Query Health Concept-to-Codes (C2C) SWG Meeting #11 February 28,

Today’s Agenda TopicPresenterTime Allotted Some general comments and thoughts on this groups tasks to date and next steps Mike Buck2:30 – 2:40 pm Review of Current and Future TasksPresha Patel2:40 – 2:50 pm Discussion of Recurring Key Themes Suggested inputs to Technical Expression Additional key themes to consider Presha Patel2:50 – 3:05 pm Integration of C2C to QH Technical Framework Query Composition Query Execution Dragon Bashyam3:05 – 3:30 pm Questions / CommentsAll3:30 onwards 2

C2CPresentation Series 3

Next Steps C2C Current and Future Tasks Current Tasks Standards Tools Distributed Query Networks C2C Output Summary of Various Approaches taken by Organizations Identification of Key Themes and Best Practices C2C Output Summary of Various Approaches taken by Organizations Identification of Key Themes and Best Practices List of Constraints to analyze Best Practices for QH within the Technical framework List of Constraints to analyze Best Practices for QH within the Technical framework Identify and assign Value Sets for a core set of data elements within the Harmonized QH CEDD as part of the Cross Walk Align Proposed Technical Expression with Existing Value Sets and Vocabulary Task Force Recommendations Develop Standardized Approach to Access Value Sets (IHE SVS Profiles, HL7 CTS & CTS 2) Dec 2011– February 2012 Feb TBD Conduct Environmental Scan Develop Technical Expression of C2C Technical Expression of C2C Approach as it Aligns with the Reference Implementation Identified Value Set Representations for core set of Data Element in the CEDD Selection of Existing Value Set in Alignment with the QH CEDD Reference implementation Guidance for QH Harmonized CEDD and Selected Value Set Technical Expression of C2C Approach Value Set Representation C2C Output Suggested Inputs Suggested Outputs Clinical CEDD Technical C2C / Technical Task Team 4 Value Sets A A D D C C B B

All Recurring Key Themes The below list includes themes across many of the different presentations to date. The next 2 slides address how these may be incorporated into the Technical Expression. 1.All mappings are Purpose and Goal Specific 2.Hierarchy within mappings is important to ensure the concepts are appropriately mapped and can be drilled down to a granular level 3.A centralized Data Dictionary or central Terminology System is used to store mappings and is common practice in many healthcare organizations 4.As Standards such as ICD9, SNOMED CT, LOINC etc. are modified and updated, ongoing maintenance of mappings can be challenging 5.Identifying a Best Match OR Alternate/Default Map is necessary since concepts may not always have an exact map 6.It is important to identify the context of the queries to understand what information is being requested (example - Ordered drug vs. Administered drug) 7.Ongoing maintenance of mappings is very resource intensive and requires dedicated skilled resources such as Clinicians/ Informaticists 8.Many mapping tools and resources are publicly available or accessible that can be leveraged by organizations and further developed, refined, and maintained for use 9.Most Concept Mapping tools maintain data in its original form 5

Recurring Key Themes – Direct impact to Technical Framework The below list includes themes across many of the different presentations to date. The key themes in blue below directly impact the Technical Framework of QH. All others are addressed on the next slide. 1.All mappings are Purpose and Goal Specific 2.Hierarchy within mappings is important to ensure the concepts are appropriately mapped and can be drilled down to a granular level 3.A centralized Data Dictionary or central Terminology System is used to store mappings and is common practice in many healthcare organizations 4.As Standards such as ICD9, SNOMED CT, LOINC etc. are modified and updated, ongoing maintenance of mappings can be challenging 5.Identifying a Best Match OR Alternate/Default Map is necessary since concepts may not always have an exact map 6.It is important to identify the context of the queries to understand what information is being requested (example - Ordered drug vs. Administered drug) 7.Ongoing maintenance of mappings is very resource intensive and requires dedicated skilled resources such as Clinicians/ Informaticists 8.Many mapping tools and resources are publicly available or accessible that can be leveraged by organizations and further developed, refined, and maintained for use 9.Most Concept Mapping tools maintain data in its original form 6

