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Query Dispatch and Aggregate QDA Work Item ProposalOctober 2014
Vincent van Pelt (Nictiz)Mark Sinke (ForCare)Walco van Loon (ForCare)Albert-Jan Spruyt (Nictiz)
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
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, …
QDAQuery 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)
XDS
Provide and Register Document Set (ITI-41)
Retrieve Document Set (ITI-43)
RegisterDocument Set (ITI-42)
Registry StoredQuery (ITI-18)
Document Registry
DocumentSource
DocumentRepository
DocumentConsumer
Register On-DemandDocument Entry (ITI-61)
XDS + ODD
Provide and Register Document Set (ITI-41)
Retrieve Document Set (ITI-43)
RegisterDocument Set (ITI-42)
Registry StoredQuery (ITI-18)
Document Registry
DocumentSource
DocumentRepository
DocumentConsumer
On-DemandDocument Source
Register On-DemandDocument Entry (ITI-61)
XDS + ODD (+ persistent storage)
Provide and Register Document Set (ITI-41)
Retrieve Document Set (ITI-43)
RegisterDocument Set (ITI-42)
Registry StoredQuery (ITI-18)
Document Registry
DocumentSource
DocumentRepository
DocumentConsumer
On-DemandDocument Source
Provide and Register Document Set (ITI-41)
Register On-DemandDocument Entry (ITI-61)
XDS + ODD + ?
Provide and Register Document Set (ITI-41)
Retrieve Document Set (ITI-43)
RegisterDocument Set (ITI-42)
Registry StoredQuery (ITI-18)
Document Registry
DocumentSource
DocumentRepository
DocumentConsumer
On-DemandDocument Source
Provide and Register Document Set (ITI-41)
Not defined how this profile creates the on-demand document
Register On-DemandDocument Entry (ITI-61)
QDA
Provide and Register Document Set (ITI-41)
Retrieve Document Set (ITI-43)
RegisterDocument Set (ITI-42)
Registry StoredQuery (ITI-18)
Document Registry
DocumentSource
DocumentRepository
DocumentConsumer
On-DemandDocument Source
QDA
Provide and Register Document Set (ITI-41)
EHR
Pharmacy
Laboratory
Radiology
Pathology
Nursing
1: Dispatch queries
2: Aggregate results
CDAresults
Create Multi-Source Summary (ITI-xx)
CDA Master template
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 <any> 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?
Configuration
Report request: MedSumm 1
ReportID
Master templateID
Use RECON?
Use DEN?
Use DSG? Use MCV?
MedSumm 1 MedSumTempl1 Y N N N
MedSumm 2 MedSumTempl2 N N N N
PatientSumm 1 PatSumTempl1 N Y Y N
LabSumm 1 LabSumTempl1 N Y Y Y
Configuration
Report request: MedSumm 1
ReportID
QueryID
Query Method
Target OID Result Template OID
Query parameters
Query standard xx
MedSumm 1 MedPrescr HL7 Query
PCP A PRE …
MedSumm 1 MedPrescr HL7 Query
Hospital B PRE …
MedSumm 1 MedDisp HL7 V2 Pharmacy X DIS …
MedSumm 1 MedLabData QED Laboratory Y LAB-x …
MedSumm 1 MedDiagData
XDS EMR-Hospital Z DIAG-x …
PatientSumm 1
DiagData … … … …
PatientSumm 1
LabData … … … …
Query result 1
Query result 2
Query results ....
Report result: MedSumm 1 Aggregation
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