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Query Health:Distributed Population Queries
Farzad Mostashari, National Coordinator for Health IT (ONC)
Todd Park, Chief Technology Officer (HHS)
Doug Fridsma , Director Standards & Interoperability (ONC)
Rich Elmore, Coordinator – Query Health (ONC)
September 6, 2011
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Please note that this presentation and the Q&A session are being recorded and will be available on
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This session will be live tweeted on Twitter
Hashtag: #QueryHealth
Notices
Query Health:Distributed Population Queries
Farzad Mostashari, National Coordinator for Health IT (ONC)
Todd Park, Chief Technology Officer (HHS)
Doug Fridsma , Director Standards & Interoperability (ONC)
Rich Elmore, Coordinator – Query Health (ONC)
September 6, 2011
• Strategic Rationale• Summer Concert Series• Query Health• Alignment
Topics
What if?
… you could ask questions about quality and performance that helped you to be proactive in improving population health in your community?
What if?
… you could compare effectiveness of treatments for patients in your community? And refine the analysis as you learn more about the underlying conditions and treatments.
What if?
… you could provide answers about performance and quality without exposing patient level information?
What if?
… you could deploy scarce vaccines in the right quantities to the right locations because you understood the at-risk populations at that moment in time across your community?
What if?
… you could improve your understanding of public health hazards in your community, with timely responses to questions about an outbreak?
What if?
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.
Vision
1. Eyes on the prize: Deliver better population health and care
2. Build on what’s available today and adapt - don’t rip & replace
3. Foster innovation and use the market
4. Watch out for the little guy – minimize burden to providers and use information available in the routine course of care
5. Open, transparent, and democratic process.
Keep the patients at the center
Principles
Context:
The nation is reaching critical mass of deployed Electronic Health Records (EHRs) with greater standardization of information in support of health information exchange and quality measure reporting.
The Opportunity: Turbo charge your understanding of population health, performance and quality
• Enable proactive patient care in your community
• Deliver insights for local and regional quality improvement
• Facilitate consistently applied performance measures and payment strategies for your community (hospital, practice, health exchange, state, payer, etc.) based on aggregated de-identified data
• Provide treatments that are most effective for your community
Context and Opportunity
• High transaction and “plumbing” costs– Variation in clinical concept coding, even within organizations– Lack of query standards – Lack of understanding of best business practices
• Centralizing tendency– Moves data further away from source– Increases PHI risk exposure– Limits responsiveness to patient consent preference – less
actionable
• Limited to large health systems– With larger IT or research budgets – Few notable exceptions
The Challenge
Turbo-charge your understanding of patient population health in your community
Questions about disease outbreaks,
prevention activities, health research,
quality measures, etc.
Summer Concert Series
Summer Concert Series: Speed, Adaptability and Patient Coverage
Mini-Sentinel
Rich Platt and Jeff Browni2b2 / SHRINE
Zak Kohane and Shawn Murphy
References:http://wiki.siframework.org/file/view/ONC+Summer+Series-+Query+health_Brown+PlattV1.pdfhttp://wiki.siframework.org/file/view/i2b2-SHRINE+Query+Health+Presentation+8-30-2011.pdf
Summer Concert Series: Condition Counts and Disease Prevalence
Regenstrief
Shaun GrannisOMOP
Patrick Ryan, Marc Overhage, Tom. Scarnecchia
References:http://wiki.siframework.org/file/view/Regenstrief+Query+System+Grannis+20110829.pdfhttp://wiki.siframework.org/file/view/OMOP+Ryan+ONC+29Aug2011+final.pdf
Summer Concert Series: Disease Outbreak Monitoring
Distribute
David BuckeridgeCDC’s BioSense
Taha Kass-Hout
References:http://wiki.siframework.org/file/view/Distribute.pdfhttp://wiki.siframework.org/file/view/BioSense_Redesign_S%26I_20110826_Kass-Hout.pdf
Summer Concert Series: Proactive and Preventative Care
DARTNet
Wilson PaceHub Population Management System
Jesse Singer and Michael Buck
References:http://wiki.siframework.org/file/view/ONC+Summer+Series-+Query+health_Brown+PlattV1.pdfhttps://cbmi.med.harvard.edu/shrine2011/sites/cbmi.med.harvard.edu.shrine2011/files/Harvard%20Catalyst%20SHRINE_%20Zak%20Kohane_0.pdf
Summer Concert Series: Performance and Quality Reporting
Population CCR
Steven WaldrenhQuery
Andy Gregorowicz and Marc Hadley
References:http://wiki.siframework.org/file/view/queryHealth-popCCR-20110824.pdfhttp://wiki.siframework.org/file/view/hQuery+Summer+Concert+Presentation.pdf
Summer Concert Series: Methods to Distribute Services & Queries
caGrid
Ken BuetowUniversal Public Health Node
Ivan Gotham, Lee Jones and Vince Lewis
References:http://wiki.siframework.org/file/view/Query+Health+08.19.11.pdf http://wiki.siframework.org/file/view/Summer+Concert+Series+2011+-+introduction+v5.pdf
Summer Concert Series: Challenges
Distributed Population
Queries
Best Practices for Data Use /
Sharing
Sustainability
Organization, Management
and Coordination
Auditability
Privacy, Security and
Consent Consistency of Clinical
Concepts
Data Extensibility
Queries Across
Organizations
Multiple Networks
Query HealthScope and Approach
Practice drives standards1. Rough consensus2. Running code (open source)3. Pilot4. Specifications5. Standards
Query Health – Distributed Population
Queries
Standards & Service
Public / Private
Partnership Project
Community Driven,
Consensus-based
EHRs & Other
Clinical Records
HIT Policy Committee:
