Query Health Technical WG 3/15/2012

Agenda TopicTime Slot Administrative stuff and reminders2:05 – 2:10 pm RI Update2:10 – 2:20 pm QRDA Specification Update Query Envelope Update 2:20 – 2:40 pm C2C WG Update2:40 – 2:50 pm

Administrative Reminders S&I Framework F2F – Alexandria, VA Query Health stream of activities April 11 th to 13 th Wednesday Afternoon 1pm EST to Friday 3pm EST. Alexandria Westin: – Address: 400 Courthouse Square, Alexandria, VA, – Phone: – Website: – Public Transportation: King Street Metro (Blue/Yellow Lines) – 3 Blocks Ronald Reagan Airport (DCA) – 6 miles Booking Accommodations: –See F2F Logistics page on wiki for detailsF2F Logistics – Phone: – Rate: $169/night (excluding tax) This rate is only available through 5pm ET on April 2 Group rate includes free wireless in all guest rooms

RI Update RI Repository Link: PopMedNet Working on reconciling the multiple code branches - created for HIMSS Working on releasing a version for MDPHNet at the end of the month/first week of April. Analyzing the Query Envelope gaps to finish the PopMedNet Policy Implementation hQuery Finishing the cleanup, Brought the branches back together Worked on the increasing the test coverage on the query gateway – 100% hQuery Gateway can Accept HQMF or Native Java Script queries now Start working on enhancing HQMF Execution… Process i2B2 XML Translators New Version of i2B2 XML to HQMF Translator from Keith Boone on the Repository HQMF to Java Script Translator from Marc Hadley on the hQuery Repository i2B2 Create a mapping of CEDD to the i2B2 Schema – directly useful to NY Pilot Complete Translator work for HQMF i2B2 XML to HQMF HQMF to i2B2 Native query

i2B2 HQMF Translator work Cleanup Demographics processing Handle State, City and Zipcodes Handle Address Handle Gender Handle Marital Status Handle Race Handle Religion Processing Classifiers Handle Patient counts Handle Stratification by Gender Handle Stratification by zip codes Handle Stratification by Practices Handle Lab Results Handle Non numbers for tests Support for Additional Sections / Criteria Add support for encounters Add support for medications Add support for procedures

QRDA Updates QRDA IG document in progress and hope to review soon. Draft posted: Srinivas has represented NQF 59 results Posted on the Google Code Repository: Update from Srinivas based on Review last week

 QRDA Header  QRDA Body  Reporting Parameters Section  MeasureSet Section  Measure Section  MeasureSet Section  Measure Section  QRDA Header  QRDA Body – Reporting Parameters Section – Measure Section Edits to QRDA Cat-III structure As per draft standard 7 For Query Health

 CONF-QRDA-III-20: A QRDA Category III report SHALL contain at least one and MAY contain more than one Measure Set section containing information about the measure set.  CONF-QRDA-III-20: A QRDA Category III report MAY contain one or more Measure Set sections containing information about the measure sets. Edits to QRDA Cat-III draft standard As per draft standard 8 For Query Health Rationale: The HQMF query addresses only a single measure, not a Measure Set, so it is recommended to make Measure Sets optional in the response.

 CONF-QRDA-III-21: A QRDA Category III report SHALL contain at least one and MAY contain more than one Measure section, each containing information about a single measure.  CONF-QRDA-III-21: A QRDA Category III report SHALL contain exactly one Measure section, containing information about a single measure. Edits to QRDA Cat-III draft standard (contd.) As per draft standard 9 For Query Health Rationale: The HQMF query addresses only a single measure, so it is recommended to remove results for multiple measures in the response. However a Query envelope may contain multiple QRDA cat-III responses

Using business names … In HQMF standard, it is recommended to go for business names as HQMF uses section, entry, and sourceOf in many places. The rationale is that the semantics of these items are expressed in etc., in the XML and this makes the XML difficult for readers to understand. But in my opinion, this XML is meant for computers, not for humans. Also in QRDA cat-III response, unlike HQMF, one can’t find so many sections, entries etc. Further unlike HQMF, the QRDA Cat-III is built on top of HL7 CDA and is a peer to HL7 CCD, which is more widely used Recommendation: Do not use business names in QRDA cat-III 10

Using CLASSIFIERS … In HQMF standard proposed edits, there is a mention of CLASSIFIERS to enable Measure (Query) results to be broken down by population subgroups: e.g., age range, gender, race/ethnicity. But this may call for addition of another new SECTION in HQMF other than Data Criteria and Population Criteria; which is I don’t see in that proposal. However CLASSIFIERS are supported by the way of “measure-specific grouping data elements” of Measure Section in the QRDA Cat-III response 11

Referencing HQMF query in QRDA Cat-III Need: QRDA Cat-III response needs to contain the reference to HQMF query that is being used to create this response Recommendation: Use the “relatedDocument” element in QRDA Header to capture the HQMF query information in the QRDA cat-III response (though the original intent of relatedDocument is to connect the parent document and it’s child document. However here it is being used to connect a query and it’s response) 12

Query Envelope Discussion Security Risk Analysis – First Pass completed. Special Thanks to John Moehrke for facilitating the Analysis. Three Different Spreadsheets Consolidated Risk Analysis for both use cases expecting Aggregated and Non- Aggregated (PHI) results. Risk Analysis for Use Cases expecting Aggregated data as query results Risk Analysis for Use Cases expecting Non-Aggregated (e.g PHI) data as query results Review and provide feedback on the Risks / Mitigation steps identified.

C2C - Summary of Decisions and Suggested Next steps 1.Healthcare Industry has a significant gap in creating, managing and publishing “Value Sets” mapped to common concepts. –Community recommends to the HITSC to work with organizations such as NLM, NQF and others to set up the above capability. 2.For Query Health, one suggestion was to start with NQF CQM based Value Sets and improve from there. –This is a very good source as evidenced by the community and Query Health will start from these value sets. 3.In order to share value sets in a standard way, Query Health will adopt the IHE SVS Restful web service approach and will pilot that using the NQF Value Sets. 4.The CEDD is a significant specification to promote common definitions of queries across multiple Data Sources –Enhance the CEDD to include the vocabulary mapping, value sets for elements where applicable and map to the reference implementation frameworks of i2B2, hQuery and PopMedNet to ensure completeness 5.Multiple tools and interfaces can be used for Query Composition, but simple intuitive ways are necessary and the concept hierarchy representation of i2B2 has been proven to work in the real world. –Adopt i2B2 approach and create the hierarchy for Query Health pilots.

Next Steps for C2C Activities Activity 1 will be performed by the Initiative Coordinator / ONC as part of their regular briefing to HITSC Activities 2 (NQF VS) and 4 (CEDD enhancement) will be part of the CEDD work stream in the Clinical WG Activities 3 (IHE SVS Profile) and 5 (i2B2 Concept Hierarchy) will be part of the Technical WG

Specification Updates HQMF IG document in progress and hope to review soon. Draft posted: Query Catalog for sample query representation and validation posted on wiki Draft posted: Need volunteers to fill this out, one query at a time. CEDD Draft Specification posted: %29http://wiki.siframework.org/Query+Health+Clinical+Element+Data+Dictionary+%28CEDD %29

Next Steps Specification Reviews Review Query Envelope Risk Analysis and provide feedback Feedback on QRDA activity. Specification Usage Volunteers needed to represent Sample Queries using revised HQMF models and schemas. Volunteers requiring access to the code repository Please sign up for a google account at Project Repository - Sign up for the RI at