1. Research Network Query Interoperation James R. Campbell University of Nebraska

2. Requirements of Networked Query Semantic Interoperation 1.Standardized (agreed) formalism for query language 2.Shared (standardized) information model a)Top level ontology (data classes and attributes) b)Terminology model (domain ontology) 3.Domain data archetypes (data type specification) 2

3. Query Interoperation i2b2GPC 2014 Query formalism Shared SQL Top level ontology ONTOLOGY metadata (MODIFIER_CD) GPC metadata (BABEL) Terminology model CONCEPT_CDGPC ICD-9-CM Data type specification Metadataxml (MODIFIER_CD) --- 3

4. EHR Healthcare Data Interoperation ONC S&I Framework EHR vendorEpic 2012MU Stage 2 (2012  ) Epic 2015 Query formalism EDI (business)EDIHL7 QUERY EDI HL7 HIE EDI Patient-CCDA Top level ontology Proprietary information model Clarity tablesHL7 RIM CCDA Terminology model ICD-9-CM CPT HCPCS ICD-9-CM CPT HCPCS ICD-*-CM CPT HCPCS SNOMED CT LOINC RXNORM NDC MVX CVX ICD-*-CM CPT HCPCS SNOMED CT LOINC RXNORM NDC MVX CVX Data type specification Site specific(Model system) Site specific (Model system) Site specific COGITO / i2b2 data specs 4

5. UNMC Goals Implementing i2b2 Deploy KU extracts updated to Clarity v2012 (now 2014) Take advantage of standard terminology that had appeared in Epic since KU started their project Develop Ontology metadata for MU domain ontologies to: – Meet PCORI requirements for network query management – Share and standardize for GPC network queries – Provide consistent data management interface to UNMC research/public health communities 5

6. GPC-Epic Research Standards Transformation Architecture Meaningful Use MapsClarity ETL Maps i2b2 Ontology Metadata Demographics LOINC LOINC(site) SNOMED CT Problem List SNOMED CT(IMO)SNOMED CT Encounter diagnoses Billing diagnoses ICD-9-CM(IMO)ICD-(*)-CM Social history LOINC SNOMED CT Laboratory results LOINC(site)LOINC Clinical findings LOINC(site) SNOMED CT LOINC Medication orders Prescriptions RxNORM(FDB)RxNORM Medications Administered Medications Dispensed NDC (Surescripts)RXNORM NDC Procedures CPT ICD-9-PCS HCPCS CPT ICD-9-PCS HCPCS(Colorado) Immunizations CVX MVX(site) Documents LOINC(site) 6

7. Issues within GPC re/interoperation Our sites have heterogeneous data resources and control/management of source data Sites are at different stages (?) of MU compliance within their EHR Problems with i2b2 metadata build for MU ontologies 7

8. Problems of i2b2 metadata build for support of top level ontology Complex polyhierarchies like SNOMED CT require large metadata sets ‘LIKE’ string match queries for aggregation are prone to errors of metadata deployment Run-time aggregation queries are less efficient in polyhierarchy ‘tangles’ Transitive closure tables improved run-time efficiency and provided an understandable formalism for distributing i2b2 ONTOLOGY metadata PATH-based queries were accurate but run-time varied substantially based upon PATH chosen 8

9. Composed i2b2 SQL 9

10. Metadata Structural Differences PATH vs TC 10

11. UNMC Enterprise Research Information Models 2015 11 C H R O N I C L E S (Cache) C L A R I T Y (SQL) COGITO Data warehouse i2b2 (SQL) i 2 b 2 (SQL Star Schema) P C O R I C D M v3 Popmednet SAS programs SQL ODBC Shared SQL ETLs Standards mapping Meaningful Use Mapped Standards I2b2 Ontology Metadata CDM V2 SQL SAS

12. Query Interoperation i2b2GPC 2014UNMC 2014 Data Characterztn GPC CDM V3 Query formalismShared SQL SAS code Top level ontology ONTOLOGY metadata (MODIFIER_CD) GPC metadata (BABEL) ONC metadata (GPC metadata) CDM V2 CDM V3 SAS Datasets Terminology model CONCEPT_CDGPC CONCEPT_CDs ICD-*-CM CPT HCPCS SNOMED CT LOINC RXNORM NDC CDM V3 mixed subset ONC Data type specification Metadataxml---Metadataxml (ONC datatypes) CDM V3 12

13. What UNMC can offer GPC colleagues today Metadata software for SNOMED CT, RxNORM, NDC incl some metadataxml Clarity extracts: Problems, Encounter dx, PMH, DRG, FS:Vital signs/exam/PRO/monitoring, Encounters, Procedures, Surgical history, Enrollment, Dispensing, Lab results, Outpt prescriptions, CDM SQL build: all V1, Dispensing, Conditions, Prescribing, (Lab_result_CM) 13

14. Questions?