Transcript Occurs within Beth Israel Hospital

Query Health Technical Approach Primer
Operations Workgroup
Table of Contents
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Goal of the Query Health Technical Approach
Key Actors
The Query Lifecycle
Query Health Specifications & Standards
Query Envelope
HQMF
QRDA
OWG Focus
Glossary
Goal of the Query Health Technical Approach
• The goal of the technical approach document is to identify the
technical requirements necessary at each step of the query process.
• Technical Approach must promote interoperability.
• Requestors want the ability to make queries and receive results
in a standardized way.
• Responders want the ability to use whatever technologies they
want and implement it in whatever they want.
• Both must have a common understanding of data element
definitions (e.g., is sex expressed as ‘sex’ or ‘gender’?)
Key Actors
“Technical Approach”
Actor
Description
“Real World” Actor
Requesting Organization
Initiates the Query
Public Health Agency
Responding Organization
Subscribes to the Query
and generates results upon
request
Provider/Provider
Organization/HIE/RHIO
Our Example
This document will focus on a query sent by a
Requesting Organization (New York State Department
of Health) and sent to a Responding Organization (Beth
Israel Hospital).
The Query Lifecycle
Origins of the Technical Approach
• The Query Health Technical Approach was created by the Query
Health Technical Workgroup.
• The Technical Workgroup examined three of the best approaches
from the Summer Concert Series.
• hQuery
• i2b2
• PoPMedNet
• The Technical Workgroup took the most relevant aspects from each
of these three approaches to craft a custom Technical Approach for
Query Health.
The following slides will explain the Technical Approach step by step.
First, the step and the key actors will be highlighted on the graphic.
Next, a slide will explain what happens during that step.
Lens through which to view the Technical Approach
As we go through the Technical Approach, view it through the lens of a
“Risk Assessment”:
• What is the privacy implication of this step?
• What is a security risk association with this step?
• What policies are in play here?
Step 1: Create Query
Occurs within the
Department of Health
Step 1: Create Query
The New York State Department of Health must create a query using
one of three possible ‘Query Builders’:
• hQuery
• i2b2
• HQMF
These builders were chosen so that requestors do not have to be
technical experts to create a query. Instead, they can create queries
using common clinical language in a user-friendly interface.
Occurs within the
Department of Health
Step 2: Query is sent to PopMedNet Portal
Occurs within the
Department of Health
Step 2: Query is sent to PopMedNet Portal
The query is sent in the format of Modified HQMF* to the PopMedNet
Portal.
• PopMedNet has a user-friendly web-based portal, where queries are
submitted.
*HQMF is a standard for representing health quality measures as an
electronic document. The Query Health initiative is making
modifications to the standard to suit the needs of Query Health.
Occurs within the
Department of Health
Step 3: PMN Portal sends Query to PMN Data Client
Query Transported
from Department of
Health to Beth Israel
Hospital
Step 3: PMN Portal sends Query to PMN Data Client
The PopMedNet Portal sends the query, via Query Envelope, to the
PopMedNet Data Client.
• The Query Envelope is designed to be query and content agnostic
and ensure enforcement of privacy and security requirements.
• The PopMedNet Data Client is the counterpart of the PopMedNet
Portal where queries are received by (Beth Israel Hospital).
Query Transported
from Department of
Health to Beth Israel
Hospital
Step 4: PMN Data Client sends Query to Procedural
Translator
Occurs within Beth
Israel Hospital
Step 4: PMN Data Client sends Query to Procedural
Translator
PMN Data Client sends the Query to the Procedural Translator which
creates specific directions on how to run the query. The Procedural
Translator takes the message in HQMF (declarative language) and
translates it to JavaScript or SQL (procedural languages).
Declarative vs. Procedural Languages
Declarative
“Make me a cake”
Procedural
Mix 3 cups of flour, 2 ¼ cups of sugar, 2
tsp. of baking powder, 1 tsp. salt, 3
sticks of butter, ½ tsp. of vanilla extract,
1 cup milk, and 8 large egg whites. Bake
at 350 for 40 minutes.
Occurs within Beth
Israel Hospital
Note: In this step,
Responding
Organizations, like Beth
Israel, have the right to
reject any query.
