1. Query Health Vendor Advisory Meeting 12/15/2011

2. Agenda Provide Overview of Query Health Seek Guidance and Feedback on Integration Approaches

3. Query Health Objective Enable a learning health system to understand population measures of health, performance, disease and quality, while respecting patient privacy, to improve patient and population health and reduce costs.

4. Query Health Roadmap 4 Expected to create the necessary specifications and recommend standards that will be Proven in Pilot Implementations Allows Organizations to compute population level summaries for various use cases Eventually be part of MU Roadmap once HITSC and ONC approves the standards Vendors will be asked by organizations to incorporate or integrate with Query Health CEDD specifications and standards to support population measures

5. Improve community understanding of patient population health Clinical Information Question Aggregate Result Clinical Information Questions about disease outbreaks, prevention activities, health research, quality measures, etc.

6. Distributed Query Networks, Voluntary, No Central Planning Community of participants that agree to interact with each other. There will be many networks; requestors and responders may participate in multiple networks. The network will enforce an initial, but not necessarily final, authorization boundary. Authorized Requestors Participating Responders Query

7. Use Cases and Requirements Focus on the data from the clinical record (e.g., EHRs, HIEs, payer clinical repositories, PHR, etc.) User stories –Generic – for general distributed queries, to lay a requirements- driven foundation –Expanded Analysis – for the pilots, specific to an outpatient setting, distributed query of clustered metrics related to diabetes

8. Aggregated Count DataPatient Data Health Information Exchange (Intermediary) Query & Results Reviewer Query & Results Reviewer Data Source Expanded Analysis of Diabetes Interactions Public Health Agency (Information Requestor) Public Health Agency (Information Requestor) 7. Returns Query Results to Information Requestor Firewall 3. Sends Query to Intermediary 6. Return Query Results to Intermediary 4. Distribute Query to Data Sources 1. EHR / Clinical Record (Patient Data) 1. EHR / Clinical Record (Patient Data) 2. Query Health CEDD Implementation Note: All patient level data stays behind the firewall. Translate patient data to Query Health CEDD 5. Execute Query, format & return Results Responding Organization

9. Query Health Specifications and Standards Context Information Requestors Queries Results Queries Results Query Network CIM Responding Organization “1” Responding Organization “N” Four Areas targeted for standardization to promote interoperability 1.Query Envelope to package queries and results 2.Query Format to express queries in a declarative format 3.Results Format to express results in a declarative format 4.Query Data Model to promote common data element definitions across organizations

10. Query Health Specifications and Standards Specifications PurposeStandards Selected to create the specifications Rationale Query EnvelopeRequired to package queries, results and associated metadata in an interoperable manner PopMedNet QueryEnvelope The Query Envelope allows a generic way to package queries and results and is agnostic to the actual query or results and their formats. In addition the envelope carries the required metadata to enforce the Query Health security and policy sandbox requirements. Query FormatRequired to promote interoperability among the various query network participants within and across query networks HQMF * * - The existing standard has to be modified for Query Health purposes. The HQMF standard allows for expressing a large majority of queries related to Meaningful Use, ACO related queries, Comparative effectiveness, Population measures and basic research related queries. In addition it allows for Queries to be represented in a declarative fashion independent of the implementation language. For Queries which cannot be represented using HQMF the Query Health Reference Implementation will provide native format options to express queries. Results FormatRequired to promote interoperability among the various query network participants within and across query networks QRDA Category III ** ** - The existing standard will have to be analyzed further before finalizing. This was not discussed during the F2F but was mentioned a couple of times. The QRDA Category III allows for returning aggregate or summary level results that will be useful too report results for Meaningful Use, ACO, Comparative effectiveness results and many basic research results related to populations. In addition it allows for Results to be represented in a declarative fashion independent of the implementation language. For Results which cannot be represented using QRDA the Query Health Reference Implementation will provide other options based on MIME Types. Query Data Definitions Required to create executable queries and promote common data definitions between information requestors and responding organizations The Query Data Definitions will be created as part of the Query Health Initiative based on sections in C32. The Query Data Definitions will allow query composers to know what data exists for queries and also allows for a common definition of the data across organizations. The C32 sections were chosen as a source to identify the data elements since it is supported by a large majority of EMR’s.