Recurring Key Themes Do not directly impact Technical Framework However, Important to consider While not all key themes on the last slide may directly impact the Technical Framework, it is important to consider some of the key themes seen in the C2C presentation series (in green below) 1.All mappings are Purpose and Goal Specific 2.Hierarchy within mappings is important to ensure the concepts are appropriately mapped and can be drilled down to a granular level 3.A centralized Data Dictionary or central Terminology System is used to store mappings and is common practice in many healthcare organizations 4.As Standards such as ICD9, SNOMED CT, LOINC etc. are modified and updated, ongoing maintenance of mappings can be challenging 5.Identifying a Best Match OR Alternate/Default Map is necessary since concepts may not always have an exact map 6.It is important to identify the context of the queries to understand what information is being requested (example - Ordered drug vs. Administered drug) 7.Ongoing maintenance of mappings is very resource intensive and requires dedicated skilled resources such as Clinicians/ Informaticists 8.Many mapping tools and resources are publicly available or accessible that can be leveraged by organizations and further developed, refined, and maintained for use 9.Most Concept Mapping tools maintain data in its original form 7

QH Technical Approach and Integration points to Concept to Codes Areas where the Concept to code integrates with the Technical Approach 8 Query CompositionQuery Execution The subsequent slides outline 1.Key Themes that may align with both Query Composition and Query Execution tasks (1-9) 2.Alignment of the 4 Tasks on Next Steps to integration points for Query Composition an Execution A A B B C C D D A A Technical Expression

Query Composition Key Themes + Future Tasks ModulePurposeStandards/SpecificationsCurrent RI Approach 1 – Purpose and Goal specific 2 - Hierarchy Concept Hierarchy Required to organize related concepts (for e.g. all cardio vascular concepts, Diabetes concepts etc. Tree structures, RDF etc..(Need to look at HL7 / IHE to see if there are any other standards that we can look at) i2B2 has used a hierarchical tree structure, this is built from NCBO ontology tree 1 – Purpose and Goal Specific 5 – Best Match and Alternate Default maps 6 – Identify Query Context Concept to Value Set mapping Mapping of the Concepts to the value set from one or more code systems (for e.g. Diabetes are associated with many codes from SNOMED and CPT) Value sets within Queries are represented using HQMF OID’s which are links to external value sets. Value Sets can be exposed and represented using IHE SVS, Need to have a bulk interface to expose/load value sets i2B2 uses XML but is not using any of the standards 1 – Purpose and goal Specific 8 – Publicly Available tools/resources Authoritative Organization for Value Sets Provide a set of curated value sets and has good governance process to accept changes and modify existing value sets NQF, UMLS, CDISCi2B2 uses NCBO but unsure if NCBO maps to standard code systems …like NQF does 1 - Purpose and Goal specific 6 – Identify Query Context Value Set Creation Creation of small value sets for research purposes using standard code systems Ontology Browsing standards maybe using RDF kinds of standards Tools that can be exposed using standard interfaces so that a person can browse and pick the codes that they want to be part of the concept. NCBO has a simple REST interface, UMLS, IHTSDO all have tools for these i2B2 has an approach that can be looked at here. 9 C C C C B B CEDD + VS Identify VS A A Technical Expression

Query Execution – Options Applicability of the C2C work depends on the configuration of the data source and the potential execution models listed below 10 ModulePurposeStandards/SpecificationsCurrent RI Approach Value Set TranslatorRequired to translate standard codes/value sets to local codes using some sort of local mapping Ontology Browsing standards maybe using RDF kinds of standards to determine mappings for local codes/value sets to standard code sets/value sets. i2B2 has an approach that can be looked at here. The approach uses NCBO browsing capability that can be leveraged. ModulePurposeStandards/SpecificationsCurrent RI Approach Terminology Translator Required to map codes/value sets from one code system to codes/value sets from a different code system CTS2 standard, LexEVS, UMLS have approaches to do this i2B2 does not do this currently in any form ModulePurposeStandards/SpecificationsCurrent RI Approach No additional workNA Execution engines will use the standards based Query and associated value sets to execute the query Data Source Option #1: Data Source is using schema based on Query Health CEDD. Vocabularies represent CEDD chosen vocabularies for representing the data elements and the data values Data Source Option #2: Data Source is using native/local schema. Vocabularies represent local vocabularies and are not mapped to any standards Data Source Option #3: Data Source is using standards not aligned with Query Health CEDD. Vocabularies could be mapped to code systems which are not what we recommend (for e.g CPT vs SNOMED) and may also mix in local vocabularies D D Standardized approach to access VS A A Technical Expression