Step 5: Procedural Translator sends Query to Execution
Engines
Occurs within Beth
Israel Hospital
Step 5: Procedural Translator sends Query to Execution
Engines
The Procedural Translator sends the query to the Execution Engines.
• They query is now in JavaScript or SQL (procedural languages)
• The Execution Engines run the queries while matching the concepts (e.g.
“diabetes” and/or codes (e.g. an ICD 9 code) to the Data Sources using the
CIM(CEDD).
– Clinical Information Model (CIM)/Clinical Elements Data Dictionary
(CEDD) is a dictionary that is an ‘overlay’ on the Data Source. It is a
translation tool.
– Example: A query may ask for the number of people taking a particular
medication. The system will use the CIM/CEDD as a reference to
identify the number of patients who have that medication listed in their
‘active medications list.’
• All of this occurs behind Beth Israel’s firewall, thus maintaining patient
privacy and security of data.
E
Occurs within Beth
Israel Hospital
Step 6: Execution Engines send results to QRDA
Translator
Occurs within Beth
Israel Hospital
Step 6: Execution Engines send results to QRDA
Translator
The Execution Engines take the results, which are still in JavaScript or
SQL and send them to the QRDA Translator, to be changed to QRDA.
• QRDA is a document format that will provide a standard structure with
which to report results.
• Remember: The Department of Health does not necessarily understand
the coding language of Beth Israel Hospital (JavaScrip or SQL).
• Therefore results must be translated in a standard way before they can
be sent back to the Department of Health.
• The standard selected by the Technical Workgroup for expressing query
results is QRDA Category III*.
*QRDA Category III was selected
because it allows for returning
aggregate or summary level results.
Occurs within Beth
Israel Hospital
Step 7: QRDA Translator sends results back to PMN
Data Client
Occurs within Beth
Israel Hospital
Step 7: QRDA Translator sends results back to PMN
Data Client
The QRDA Translator sends the results back to the PopMedNet Data
Client, which routes them back to the PopMedNet Portal.
• The PopMedNet Data Client is the last stop at Beth Israel before the
results are sent back to the Department of Health.
Occurs within Beth
Israel Hospital
Step 8: PMN Data Client sends results back to PMN
Portal
Query Transported
from Beth Israel
Hospital to Department
of Health
Step 8: PMN Data Client sends results back to PMN
Portal
The PopMedNet Data Client sends the results, now in QRDA, back to
the Department of Health through the PopMedNet Portal using the
Query Envelope.
• The Query results are now in the hands of the Department of Health.
• Reminder: The Query Envelope is designed to be query and content
agnostic and ensure enforcement of privacy and security
requirements.
Query Transported
from Beth Israel
Hospital to Department
of Health
Step 9: PMN Portal sends the results to the Results
Viewer
Occurs within the
Department of Health
Step 9: PMN Portal sends the results to the Results
Viewer
The PopMedNet Portal now sends the results to the Results Viewer, a
specific interface designed for reviewing query results. Now an
individual at the Department of Health can review the results.
The lifecycle of the query is now complete.
Occurs within the
Department of Health
Summary: Query Health Specifications and Standards
Query Health must standardize how queries are asked, how they are
returned, and how the information travels between parties.
Specification
Definition
Standard
Query Envelope
A means to package the
query and results along with
security/privacy
requirements, as well as
other instructions
PopMedNet Query
Envelope
Query Format
The way in which a query is
constructed, its code,
vocabulary etc.
HQMF- Health Quality
Measures Format
Results Format
The way in which a result is
reported, its code,
vocabulary etc.
QRDA- Quality Reporting
Document Architecture
Query Envelope
PopMedNet Query Envelope – essentially wraps metadata around data
and protects it with a data/security layer
• Metadata is essentially data that describes data
• It offers integration among different systems; designed to have
some flexibility
• Designed to be query and content agnostic
What does the Query Envelop mean to the Operations
WG?
• The Query Envelope contains supporting metadata that ensures
enforcement of privacy and security requirements defined in the
Query Health Policy Sandbox (e.g., Small Cells, Author, Verifier)
• What metadata needs to be a part of the package?
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Author?
Reviewer?
Time for completion?
Instructions?
Encryption?
What else?
• What security implications do you see during the data exchange?
HQMF – Health Quality Measures Format
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Under HHS direction, NQF was tasked with retooling 113 endorsed quality
measures from a paper-based format to an eMeasure format.
