Transport Protocols Application Transport Protocols Query Structure Query Vocabularies and Value Sets Authentication/Autho rization Result Structure Result Vocabularies and Value Sets Information Models DAF – Substitutability Transport Layer Security Layer Query Structure Query Results Data Model to support queries Data Access FrameworkInitial Candidate Standards HTTP SMTP SOAP (IHE SOAP) SOAP (IHE SOAP) RESTful (IHE mHealth) RESTful (IHE mHealth) Direct TLS+SAML TLS+OAuth2 S/MIME ebRIM/ebRS HL7 FHIR HL7 HQMF C-CDA HL7 v2.5.1 QRDA I, II, III MU2 ModSpec RTM 7 HL7 v2.5.1 HL7 FHIR

8. Data Access Framework Local Access via Intra-Organization Query Targeted Access via Inter-Organization Query 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 X Hospital System Y Hospital System DAF – Overall Context 8

9. DAF – Scope The work of this initiative will be done in 2 phases: Phase 1 is focused on Local Access via Intra Organization Query Phase 2 is focused on Targeted Access via Inter Organization Query The following capabilities are In-Scope: Define the modular layers for Data Access Framework to support identified business and functional requirements. Identify the existing standards that can be used for each layer of the Data Access Framework including guidance for substitutability of standards for both Local Access and Targeted Access. Define Implementation Guides leveraging existing standards where necessary to structure queries and query results for identified business and functional requirements. Identify/modify/create standardized APIs that allow applications to query data in a consistent manner across EHRs. We will work with the Federal Advisory Committees and Office of Policy and Planning to coordinate policy issues 9