Data Access Framework (DAF) Relationship to Other ONC Initiatives 1

Data Access Framework (DAF)Relationship to

Other ONC Initiatives

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Data Access Framework (DAF)Data Access Framework (DAF) Methods for standards based access to clinical documents and discrete data for individual patients,

multiple patients or aggregations of patients for patient care and for research from local, targeted and multiple sources In Phase 1 and 2 for patient care, DAF adopted IHE standards for document query and emerging

HL7 FHIR for data element query DAF Phase 3 for Research focuses on meeting needs of clinical outcomes research communities

(PCORI) although its modular design should be extensible to other secondary uses DAF Phase 3 for Research intends to adopt HL7 FHIR to standardize query, data extraction using

APIs, mapping/formatting and results reporting Initially DAF will only query for common clinical data set as defined by ONC collected during

routine clinical workflow and as represented in FHIR resources and profiles Security & Privacy: DAF Phase 1 & 2 reference defined standards and profiles in the DSTUs. DAF

Phase 3 has not referenced standards yet, but is working with HEART

Status of Standards and Implementation Guides: Data Access Framework (DAF) Data Elements-based Query FHIR Profile

Published under HL7 on September 23, 2015 DAF FHIR Implementation Guide

Published under HL7 on September 23, 2015 The Data Access Framework (DAF) Document Metadata Based Access Implementation Guide

Published under IHE on September 24, 2015

http://www.hl7.org/fhir/profilelist.html

http://hl7.org/fhir/daf/daf.html

http://ihe.net/uploadedFiles/Documents/PCC/IHE_PCC_IG_DAF_National-Extension.pdf

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Query Health (QH)Query Health (QH) QH is the predecessor of DAF, SDC, and CQF initiatives, providing valuable

lessons-learned for those subsequent efforts

Methods for distributing queries and retrieval of results for patient or population level data of interest from multiple sources QH attempted to address requirements of multiple secondary users

including quality measures, population health, public health, et.al. QH could not standardize methods to extract or map query data from

diverse data sources but rather focused on the query envelope and results container

QH did not restrict or standardize types of data or information models to be queried

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Structured Data Capture (SDC)Structured Data Capture (SDC) Methods for distributing patient level data collection forms with semi-automated populated

and manually entered data and returning completed forms to central repository from multiple sources SDC specifies methods for forms creation, distribution, filling and reporting and has

adopted HL7 FHIR resources and profiles SDC does not restrict data elements beyond FHIR resources but secondarily defines a

data element dictionary method for standardizing metadata Security & Privacy: SDC may be limited in the short term by HL7's SMART on FHIR

OAuth scopes as well as unresolved HL7 purpose-of-use definition issues

Status of Standards and Implementation Guides: Structured Data Capture (SDC) FHIR Profile

Published under HL7 on September 23, 2015 Structured Data Capture (SDC) FHIR Implementation Guide

Published under HL7 on September 23, 2015 Structured Data Capture (SDC) Data Element Exchange Implementation Guide

Published under HL7 on September 23, 2015 Structured Data Capture (SDC) (Technical Framework Supplement)

Published under IHE on September 5, 2014

http://www.hl7.org/fhir/profilelist.html

http://hl7.org/fhir/sdc/sdc.html

http://hl7.org/fhir/sdcde/sdcde.html

http://www.ihe.net/uploadedFiles/Documents/QRPH/IHE_QRPH_Suppl_SDC.pdf

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Clinical Quality Framework (CQF)Clinical Quality Framework (CQF) Methods for developing patient level queries for electronic quality measures,

including the Quality Data Model and Clinical Quality Language (CQL) for complex queries, to be used in reporting (eClinical Quality Measures) eCQMs from multiple sources and as a basis for Clinical Decision alerts concerning compliance CQF provides tools, methods and a standard QM model for quality measure

developers to author quality measure definitions and calculations including complex QM queries and their standard reports

CQF uses FHIR resources and profiles although it also supports legacy standards including QRDA

CQF provides methods for distributing and incorporating clinical decision support based on eCQM compliance

Security & Privacy: CQF is in the same arena as DAF Phase 3, but has not directly referenced HEART's work yet

Status of Standards and Implementation Guides (HL7): Quality Information and Clinical Knowledge (QUICK) model Clinical Quality Expression Language Clinical Quality Common Metadata Decision Support Service Implementation Guide, DSTU Updates

http://www.hl7.org/special/Committees/projman/searchableProjectIndex.cfm?action=edit&ProjectNumber=1045




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DAF Points of ComparisonDAF Points of Comparison

DesignDesign DAF was designed for use of multiple stacks to support evolving

technologies and standards

DAF uses existing and does not define data elements or information models

DAF could be used to extract and populate SDC forms

DAF could be used to query for completed SDC forms as document

DAF might be extended to query for eCQM data and use CQL for more complex queries

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DAF Points of Comparison DAF Points of Comparison

Patient Care and Secondary UsePatient Care and Secondary Use Only DAF explicitly supports queries for documents or data elements for

individual patient care DAF uses IHE XD* stack for querying for clinical documents (potential

to also use FHIR based MHD) although CQF support for CDS is directed at individual patients

DAF Phase 3 for Research and the other three initiatives are focused on secondary use of data SDC and QH are designed to support broader communities including

public health, clinical research, population health as well as quality measures

DAF Phase 3 for Research is specifically focused on PCORI communities, as CQF is focused on eCQM developers

*IHE XD set of profiles (i.e. XDS, XDR, XDM, etc.)

