1. Query Health Distributed Population Queries Implementation Group Meeting December 6, 2011

2. Agenda Where we are going Weekly Summary –Clinical –Operations –Technical Important Announcements Open Discussion / Next Steps

3. Query Health Where We are

4. Query Health Meeting Time Reminders Implementation Group Tuesdays 1:30pm-3:00pm EDT Clinical Working Group Wednesdays 12pm-1pm EDT Clinical Concept Mapping Sub-Working Group Tuesday 3pm-4pm EDT Operations Working Group Thursdays 11am-12pm EDT Pilots Sub-Working Group Thursdays 3:30pm-4:30pm EDT Technical Working Group Thursday 2pm-3 pm EDT

5. Action Items DescriptionOwnerStatusDue DateNotes Provide and review data use agreements from your organizations to Operations Working Group Working Group Participants OpenOngoing Review and comment on draft technical consensus document – consensus process begins later this week Working Group Participants OpenOngoing Volunteer to participate in the Query Health Pilots Sub-team Working Group Participants OpenOngoing Volunteer to participate in the Query Health CIM activity Working Group Participants OpenOngoing Volunteer to participate in the Query Health Clinical Concept Mapping activity Working Group Participants OpenOngoing

6. Clinical Working Group December 6, 2011

7. Working on Query Health extensions to the S&I Framework CIM

8. CIM Kick-off this past week, outlining the Query Health CIM Crosswalk – available at http://wiki.siframework.org/Clinical+Information+Model+Activity http://wiki.siframework.org/Clinical+Information+Model+Activity Encourage review by Clinical Working Group members of existing technical foundation data models (focus on clinical content) –SHRINE (i2B2) –Mini-Sentinel (PopMedNet) hQuery Volunteers being outlined for key sections of the crosswalk: –Available at the following URL: https://docs.google.com/spreadsheet/ccc?key=0ApW4Ox66ml2IdEt YR0lwenlJVWl6RC1vVnZuaEppeWc Recap of Next Steps on the CIM

9. Concept Mapping Scope Based on discussions we’ve had with existing query health networks it appears there are two approaches for mapping concepts to codes –Concept to Code Mapping at the Information Requestor (Option 1) –Concept to Code Mapping at the Data Source (Option 2) The final deliverable from this WG will be a document summarizing a suggested framework to create a concept to code “black box” –Inputs to develop this document will come from SME presentations on Concept Mapping during the weekly meetings 9

10. Operations Working Group December 6, 2011

11. Discussed key challenges identified during panel discussion with Summer Concert Series participants –Legal challenges related to data use and data sharing Navigating the legal/regulatory terrain –Data validity Ensuring data accuracy Consistency of Clinical Concepts –Governance Which queries are allowed? Who can submit them? Automatic approval vs. manual approval by data partners (different levels of control) Are there different considerations for ‘Public to Private queries’ vs ‘Private to Private queries’? Should there be different levels of access for different classes of data users? Key Topics Covered/Discussed

12. Develop Sample Data Use Agreement – key terms required for Query Health Consider the role of an HIE as a data provider; Separates the data owner from the data steward. –May have impact on the policy sandbox. Provide best practice guidance where practitioners are running into differences in opinion on query requirements/regulations. Identify opportunities to lower the cost to establish a query network and run queries; need to ID highest impact opportunities without any change to regulations. –May be situational –May be domain dependent –May require help from ONC policy makers Proposed Work Products

13. Operations Workgroup Next Steps Draft Sample Data Use Agreement

14. Pilots Sub-Work Group December 6, 2011

15. Pilots SWG Update Pilots SWG kicks off Thursday, 12/8 via telecon and WebEx. –Wiki page has been established. –Kick-off agenda has been posted. –Initial invitations have been sent to S&I Framework distro list. Pilot Project Profile document has been composed and reviewed. –To be made available via Wiki page prior to kick-off meeting. –Used to qualify proposed pilots and to track development during project development. EHR & HIE vendors’ advisory meeting on mapping / loading internal datastores to query reference implementation datastore upcoming 12/15. –May help to accelerate pilot efforts.

16. Pilots SWG Next Steps Prepare overview of potential pilot projects emerging from the kick-off meeting. Ask potential pilot project participants to complete a Pilot Project Profile. –Post completed Pilot Project Profiles to Wiki space for consideration. Begin detailed pilot development timeline based on commitments from pilot participants, to be refined as commitments are made and planning progresses.

17. Technical Working Group December 6, 2011

18. Technical WG Update Successful Technical WG F2F Meeting conducted on 11/29/2011 in Washington D.C Purpose: –To solidify the details of the Query Health technical foundation and start creating a roadmap for recommending standards and creating a robust reference implementation. Rest of the slides are an update from the Technical WG F2F along with feedback from the WG call.

