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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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 Brown

i2b2 / 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 Grannis

OMOPPatrick 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

DistributeDavid Buckeridge

CDC’s BioSenseTaha 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

DARTNetWilson Pace

Hub Population Management SystemJesse 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 CCRSteven Waldren

hQueryAndy 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

caGridKen Buetow

Universal Public Health NodeIvan 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 caseEstablish Standards and Protocols for:

1. Patient Data2. Query / Case Definition3. Results

29

Interoperability Framework = Focused Collaboration

CORE PRINCIPLES

Prioritization

Transparency

Engagement

Rapid ResultsLow

Hig

h

Focus

FocusedCollaboration

A Thousand Flowers Bloom

Commandand Control

Low High

Participation

ClassicTrade-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 environmentEngage health and health care, population and patientLeverage existing programs and policiesEmbed services and research in a continuous learning loopAnchor in an ultra‐large‐scale systems approachEmphasize decentralization and specifications parsimonyKeep use barriers low and complexity incrementalFoster a socio‐technical perspective, focused on the populationWeave a strong and secure trust fabric among stakeholdersProvide 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

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