1. Data ccess Framework All Hands Community Meeting March 12, 2014

2. Meeting Etiquette Remember: If you are not speaking, keep your phone on mute Do not put your phone on hold – if you need to take a call, hang up and dial in again when finished with your other call – Hold = Elevator Music = very frustrated speakers and participants This meeting, like all of our meeting is being recorded – Another reason to keep your phone on mute when not speaking Feel free to use the “Chat” feature for questions, comments or any items you would like the moderator or participants to know. NOTE: This meeting is being recorded and will be posted on the Wikipage, under “Past Meetings” after the meeting From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute 2

3. Agenda TopicEstimated Time Presentation from the S&I Clinical Quality Framework10 minutes Update: DAF/IHE White Paper10 minutes Candidate Standards Analysis (MHD, FHIR, Standards Spreadsheet) 35 minutes Next Steps/Questions5 minutes 3

4. Notional Project Timeline S&I Lifecycle (Discovery  Pilot & Evaluation) Today 3/12 February May Signifies milestone or deliverable March AprilJune Define Use Case & Functional Requirements Define Use Case & Functional Requirements Discovery (Use Case 2) UC 2 Consensus (2/5) Draft DAF/IHE White Paper Complete (2/28) DAF/IHE White Paper Published January 2014 UC 2: Targeted Data Access: Inter- Organizational Query Implementation (DAF/IHE Community) DAF IHE/ S&I Joint Work Group IHE Activities Publish DAF/IHE White Paper IG Consensus Implementation (S&I Community) Candidate Standards Analysis TWG 1: Document Metadata based access for LDAF & TDAF Finalize Actors + Transactions + Technology Stacks and Standards Create IG’s based on existing standards Create SWG to modify/add standards as necessary Update IG’s based on SWG output Candidate Standards Analysis Finalize Actors + Transactions + Technology Stacks and Standards Create SWG to profile standards for data element access TWG 2: Data Element based access for LDAF & TDAF White Paper Comment Period

5. Clinical Quality Framework Initiative Launch March 21, 2014 12-1pm cqframework.info Co-Coordinator: Ken KawamotoCo-Coordinator: Marc Hadley ONC Sponsor: Alicia MortonCMS Sponsor: Minet Javellana ONC Sponsor: Lauren RichieProject Manager: Bridget Blake

6. 6 The standards used for the electronic representation of CDS and CQM were not developed in consideration of each other, and use different approaches to patient data and computable expression logic Adhering to different standards places an additional implementation burden on vendors and providers with homegrown systems It is currently difficult to share logic between eCQMs and CDS rules Clinical Quality Framework Initiative: Background, Patient DataComputable Expression Logic Clinical Decision Support  Virtual Medical Record (for both physical and logical models)  CDS Knowledge Artifact Implementation Guide Electronic Clinical Quality Measurement (eCQM)  Quality Reporting Data Architecture (for physical model)  Quality Data Model (for logical model)  Health Quality Measure Format (for physical model)  Quality Data Model (for logical model)

7. Clinical Quality Framework Value Statement CDS and eCQM are both important aspects of clinical quality improvement (CQI). Harmonizing the electronic standards used for these two domains will have a number of important benefits including: –Reduced burden on implementers. –Increased re-use of expressions from eCQM in CDS and vice versa. –Improved standards quality through the unification of community effort.

8. Clinical Quality Framework Draft Scope To identify, define, and harmonize electronic standards that promote integration between Clinical Decision Support (CDS) and electronic Clinical Quality Measurement (eCQM) in the areas of: –Metadata: Identify common metadata across the two domains and harmonize the identification and representation of that metadata –Patient Data Model: Develop a patient data model that supports the requirements of eCQM and CDS –Logical Expression Language: Develop a common expression language that can be used to define both CDS and eCQM logical expressions. To refactor existing CDS and eCQM standards to utilize the harmonized standards. To the extent possible, to pilot the standards and refine them accordingly. To engage the clinical quality community to optimize the rigor and usability of the harmonized CDS and eCQM specifications. Note: Out-of-scope items will be identified by the Clinical Quality Framework initiative team during the discovery phase.

9. Clinical Quality Framework Call for Participation The kickoff will be on 3/21/14 from 12-1 p.m. –https://siframework1.webex.com/siframework1/onstage/g.php?t=a&d=669782317https://siframework1.webex.com/siframework1/onstage/g.php?t=a&d=669782317 –Dial In: 1-650-479-3208 –Access code: 669 782 317 Community involvement in the harmonization of the eCQM and CDS standards gives participants the following: –The ability to accelerate the standards development process –Early access to standards under development for internal prototyping, etc. We are seeking volunteers for the following: –Use Case Sub-team Lead(s) –Standards Editorial Sub-team Lead –HL7 Clinical Decision Support Work Group Liaison –HL7 Clinical Quality Information Work Group Liaison –HL7 Structured Documents Work Group Liaison Sign up at http://wiki.siframework.org/Clinical+Quality+Framework+Join+the+Initiativehttp://wiki.siframework.org/Clinical+Quality+Framework+Join+the+Initiative