19. F2F Meeting Summary Results of the Meeting can be broadly classified into the following: –Identified the Query Health specifications and standards –Identified the components of the Reference Implementation and the components that we can leverage from the existing distributed query implementations to build the Reference Implementation –Identified a number of parallel work streams to document the specifications and standards and create the Reference Implementation –Actions and areas of concern that need to be further analyzed

20. Query Health Specifications and Standards Context Information Requestors Queries Results Queries Results Query Network CIM Responding Organization “1” Responding Organization “N” Four Areas targeted for standardization to promote interoperability 1.Query Envelope to package queries and results 2.Query Format to express queries in a declarative format 3.Results Format to express results in a declarative format 4.Query Data Model to promote common data element definitions across organizations

21. Query Health Specifications and Standards Specifications PurposeStandards Selected to create the specifications Rationale Query EnvelopeRequired to package queries, results and associated metadata in an interoperable manner PopMedNet QueryEnvelope The Query Envelope allows a generic way to package queries and results and is agnostic to the actual query or results and their formats. In addition the envelope carries the required metadata to enforce the Query Health security and policy sandbox requirements. Query FormatRequired to promote interoperability among the various query network participants within and across query networks HQMF * * - The existing standard has to be modified for Query Health purposes. The HQMF standard allows for expressing a large majority of queries related to Meaningful Use, ACO related queries, Comparative effectiveness, Population measures and basic research related queries. In addition it allows for Queries to be represented in a declarative fashion independent of the implementation language. For Queries which cannot be represented using HQMF the Query Health Reference Implementation will provide native format options to express queries. Results FormatRequired to promote interoperability among the various query network participants within and across query networks QRDA Category III ** ** - The existing standard will have to be analyzed further before finalizing. This was not discussed during the F2F but was mentioned a couple of times. The QRDA Category III allows for returning aggregate or summary level results that will be useful too report results for Meaningful Use, ACO, Comparative effectiveness results and many basic research results related to populations. In addition it allows for Results to be represented in a declarative fashion independent of the implementation language. For Results which cannot be represented using QRDA the Query Health Reference Implementation will provide other options based on MIME Types. Query Data Definitions Required to create executable queries and promote common data definitions between information requestors and responding organizations The Query Data Definitions will be created as part of the Query Health Initiative based on sections in C32. The Query Data Definitions will allow query composers to know what data exists for queries and also allows for a common definition of the data across organizations. The C32 sections were chosen as a source to identify the data elements since it is supported by a large majority of EMR’s.

22. Query Health Reference Implementation Top Level Components PopMedNet Components Standards Translation Components i2B2 Components hQuery Components hQuery Query Builder UX HQMF Query Builder UX PMN Portal PMN Data Client HQMF to Procedural Translator hQuery Execution Enginei2B2 Execution Engine Data Sources Native to QRDA Translator i2B2 Query Builder UX Results Viewer hQuery CIM (JSON) i2B2 CIM (STAR Schema) C32 or ETL Policy Enablement Components HQMF * JavaScript SQL Native Formats * QRDA Category III * - For Queries or results that cannot be translated to standards, native formats will be passed through the various components and will be executed successfully Query Envelope Requesting Organization Responding Organization

23. Work Streams for Reference Implementation PopMedNet Work Stream –Create the next version of PopMedNet which includes specifications and details that facilitate the integration of i2B2 and hQuery –Integration of i2B2 and hQuery via Plugins –Initial discussion on plugin architecture started at the F2F meeting. –Document the Query Envelope Standards and specification I2B2 Work Stream –Check the feasibility of mapping C32 to i2B2 STAR Schema –Work on i2B2 query handoff integration to PMN Portal –Work on PMN Data Client handoff to i2B2 hQuery Work Stream –Understand the C32 to JSON mapping for the user stories –Work on hQuery query handoff integration to PMN Portal –Work on PMN Data Client handoff to hQuery Standards Work Stream –Transforms from i2B2 and hQuery to HQMF –Query Builder Interface for HQMF (Possibly MAT from NQF) –Translation from HQMF to i2B2 and hQuery and handoffs with PMN Data Client –Native Results to QRDA Translation ---- **** New, was not discussed at F2F –Document the HQMF Changes Required / Constraints required / Implementation guidance –Document the QRDA Changes Required / Constraints required / Implementation guidance

24. Actions related to Work Streams Actions assigned to the Support Team: –Setup Google Code Repository for the Reference Implementation development –Coordinate the different work stream activities and setup appropriate off-line meetings to flush out details –Setup repository of C32 documents for usage within the RI –Setup meeting with EMR and HIE vendors to discuss C32 vs ETL vs other approaches to integrate Data Sources to CIM Model Area of Concern that was expressed and needs to be understood better –Post the Technical Approach document to the wiki for review and feedback by the group so that we can move towards consensus on the approach quickly.

25. Next Steps Review and Provide feedback on Technical Approach consensus document. Consensus starts later this week. Sign up and volunteer for the various work streams –Will be setting up wiki’s to perform the activities in the various work streams

26. Important Announcements Clinical Working Group Activities underway –Clinical Information Model (CIM) –Clinical Concept Mapping Operations Working Group Activities underway –Pilots Subteam Query Health Vendor Collaboration Advisory Meeting –Thursday, December 15, 2011, 11:00 am to 2:00 pm