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Data Access Framework (DAF)

S&I Initiative Update

June 19th, 2014

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Overview (Recap)

• BlueButton initiatives enabled patients to access to their own data

• DAF is similar, except it is focused on enabling providers to access their patient’s data using modular and substitutable standards– Within their own Local Organization (Local DAF)– From another Targeted Organization (Targeted DAF)– Between multiple Organizations (Federated DAF – Future

phases)

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Challenges to Address

Data Access Complexities include:

– Ability to access data within and across organizations using standards

– Ability to access patient’s data using document metadata paradigm• Get latest Lab Report for a Patient so that I can check her HBA1C

levels• Get CCD’s for the last 3 years for a patient• Get the last History and Physical Note for the patient

– Ability to access patient’s data based on discrete data elements captured within a patient record

• Get latest lab report for a patient where HBA1C > 7%• Get me all patients < 5 years who are due for an immunization• Get me all patients > 75 years with HBA1C > 7%

– Enable both Patient level (Local and Targeted ) and Population level data (Data about multiple patients – only for Local)

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Out Of Scope

DAF does not address the following:– Trust establishment between organizations for Targeted Query

• Could leverage all the trust work happening in Direct

– Discovery of End Points for Targeted Query

– Patient Matching rules and algorithms that organizations may implement

– Policies that allow/dis-allow disclosure of patient data

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Current State

• S&I/IHE PCC DAF White Paper– Describes how to use existing IHE profiles to meet DAF needs and identifies

gaps that need to be filled (Both new profiles and change proposals)– Gaps being prioritized to inform upcoming IHE Planning Cycle.– Currently under Public Comment period http://www.ihe.net/Public_Comment/#

pcc• S&I Document Metadata Based Access Work Group

– Allows ability to access patient data using document metadata paradigm– Finished Candidate standards analysis– Creating an Implementation Guide around the standards

• S&I Data Element Based Access Work Group– Currently performing standards analysis – Completed FHIR, working on others identified by the community (HL7v2, QED,

HQMF etc)• S&I DAF Direct Transport WG (Community/Volunteer driven WG)

– Working on a solution using all the content models from Document and Data Element Based Access Work Groups but changing the Transport from SOAP/HTTP to Direct/SMTP.

Create IG based on existing standards

WP Comment

Period

Notional Project Timeline S&I Lifecycle

(Discovery Pilot & Evaluation)

August November

September

October December

DAF/IHE White Paper Published

July

Implementation (DAF/IHE

Community)

DAF IHE/ S&I Joint Work GroupIH

E A

cti

vit

ies

Document IG

Consensus

Implementation (S&I Community)

Implementation (S&I Community)

TW

G 1

: D

ocu

men

t M

eta

data

b

ased

access

for

LD

AF &

TD

AF

Candidate Standards Analysis

Finalize Actors + Transactions +

Technology Stacks and Standards

TW

G 2

: D

ata

Ele

men

t b

ased

access f

or

LD

AF &

TD

AF

Creating Operation Plan for Pilot Testing

Balloting Activities

Pilots and Testing

Pilots & Testing

Create IG Creating Operation Plan for Pilot Testing

Pilots & Testing

Pilots and Testing

Balloting Activities

Data Element IG Consensus

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IHE/S&I Joint White Paper

Data Access Behavior Model

Network Transport

Implementable Information

Model

IHE Profile

Patient Population

Patient Demographics

Request/Response MLLP HL7 V2 ADT PIX/PDQ

Gap1

SOAP HL7 V3 Patient Administration

PIX/PDQ V3 XCPD (Federated)

REST FHIR Patient PDQM

Publish/Subscribe SOAP HL7 V3 Patient Administration Gap2

REST FHIR Patient

Encounter Documents and Metadata

Request/Response SOAP ebXML RIM+CDA XDS/XCA MPQ

REST FHIR+CDA MHD Gap3

SMTP Gap10

Publish/Subscribe SOAP ebXML RIM+CDA DSUB Gap4

REST FHIR+CDA Gap5

SMTP Gap11

Detailed Clinical Data

Request/Response SOAP HL7 V3 Care Record QED8 Gap6

REST FHIR Gap7

Publish/Subscribe SOAP HL7 V3 Care Record CM9

REST FHIR Gap7

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Document Metadata Based Access Overview

