1. Data Access Framework (DAF) John Feikema ONC Initiative Coordinator

2. 2 Health IT systems (EHRs, Data Warehouses, etc.) may be limited in their ability to perform data queries, APIs, or services to access data sets. Therefore, it is important to create a standardize data access method: – 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; and – 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. 3 As a result, DAF is creating a framework that seeks to identify, create and/or modify standards to enable providers, their tools and applications, to access their patient’s data – Within their own organization and across organizations in a modular and substitutable fashion DAF will also 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

4. 4 DAF will… – 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

5. 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. 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. 7 Data Access Framework Mechanisms

8. 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.

9. 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 Implementa tion Meeting TWG 1: Document Metadata based access for LDAF & TDAF

10. 10 Completed a White Paper with IHE that has identified the current gaps for document metadata and data element based access – Currently working to find resolutions for each of those gaps Working on developing an implementation guide for document metadata – Currently reviewing the requirements for the SOAP Query Stack Evaluating standards for data elements Data Access Framework Current Status

11. 11 Data Access Framework Current Gaps

12. 12 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

13. 13 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

14. 14 Data Access Framework Resources To take part in our current Harmonization and Standards work activities visit: http://wiki.siframework.org/DAF+Standards+Harmonization+and+I mplementation http://wiki.siframework.org/DAF+Standards+Harmonization+and+I mplementation To join our weekly webinars, visit the DAF Wiki Homepage for the latest meeting information: http://wiki.siframework.org/Data+Access+Framework+Homepage http://wiki.siframework.org/Data+Access+Framework+Homepage To subscribe to our mailing list, simply complete the “Join this Initiative” Form: http://wiki.siframework.org/Data+Access+Framework+Join+the+Initiative http://wiki.siframework.org/Data+Access+Framework+Join+the+Initiative To access current and archived meeting materials, visit the Project Meeting Artifacts section: http://wiki.siframework.org/Project+Meeting+Artifacts http://wiki.siframework.org/Project+Meeting+Artifacts

15. Questions 15

16. 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 16