10. Data Access Framework Technical Work Group March 12, 2014

11. 11 DAF Technical Work Group Abstract Model

12. 12 Transactions/Queries Required for DAF Find Document(s) based on Patient Identifiers Find Document(s) based on Patient Demographics Get Document(s) based on Document Identifiers Get Document(s) based on Patient Identifiers Get Document(s) based on Patient Demographics Get Document(s) for Multiple Patients based on Patient Ids Supply and Consume User Assertions Capture Patient Consent Find Patient Identifiers based on Patient Demographics Find Patient Demographics based on Patient Id DAF Queries for Document Metadata Based Access

13. Document Metadata Based Access Using FHIR - Analysis 13 FHIR Client FHIR Server XDS Repository FHIR Repository Other Repository Query Results

14. Document Metadata Based Access Using FHIR – Analysis CONTINUED 14 Document Handling Resources Document Reference (Reference to existing XDS or other documents) Document Reference Document Manifest (Collection of Document References) Document Manifest Composition (To compose documents) Composition Bundles and Tags (To provide list of documents, security labels and metadata using tags) Bundles and Tags

15. Document Metadata Based Access Using FHIR – Analysis CONTINUED 15 Adoption of FHIR for DAF will require at a minimum Creation of a Profile or use the existing FHIR XDS profile for Document access using Document Reference and Document Manifest FHIR XDS profile will have to be analyzed to determine how well it maps to existing XDS infrastructure Create a Profile for using the Document Composition resource as appropriate

16. Document Metadata Based Access Using MHD – Analysis 16 MHD profile supports the following transactions which are relevant to DAF Get Document Dossier – This transaction is used to get the metadata related to a particular Document Entry. Find Document Dossiers – This transaction is used to provide parameterized queries that result in a list of Document Entries. Get Document – This transaction is used to get a single document.

17. Document Metadata Based Access Using MHD – Analysis CONTINUED 17 IHE is planning to align MHD to FHIR this year So the existing MHD profile is expected to change and be more aligned with FHIR Need to determine path forward in terms of MHD and FHIR and their potential alignment Will be having more discussions on this topic to understand timelines/alignment objectives and other aspects

18. Candidate Standards Spreadsheet 18 Discussion of Standards Spreadsheet

19. Next Steps Attend our next All Hands call on Wednesday, March 19 th, at 12:00 pm (EST) where we will: ‾Analyze candidate standards and their maturity for DAF Document Metadata based access ‾Discussion of Direct for DAF Document Metadata based access ‾Document and publish Candidate Standards spreadsheet for community access as a Google Spreadsheet 19

20. Document Metadata Based DAF Queries to IHE Profiles Mapping (Initial Version) 20 Transactions/Queries required for DAF TransportLDAFTDAFFDAF Find Patient Identifiers for Patient Demographics SOAP PIX/PDQv3PIX/PDQv3 - ITI 45, ITI 47 PIX/PDQv3PIX/PDQv3 - ITI 45, ITI 47 XCPDXCPD – ITI55 XCPDXCPD – ITI55 REST GAP (In progress in IHE) Find Document(s) based on Patient Identifiers SOAPXDSXDS – ITI 18 XDSXDS – ITI 18 XCAXCA - ITI 38 XCAXCA - ITI 38 RESTMHDMHD – ITI 66, ITI 67?? Find Document(s) based on Patient Demographics SOAPGAP RESTGAP Get Document(s) based on Document Identifiers SOAPXDSXDS – ITI 43 XDSXDS – ITI 43 XCAXCA - ITI 39 XCAXCA - ITI 39 RESTMHDMHD – ITI 68?? Supply and Consume User Assertions to support security aspects of the query SOAP XUAXUA – ITI 40 BPPC XUAXUA – ITI 40 BPPC XUAXUA – ITI 40 BPPC RESTIUAIUA - ITI Y1, ITI Y3IUAIUA - ITI Y1, ITI Y3IUAIUA - ITI Y1, ITI Y3

21. Questions 21

22. Data Access Framework Resources DAF Wiki Homepage – http://wiki.siframework.org/Data+Access+Framework+Homepage http://wiki.siframework.org/Data+Access+Framework+Homepage Become a Community Member – http://wiki.siframework.org/Data+Access+Framework+Join+the+Initiativ e http://wiki.siframework.org/Data+Access+Framework+Join+the+Initiativ e DAF Charter – http://wiki.siframework.org/Data+Access+Framework+Charter+and+Me mbers http://wiki.siframework.org/Data+Access+Framework+Charter+and+Me mbers DAF Standards, Harmonization and Implementation Activities – http://wiki.siframework.org/DAF+Standards+Harmonization+and+Imple mentation http://wiki.siframework.org/DAF+Standards+Harmonization+and+Imple mentation Standards and Interoperability(S&I) Framework – http://wiki.siframework.org/Introduction+and+Overview http://wiki.siframework.org/Introduction+and+Overview S & I Calendar of Events – http://wiki.siframework.org/Calendar http://wiki.siframework.org/Calendar 22

23. 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 Use Case Development: – Presha Patel presha.patel@accenture.compresha.patel@accenture.com – Hema Patel hema.patel@accenture.comhema.patel@accenture.com Standards Support: – Angelique Cortez angelique.j.cortez@accenture.comangelique.j.cortez@accenture.com Vocabulary and Terminology Subject Matter Expert: – Mark Roche mrochemd@gmail.commrochemd@gmail.com 23