Policy Guideposts
Query Health:Example User Story – Case Control, Vaccine Efficacy
1. Quality Compliance : Number of patients over the age of 50 who have received the flu vaccine (NQF 0041).
2. Surveillance: Determine what patients have received the vaccine and have contracted the flu.
3. 2 x 2 of Vaccine and Flu Diagnosis 4. Refine Query (for example for H1N1).
– Add GI symptom – Specify H1N1 vaccine
Individuals Who Contracted the Flu
Individuals Who Did Not Contract the Flu
Population Total
Received Vaccine 20 50 70
Did Not Receive Vaccine
80 10 90
Population Total 100 60 160
Query Health:Example User Story – Case Control, Statin Efficacy
Hyper-lipidemic
Not Hyper-lipidemic
Population Total
Individuals Who Take a Statin
200 500 700
Individuals Who Do Not Take a Statin
800 100 900
Population Total 1,000 600 1,600
1. Quality Compliance : Number of patients over the age of 18 who have been diagnosed with CAD and are taking a statin (NQF 0074)
2. Surveillance: Determine how many patients are hyperlipidemic.
3. 2 x 2 of Statin and Hyperlipidemia
4. Refine QuerySelect two statinsCompare efficacy of two statins
Hyper-lipidemic
Not Hyper-lipidemic
Population Total
Patients on Medication A
50 300 350
Patients on Medication B
150 200 350
Population Total 200 500 700
Query Health ObjectiveSimple scalable secure use case
Establish Standards and Protocols for:1. Patient Data2. Query / Case Definition3. Results
29
Interoperability Framework = Focused Collaboration
CORE PRINCIPLES
Prioritization
Transparency
Engagement
Rapid ResultsLo
wH
igh
Focus
FocusedCollaboration
A Thousand Flowers Bloom
Commandand Control
Low High
Participation
Classic
Trade-Off
Bottom Up Use Case Development Within a Top-down Coordination FrameworkENABLING
Query HealthOrg & Timeline
S&I Framework Governance• Open Government Initiative • Engaging leaders from providers, health IT vendors, states / HIOs,
federal partners, and research community
Meaningful Use and Standards• Standardized information models and terminologies, e.g.,
SNOMED, LOINC – vocabulary value sets associated with patient care and quality metrics
• CIM model to support user stories, leveraging S&I initiatives and existing distributed query models
• Transport approach will leverage the NwHIN
Goals Alignment with:S&I Framework
Build a shared learning environment
Engage health and health care, population and patient
Leverage existing programs and policies
Embed services and research in a continuous learning loop
Anchor in an ultra‐large‐scale systems approach
Emphasize decentralization and specifications parsimony
Keep use barriers low and complexity incremental
Foster a socio‐technical perspective, focused on the population
Weave a strong and secure trust fabric among stakeholders
Provide continuous evaluation and improvement
Goals Alignment with: Digital Infrastructure for a Learning Health System
ReferenceIOM 2011. Digital Infrastructure for the learning healthcare system: Workshop series summary. National Academies Press.
Query HealthRecap
Implementation GroupTuesdays 1:30pm-3:00pm EDT (Starting 9/13)
Technical Work GroupWednesdays 11am-12pm EDT (Starting 9/7)
Clinical Work Group Wednesdays 12pm-1pm EDT (Starting 9/7)
Business Work GroupThursdays 11am-12pm EDT (Starting 9/8)
First Face to Face MeetingOctober 18-19
Discussion
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hashtag: #QueryHealth
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The moderator will select questions for the panelists
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