1. Query Health Distributed Population Queries Implementation Group Meeting October 4, 2011

2. Participation Instructions for WebEx Please Note: This session will be recorded Lines are open so please mute your line to avoid “Music on Hold” 1.Select the “Q&A” button in the WebEx toolbar. 2.Select “All Panelists” in the Q&A box. 3.Type your question and hit send. 4.We’ll call on you to state your comment / question.

3. Agenda Summary of Last Meeting & Reminders WG updates Clinical Technical Business Charter – Final Call for consensus Discussion Forums Open discussion / Next Steps

4. Query Health Scope and Approach Practice drives standards 1.Rough consensus 2.Running code (open source) 3.Pilot 4.Specifications 5.Standards HIT Policy Committee: Policy Guideposts

5. Query Health Where We are

6. Query Health Calendar Implementation Group Tuesdays 1:30pm-3:00pm EDT Clinical Work Group Wednesdays 12pm-1pm EDT Business Work Group Thursdays 11am-12pm EDT Technical Work Group NEW TIME Thursday 2:00 pm-3:00 pm EDT First Face to Face Meeting October 18-19

7. Current Query Health Workgroup Leads

8. Query Health Who’s participating (As of 9/27) 100+ Participating Organizations – Public Health Agencies – Health IT Vendors – Health Information Exchanges – Academic Partners – Health Systems – Patient Advocacy Organizations

9. Recap of Last Meeting Reviewed Query Health Scope, Approach, Timeline, and Organization Reviewed activities of each working group Clinical – Use Cases, User Stories, Clinical Information Models Technical – Architectural principles, technical standards / specifications, design of pilot implementations Business – best practices for privacy, data use, network partner coordination Discussion on Implementation Workgroup activities

10. Action Items DescriptionOwnerStatusDue DateNotes Review changes to the charter and provide comments for consensus by 9/29/2011 Working Group Participants Closed9/29/2011Consensus completed Consensus voting on Generic User Story ENDS 10/4/2011 Working Group Participants Open10/4/2011Consensus voting comments to be worked on at 10/4 meeting Register and arrange for travel for the October Face to Face meeting Working Group Participants Open10/7/2011Registration extended an additional week Choose leaders for each of the Work Groups Working Group Participants Closed10/3/2011Each WG now has volunteer leads in place

11. Clinical Working Group Update from 9/21 Meeting

12. Presented & Discussed Community User Story proposals –Inpatient & Outpatient –All Hazards User Story (Presented by Taha Kass- Hout) Reviewed updated Generic User Story (Presented by Michael Buck)Generic User Story The community was asked to provide feedback on the Generic User Story last week Key Topics Covered/Discussed

13. User Story NameLeads & ContributorsExpected Presentation Date Link Example User Story – Case Control, Statin Efficacy Working Group Participants9/21/2011Example User Story – Case Control, Vaccine Efficacy Example User Story – Case Control, Vaccine Efficacy Working Group Participants9/21/2011Example User Story – Case Control, Statin Efficacy Expanded Analysis User StoryKim Nolen (Lead), Lindsay Hoggle9/21/2011Expanded Analysis User Story Generic User StoryMichael Buck, Susan Campbell9/14/2011Generic User Story Consumer Perspective User StoryEva Powell9/14/2011Consumer Perspective User Story All Hazards User StoryTaha Kass-Hout9/28/2011All Hazards User Story Hypothesis Generation User StoryDavid McCallie9/28/2011Hypothesis Generation User Story Hospital Inpatient Quality Reporting Program Myocardial Infarction CQM Anne KlingSubmitted via Email Hospital Inpatient Quality Reporting Program Myocardial Infarction CQM Trends in Use of Medical Products in the Inpatient Setting User Story Jeff Brown9/28/11Trends in Use of Medical Products in the Inpatient Setting User Story OutpatientMichael Brody9/28/11Outpatient User Story User Story Recap

14. Decisions Michael Buck was chosen as Working Group lead. A second lead can be added in the future. The Working Group members decided it would be best to have the Generic User Story be included as part of the Use Case supplemented by 1-2 additional User Stories. Work Assignments/Next Steps Query Health Clinical Working Group Call for Consensus –Generic User Story –Ranking of User Stories –Deadline for submitting consensus vote is COB (8 PM ET) October 4 th (TODAY!!) Key Decisions & Next Steps