11. Vendor Advisory Meeting Focus Area FOCUS AREA for this meeting

12. Aggregated Count DataPatient Data Health Information Exchange (Intermediary) Query & Results Reviewer Query & Results Reviewer Data Source Vendor Advisory Meeting Focus Area Public Health Agency (Information Requestor) Public Health Agency (Information Requestor) 7. Returns Query Results to Information Requestor Firewall 3. Sends Query to Intermediary 6. Return Query Results to Intermediary 4. Distribute Query to Data Sources 1. EHR / Clinical Record (Patient Data) 1. EHR / Clinical Record (Patient Data) 2. Query Health CEDD Implementation Note: All patient level data stays behind the firewall. Translate patient data to Query Health CEDD 5. Execute Query, format & return Results Responding Organization FOCUS AREA for this meeting

13. Key Building Blocks for the Query Health CEDD 13 –Personal Information –Demographic Information –Contact Information –Insurance Information –Healthcare Provider –Allergies –Other Adverse Reactions –Problem List –History of Past Illness –Chief Complaint –Reason for Transfer –History of Present Illness –List of Surgeries –Hospital Admission Diagnosis –Discharge Diagnosis –Medications – Admission Medications History – Hospital Discharge Medications – Medications Administered – Advance Directives – Pregnancy – Immunizations – Physical Examination – Vital Signs – Review of Systems – Hospital Course – Diagnostic Results – Assessment and Plan – Plan of Care – Family History – Social History – Encounters – Medical Equipment – Preoperative Diagnosis – Postoperative Diagnosis – Surgery Description – Surgical Operation Note Findings – Complications Section – Operative Note Surgical Procedure – Procedures – Diagnosis Code – Laboratory Results – Security Information – Care Setting – Facility Information – Entity Information – Functional Status

14. Query Health CEDD Clinical Concept Mapping Value Set Repository RxNorm Code 1 Code 2 RxNorm Code 1 Code 2 LOINC Code A Code B LOINC Code A Code B SNOMED CT Code XYZ Code ABC SNOMED CT Code XYZ Code ABC ICD 9 Code 45 Code 87 ICD 9 Code 45 Code 87 ICD 10 Code 124 Code 89 ICD 10 Code 124 Code 89 Clinical Concepts (generally unique per organization) Clinical Concepts (generally unique per organization) Map Clinical Concept Dictionary to Vocabulary Codes Clinical Concepts Query is Received Query Request based on Clinical Concepts Information Requestor (Role: Query Source) Provider/Provider Organization (Role: Data Source) Clinical Concepts are Mapped from the Clinical Concept to Data in System Data is Identified Data is Formatted to Answer Query Data is mapped to Clinical Concepts Clinical Concepts Query Results is formatted Query Results are Sent to Requestor Query Expression

15. Query Health Roadmap 15 Expected to create the necessary specifications and recommend standards that will be Proven in Pilot Implementations Allows Organizations to compute population level summaries for various use cases Eventually be part of MU Roadmap once HITSC and ONC approves the standards Vendors will be asked by organizations to incorporate or integrate with Query Health CEDD specifications and standards to support population measures

16. Open Feedback Session 16 Vendors will be asked by organizations to incorporate or integrate with CEDD specifications and standards to support population measures, Care Transitions using standards such as the Green CDA / Consolidated CDA Query Health CEDD Specifications aligned with the above and could provide a potential path for the vendors to incorporate the above standards Are there ways to work together with the vendor community that will help all the vendors in the long run Are there common data elements, concept mapping etc.. that we can focus on together

17. Open Feedback Session Cont’d 17 Feasibility of Vendors executing Queries and Returning Results without using Query Health Reference Implementation components Modified HQMF for executing queries Modified QRDA for returning results

18. Open Feedback Session Cont’d 18 Best practices to integrate source data to the Query Health Reference Implementation C32 / CDA Level 3 type of document Importers Quality of C32 data Is it Structured data Consistency of vocabularies/codes across vendors

19. Open Feedback Session Cont’d 19 Best practices to integrate source data to the Query Health Reference Implementation ETL Processing What kind of frameworks would be required for ETL processing to be successful ? Data Mapping Concept to Code Mapping Other Approaches to integrate data sources

20. Wrap Up 20