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Industry UptakeIndustry Uptake DAF profiles have been referenced by Argonaut, which is a project that will

accelerate current FHIR development efforts to provide practical and focused FHIR profiles and implementation guides to the industry

DAF Document Metadata IG profiles will be tested at the 2016 IHE NA Connectathon

SDC has tested its IHE Profile at the 2015 IHE NA Connectathon

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Standards Standards DAF, SDC, and CQF use emerging standard FHIR resources and profiles,

while QH began before availability of FHIR Lacking core standards, QH faced multiple challenges in meeting

diverse user needs for queries, diverse data formats for extraction and mappings to diverse models

While DAF, SDC and CQF use FHIR core resources and transports, each has defined their own profiles and extensions

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Data Definition and ModelsData Definition and Models Except for DAF, the other three initiatives can define new data elements to

be queried DAF currently restricts data element queries to the common clinical

data elements as collected in routine clinical workflow (which are also available to the other three initiatives)

SDC and CQF imply a pre-coordinated definition of the data of interest while DAF and QH are directed to queries for data already captured

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Policy IssuesPolicy Issues None of the initiatives explicitly address policy issues concerning access,

use and disclosure of patient data Local and Targeted DAF for individual patient’s data generally are

within the scope of HIPAA treatment, payment and operations rules

As policy issues are resolved to technical requirements, all the initiatives should be capable to implement these albeit with different methods but with likely preference to FHIR based initiatives such as HEART

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SummarySummaryDAF QH SDC CQF

Purpose Standards based access to clinical documents and discrete data for individual patients, multiple patients or aggregations of patients for patient care and for research

Distributing queries and retrieval of results for patient or population level data of interest from multiple sources

Distributing patient level data collection forms with semi-automated populated and manually entered data and returning completed forms to central repository from multiple sources

Developing patient level queries for electronic quality measures, including the Quality Data Model and Clinical Quality Language (CQL) for complex queries, to be used in reporting eCQMs from multiple sources and as a basis for Clinical Decision alerts concerning compliance

Design Designed for use of multiple stacks to support evolving technologies and standards

Could not standardize methods to extract or map query data from diverse data sources but rather focused on the query envelope and results container

Methods for forms creation, distribution, filling and reporting

Tools, methods and a standard QM model for quality measure developers to author quality measure definitions and calculations including complex QM queries and their standard reports

Patient Care

Explicitly supports queries for documents or data elements for individual patient care

Potential CDS for individual patients to support compliance

Secondary Use

DAF Phase 3 for Research is specifically focused on PCORI communities,

Designed to support broader communities including public health, clinical research, population health as well as quality measures


CQF is focused on eCQM developers

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Summary Summary CONTINUEDCONTINUED

DAF QH SDC CQF

Secondary Use

DAF Phase 3 for Research is specifically focused on PCORI communities,



CQF is focused on eCQM developers

Standards FHIR for Data Elements and Research (XD* for Documents)

Various, including HQMF and QRDA

FHIR FHIR

Data Definition

and Models

Query for existing data – does not define new data or models

Query for existing data Can define new data elements

Uses QDM and can define new data elements for eCQM

Policy Issues Patient care queries covered by HIPAA TPODoes not address policy issues for Research

Policy issues minimally addressed with sand box

Does not expressly address policy issues for secondary use

Does not expressly address policy issues for eCQM

Cross-Overs • DAF could be used to extract and populate SDC forms

• DAF could be used to query for completed SDC forms as document

• DAF might be extended to query for eCQM data and use CQL for more complex queries

Current approaches might be transition to DAF Research

Data Dictionary might be shared with other initiatives

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Summary Summary CONTINUEDCONTINUED

DAF QH SDC CQF

Status of Standards and

Implementation Guides

HL7

Data Access Framework (DAF) Data Elements-based Query FHIR Profile

DAF FHIR Implementation Guide

IHE

The Data Access Framework (DAF) Document Metadata Based Access Implementation Guide

N/A HL7

Structured Data Capture (SDC) FHIR Profile

Structured Data Capture (SDC) FHIR Implementation Guide

Structured Data Capture (SDC) Data Element Exchange Implementation Guide

IHE

Structured Data Capture (SDC) (Technical Framework Supplement)

HL7

Quality Information and Clinical Knowledge (QUICK) model

Clinical Quality Expression Language

Clinical Quality Common Metadata

Decision Support Service Implementation Guide, DSTU Updates

Security and Privacy

DAF Phase 1 & 2 reference defined standards and profiles in the DSTUs. DAF Phase 3 has not referenced standards yes, but is working with HEART

N/A SDC may be limited in the short term by HL7's SMART on FHIR OAuth scopes as well as unresolved HL7 purpose-of-use definition issues

CQF is in the same shape as DAF Phase 3, but has not directly referenced HEART's work yet

http://hl7.org/fhir/daf/daf.html