15. Business Working Group Update from 9/28 Meeting

16. Defined Goals of Business Working Group Documented and Detailed the Operations Requirements (was Business Requirements) for User Stories and inclusion in the Use Case and Requirements document being prepared by Clinical Working Group;Operations Requirements Ensure linkage between the Query Health Initiative and the guidance received from the Health IT Policy Committee (HITPC) and the Privacy and Security Tiger Team, and; Preparation of guidance documents (as prioritized by the work group), such as those related to: Adherence to privacy and security requirements and considerations; Evaluation of transaction cost / time to implement distributed queries; Other operational guidance (or feedback to other responsible groups) Merideth Vida, Support Team Lead for the Clinical Working Group, presented an overview of the Query Health Generic User Story and invited the Business Workgroup members to review and provide feedback. Key Topics Covered/Discussed

17. Business Working Group Key Decisions and Next Steps Decisions Alice Leiter chosen as Working Group lead. –Work Assignments/Next Steps –Review and populate the Operations Requirements Matrix spreadsheet (columns D and E) Focus on Generic User Story –Review the Query Health Operations Requirements-Narrative document for context on business requirements –Review Generic User Story for any privacy/security implications that need documentation –Workgroup focused on providing Business Requirements for each user story and documenting additional requirements needed for distributed queries

18. Technical Working Group Update from 9/28 Meeting

19. The WG Lead is requesting a change in the meeting time to support a broader base of potential participants Currently Wednesday 3-4pm ET or Thursday 2-3 pm ET are open and can be used with minimum conflicts with other initiatives. Group will be polled for preferences and notice will be sent out Technical Workgroup Meeting Time Adjustment

20. Technical WG Update Discussed the Abstract Model in detail Addressed the various discussion posts and followed up with others Refined the abstract model based on the discussion Refined the Query Life Cycle and added/clarified terminology

21. Discussion Items from Posts and Resolutions Incorporated Discussion PostResolution Separation of Authorization and Trust (Arien M/David M/John M/Jeff B) Clarified that the Gateway will have an authorization layer different from the Trust establishment layer Support for Intermediate conversations between Agent and Gateway (Rob Rosen) Accommodated by Submitting queries, obtaining results and refining queries based on results and resubmitting queries Support for Intermediaries or Trusted Third Parties (Rob Rosen) Clarify that the Agent can act as a Smart Agent and can meet the needs of Intermediaries. In the abstract model, split out the Agent and Aggregator into it's own box (Instead of having it as part of the Requestor) and rename composer to Query UX and put it in its own box. Composer / Agent / Aggregator relationship (Rob Rosen/Marc H) In the abstract model, split out the Agent and Aggregator into it's own box (Instead of having it as part of the Requestor) and rename composer to Query UX and put that in its own box. Query Envelope and Security/Trust Information (Marc H/Rob R) The envelope will contain sufficient security information to allow the gateway to make the identity/trust and authorization decisions. The details of the exact security information will be worked out as the Technical WG proceeds further. Support for Multiple Query Types (Marc H)Goal is to support two types in pilots; one very simple and one more complex to support the clinical workgroup user stories. Periodic Time based Queries (Publish/Subscribe) – Mike Buck Added Orchestrator to mange the necessary state and other relevant information related to time based or publish/subscribe type of queries. Notes on Abstract Model – Bobby LeeFollow up with Bobby.

22. Query Lifecycle 1.Requestor optionally uses a query builder user interface to create a query and submits it to their dedicated orchestrator. 2.The orchestrator determines at what time and frequency the query should run (one time, monthly, etc.) and submits the query when appropriate to its agent. 3.Agent submits the query over the Internet to each participating responder’s gateway and awaits responses. Gateways may provide a number of services: additional authorization, manual review, etc. 4.The standard gateway passes accepted requests to a site-specific adapter. 5.The adapter calculates site results for their site and returns them to the gateway. 6.The gateway returns site results to the appropriate agent. 7.The agent returns site results to the aggregator that combines site results into combined results 8.The aggregator makes interim and final results available to the requestor. Agent Gateway Adapter Query Builder UX Aggregator Clinical Data Clinical Data Authorized Requestor 1a 1b 4 5 6 3 8 Responder “1”Responder “N” … Orchestrator 2 7

23. Next Steps and Actions Posted the Abstract Model for Technical WG consensus Don’t forget to review and vote by October 5, 2011 Will be discussing the outcome of Abstract model consensus Validate Abstract Model using User Stories from Clinical WG

24. Charter Voice Vote Approval? All comments from the Initiative members have been received and dispositioned Consistent and rigorous focus on access to clinical data sources for queries Timeline driven by community as the workgroups evolve Identification, not definition, of standards Leverage and consideration of existing standards and technologies Work has been done to ensure outreach to any individuals/organizations with NO votes How would the Implementation Workgroup like to proceed?