HQMF is a standard for representing health quality measures as an
electronic document that is machine readable.
A health quality measure encoded in the HQMF format is referred to as an
“eMeasure”.
• eMeasures may be understood by providers to guide optimal care, and to guide
collection of Electronic Health Record (EHR) and other data, which is then
assembled into quality reports
•
HQMF Targets the following groups:
• Healthcare Providers
• EHR Vendors
• Physicians and Clinicians
• Quality Improvement Reporting Agencies
What does HQMF mean to the OWG?
•
Query Format
• Best Practice research regarding the most applicable eMeasures to
Query Health
• Best Practice research focused on how quality measures are
captured by responding organizations
• Oversight of the types of queries submitted as well as determined
usage of query results
• Who can submit queries?
• What kinds of queries are out of bounds?
• What health insurance questions cannot be asked?
• What private sensitive information cannot be queried?
• Are there groups or vulnerable populations that have cultural, religious
restrictions regarding data exchange?
• What about the exchange of highly sensitive information, such as
someone’s HIV status?
QRDA – Quality Reporting Document Architecture
• Quality Reporting Document Architecture (QRDA) is a document
format that will provide a standard structure with which to report
quality measures.
• Conforms to the requirements of the Health Level Seven (HL7)
Clinical Document Architecture Release 2.0 (CDA).
• Emerging Standard but not widely implemented
• If a result cannot be expressed in QRDA, the Reference
Implementation will provide other options based on MIME Types
• MIME: Multi-purpose Internet Mail Extensions- a specification for
sending messages over the internet
What does QRDA mean to the OWG?
• Results Format
• Policy and Security implications focused on de-identification of
results
• Who can review results?
• Could the OWG define the needed Governance body?
• How can organizations enforce the principle that all data is deidentified?
• What quality checks are in place as query results are produced to
verify the queries are correct and meet the determined security and
privacy guidelines?
Operations Workgroup Focus
The focus of the Operations Workgroup should be on a Risk Analysis
• What stands out to you as a risk with this technical approach?
Examples:
• What would be a problem when trying to implement this on a large
scale?
• Where do we need policies in place?
Glossary
Term
Definition
CIM/CEDD
The Clinical Information Model/Clinical Elements Data Dictionary describes the
data elements, the relationships of these data elements, possible datatypes for the
elements, and how they are used in support of a specific query.
Data Source
The actual location of the data within the responding organization.
Declarative
Language
Technical language that specifies what SHOULD be in an outcome without
specifying how to arrive at that outcome.
Execution
Engine
The processor that actually performs the query.
HQMF
Health Quality Measures Format is a standard for representing health quality
measures as an electronic document. It is the format in which queries are
submitted.
HQMF to
Procedural
Translator
Translates the query from HQMF into a procedural language like JavaScript of
SQL.
Metadata
Information that describes data; it is packaged along with the query in the query
envelope for security & policy enforcement.
Native to QRDA
Translator
Translates the query results from the responding organization’s native language
(e.g., JavaScript or SQL) to QRDA so it can be sent back to the requesting
organization.
Glossary
Term
Definition
PopMedNet
Data Client
The web-based location where the responding organization can view incoming
query requests.
PopMedNet
Portal
The web-based location where a requesting organization can submit a query.
Procedural
Language
Technical language which prescribes the step-by-step procedures for executing a
query.
QRDA
Quality Reporting Document Architecture is a document format that will provide a
standard structure with which to report quality measures. It is the format in which
query results are captured.
Query Builder
A Graphical User Interface (GUI) that facilitates the creation of queries (e.g.
Microsoft Office is a GUI that facilitates the creation of a Word document).
Query Envelope
A means to package the query and results along with security/privacy
requirements, as well as other instructions.
Query Format
The way in which a query is constructed, its code, vocabulary etc.
Glossary
Term
Definition
Requesting
Organization
An organization which submits a query.
Results Format
The way in which a result is reported, its code, vocabulary etc.
Responding
Organization
An organization that responds to a query.
Results Viewer
An interface which enables the requesting organization to view the query results.
Note: In some cases, the terms listed in the Glossary may have more than
one meaning. These definitions are intended to provide context solely for the
Technical Approach Primer.