Query Requestor

Query Responder

Query

Query Results

Query Stacks Required• SOAP and RESTful

Query Stacks Required• SOAP or RESTful

DAF QueriesFind Document(s) based on Patient IdentifiersFind Document(s) based on Patient DemographicsGet Document(s) based on Patient Identifiers Get Document(s) based on Patient DemographicsGet Document(s) based on Document IdentifiersGet Document(s) for multiple patients based on patient identifiersFind Patient Identifiers based on Patient Demographics

Find Patient Demographics based on Patient Identifiers

DAF Supporting CapabilitiesProvide message integrity and confidentiality of queries and results exchanged between the Query Requestor and the Query Responder

Ability to provide user and system identities as necessary for authentication and authorizationAbility to tag the queries and the query results with security metadata that will enable policy enforcement for query execution and data disclosure

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Document Metadata Based Access Query Stacks

Query Stack Component SOAP Query Stack RESTful Query Stack

Transport Protocols HTTP HTTP

Message Packaging Envelope SOAP 1.2 HTTP Message Structure

Message Integrity TLS TLS

Confidentiality TLS TLS

System Authentication Mutual TLS Mutual TLS

Access Controls/Authorization * XUA (Targeted only) * IHE IUA (Based on OAuth2) + FHIR Tags *

Consent and Security metadata * DS4P + XDS Metadata (Targeted only) * DS4P + FHIR Tags *

Auditing ATNA ATNA + FHIR Security Event

Query Structure XCA, XCPD – Patient LevelMPQ – Population Level

IHE MHD v2 (Being Aligned to FHIR Document Resources) **

Result Structure CCDA CCDA expressed via FHIR Document Resources

API’s XCA/XCPD/MPQ WSDL IHE MHD v2 **

* - Specifying profiles for Targeted DAF only, Local DAF choices left to the organization** - IHE working on finalizing IHE MHDv2 which aligns with FHIR this summer – DAF will reanalyze once it is published

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Data Element Based Access

Query Requestor

Query Responder

Query

Query Results

Query Stacks Required• Under Analysis

• FHIR - Initial Analysis performed

Query Stacks Required• Under Analysis

• FHIR - Initial Analysis performed

• Data Elements for Constructing Queries and Query Results

• Started from MU Stage 2 ToC/VDT data elements + community input

• Current Data Element Spreadsheet

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Data Element Based Access(Potential FHIR Query Stack)

Query Stack Component RESTful Query Stack

Transport Protocols HTTP

Message Packaging Envelope HTTP Message Structure

Message Integrity TLS

Confidentiality TLS

System Authentication Mutual TLS

Access Controls/Authorization * IHE IUA (Based on OAuth2) + FHIR Tags

Consent and Security metadata * DS4P + FHIR Tags

Auditing ATNA + FHIR Security Event

Query Structure FHIR Queries based on RESTful resources (FHIR Query Resource May be used along with resources)

Result Structure FHIR Resources

API’s FHIR API’s

Note: Query Stack Components for Document Metadata based Access and Data Element based Access share same components except for Query Structure and Query Results.

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Questions

Useful Links• DAF Homepage

– http://wiki.siframework.org/Data+Access+Framework+Homepage• DAF Initiative Signup

– http://wiki.siframework.org/Data+Access+Framework+Join+the+Initiative• DAF Charter

– http://wiki.siframework.org/Data+Access+Framework+Charter+and+Members• DAF Standards, Harmonization and Implementation Activities

– http://wiki.siframework.org/DAF+Standards+Harmonization+and+Implementation

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Initiative Support Leads• For questions, please feel free to contact your support leads:

– Initiative Coordinator: John Feikema john.feikema@siframework.org– ONC Sponsors: Mera Choi mera.choi@hhs.gov– Support Team:

• Project Management: – Gayathri Jayawardena gayathri.jayawardena@esacinc.com

• Technical Support: – Dragon (Nagesh) Bashyam nagesh.bashyam@drajer.com

• Standards SME:– Ed Larsen ed_larsen@comcast.net

• Standards Support: – Angelique Cortez angelique.j.cortez@accenture.com

• Vocabulary and Terminology Subject Matter Expert: – Mark Roche, MD mrochemd@gmail.com

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