1. Query Dispatch and Aggregate QDA Work Item Proposal October 2014 Vincent van Pelt (Nictiz) Mark Sinke (ForCare) Walco van Loon (ForCare) Albert-Jan Spruyt (Nictiz)

2. QDA - Business needs  Healthcare information is generated and stored in different systems.  For the exchange of information, relevant selections have to be collected from these different systems to create up-to-date summaries.  These summaries contain information coming from a combination of live databases and/or already existing documents.  Within a healthcare organization, summary documents are currently generated by software that queries the different systems using HL7 queries and/or proprietary connections, and then aggregates the results of these queries into a report, a discharge letter, a patient summary, a medication overview, et cetera.  But when cross-organizational information is needed, proprietary connections are not an option.  This calls for a generic, standardized, sustainable and scalable mechanism that collects information ‘building blocks’ from different sources (live databases or existing documents) and then aggregates them into a summary document.  Create a profile that formalizes multi-query dispatching creation and result aggregation

3. QDA - Use Cases  On-Demand Medication Overview  Prescriptions  Dispensations  Allergies, contra-indications  Relevant diagnoses  Relevant lab results  On-Demand Patient Summary  Up-to-date information from multiple systems: lab, diagnoses, allergies, medication, diagnostic studies, medical history,...  On-Demand Emergency Care Summary  Combined information from emergency call center, ambulance, Emergency department, ICU  On-Demand Laboratory List  Aggregated overview of laboratory results from different dates and locations, optionally in combination with other relevant medical information  On-Demand Integrated Care Overview  Combined information from PCP, dietician, physiotherapist, laboratory, …

4. QDA Query Dispatch and Aggregate Generic profile for the on-demand creation of multi-source summaries and aggregated reports (ITI) Can be configured with a combination of a predefined master template, and several predefined query result templates and for the aggregation into one document (PCC) Basic Process : 1. One report request  simple parameters 2. starts a set of subqueries to multiple data sources [Actor: Query Distributor]  sends out queries to multiple data sources (with different query methods)  collects the pre-defined results (in a predefine format) from these sources  stores the results in a submission set in the XDS environment 3. The resulting documents are then aggregated [Actor: Results Aggregator]  parameters: master template document, and location of the submission set  filling the master report template through XML-transformation  Optional: reconciliation and re-ordering of information, signing, encryption 4. One report result  Query Distributor returns the result in a predefined format (of the master template)

5. XDS Provide and Register Document Set (ITI-41) Retrieve Document Set (ITI-43) Register Document Set (ITI-42) Registry Stored Query (ITI-18) Document Registry Document Registry Document Source Document Source Document Repository Document Repository Document Consumer Document Consumer

6. Register On-Demand Document Entry (ITI-61) XDS + ODD Provide and Register Document Set (ITI-41) Retrieve Document Set (ITI-43) Register Document Set (ITI-42) Registry Stored Query (ITI-18) Document Registry Document Registry Document Source Document Source Document Repository Document Repository Document Consumer Document Consumer On-Demand Document Source On-Demand Document Source

7. Register On-Demand Document Entry (ITI-61) XDS + ODD (+ persistent storage) Provide and Register Document Set (ITI-41) Retrieve Document Set (ITI-43) Register Document Set (ITI-42) Registry Stored Query (ITI-18) Document Registry Document Registry Document Source Document Source Document Repository Document Repository Document Consumer Document Consumer On-Demand Document Source On-Demand Document Source Provide and Register Document Set (ITI-41)

8. Register On-Demand Document Entry (ITI-61) XDS + ODD + ? Provide and Register Document Set (ITI-41) Retrieve Document Set (ITI-43) Register Document Set (ITI-42) Registry Stored Query (ITI-18) Document Registry Document Registry Document Source Document Source Document Repository Document Repository Document Consumer Document Consumer On-Demand Document Source On-Demand Document Source Provide and Register Document Set (ITI-41) Not defined how this profile creates the on-demand document

9. Register On-Demand Document Entry (ITI-61) QDA Provide and Register Document Set (ITI-41) Retrieve Document Set (ITI-43) Register Document Set (ITI-42) Registry Stored Query (ITI-18) Document Registry Document Registry Document Source Document Source Document Repository Document Repository Document Consumer Document Consumer On-Demand Document Source On-Demand Document Source QDA Provide and Register Document Set (ITI-41) EHR Pharmacy Laboratory Radiology Pathology Nursing 1: Dispatch queries 2: Aggregate results CDA results CDA results Create Multi-Source Summary (ITI-xx) CDA Master template

10. QDA - Query Dispatch and Aggregate Query DispatcherResults Aggregator

11. Remarks  Some parts of the core functionality can be covered by existing profiles. However, some functionality is missing:  Receiving one report request, and then sending a number of preconfigured subqueries  Configuration of multi-source query summaries  Transforming information from different sources into one document  QDA is the content-agnostic tool that can be used to create specific multi-source summaries, by using predefined sets of structured documents. Questions  It would be useful if a generic ODD document reference would be available for all patients. Generic ODD documents would be possible for patient that is selected in the EHR, without actually adding another record in the Registry for each and every patient.  Currently, all records in the Registry are linked to a specific patient. The template documents for the master template (but also for the creation of a new XDW document) could also be stored in the XDS Registry if these documents could be stored without the link to a patient. Is there a possibility to store documents that are not patient-specific?

12. Configuration Report request: MedSumm 1 Report ID Master template ID Use RECON? Use DEN? Use DSG?Use MCV? MedSumm 1MedSumTempl1YNNN MedSumm 2MedSumTempl2NNNN PatientSumm 1PatSumTempl1NYYN LabSumm 1LabSumTempl1NYYY

13. Configuration Report request: MedSumm 1 Report ID Query ID Query Method Target OIDResult Template OID Query parameters Query standard xx MedSumm 1MedPrescrHL7 Query PCP APRE… MedSumm 1MedPrescrHL7 Query Hospital BPRE… MedSumm 1MedDispHL7 V2Pharmacy XDIS… MedSumm 1MedLabDataQEDLaboratory YLAB-x… MedSumm 1MedDiagDataXDSEMR-Hospital ZDIAG-x… PatientSumm 1 DiagData………… PatientSumm 1 LabData………… Query result 1 Query result 2 Query results.... Report result: MedSumm 1 Aggregation

14. QDA parameters Report ID Requestor ID Patient ID Summaryformat Collate Reconcile From-datetime To-datetime ToFormat HL7 CDA HL7 V2 message HL7 V3 Message XML document Request Report ID Requestor ID Patient ID Query ID Target ID Query Method XDS Retrieve Document Set XCA Query and Retrieve HL7 Care Record Query QED RESTful: FHIR, JSON, MHD Web Service Required document template (OID) Distribute ‘Stitch’, collate to 1 doc Use RECON to reconciliate Message wrapper? Aggregate

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