Data Access Framework (DAF) All Community

Meeting September 18th, 2013

Meeting Etiquette• Remember: If you are not speaking keep your

phone on mute• Do not put your phone on hold – if you need to

take a call, hang up and dial in again when finished with your other call– Hold = Elevator Music = very frustrated speakers and

participants• This meeting, like all of our meeting is being

recorded– Another reason to keep your phone on mute when not

speaking• Feel free to use the “Chat” feature for questions,

comments or any items you would like the moderator or participants to know.

NOTE: This meeting is being recorded and will be posted on the Meeting Minutes Wiki page after

the meeting

From S&I Framework to Participants:Hi everyone: remember to keep your phone on mute

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AgendaTopic Time Allotted

General Announcements 5 minutesTimeline discussion 5 minutesReview Finalized Key User Stories for Local DAF Use Case 35 minutes

Introduction to Functional Requirements 10 minutesNext Steps/Questions 5 minutes

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General Announcements• Use Case Sub-Work group has concluded• All Hands meeting will be cancelled next Wednesday,

September 25th, 2013 due to HL7. The next All Hands meeting will resume on Wednesday, October 2nd, 2013 at 12:00 PM (ET) to continue developing the Local DAF Use Case

• All DAF Materials are posted on the DAF (video of meetings, materials, reference materials from the meeting)– http://

wiki.siframework.org/Data+Access+Framework+Meeting+Artifacts

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S&I Framework Phases & Data Access Framework Activities

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We are Here

Notional Project Timeline

Kick-off (7/16)Pre-Discovery, Call for

Participation

Jan 2014

Nov

Discovery

S&I Lifecycle(Discovery Pilot & Evaluation)

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July 2013 Sept

Implementation

Define Use Case & Functional Requirements

Standards Gap Analysis Harmonized Specifications

Technology Evaluations

Technical Project Outline (11/14)

Use Case 1 Consented 10/29

UC

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UC

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Discovery

Define Use Case & Functional Requirements

Implementation

Standards Gap Analysis

Use Case 2 Consented 11/29

Charter Review & Consensus

Today 9/18

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Local Data Access User Story SWG (8/29)

Local Data Access Framework (LDAF)

Use Case

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Today’s Agenda:

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Discussion Topic Estimated Time

• Review Finalized Key User Stories for Local DAF Use Case

35 minutes

• Introduction to Functional Requirements 10 minutes• Next Steps 5 Minutes

Proposed Use Case Development Timeline

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Week Target Date All Hands WG Meeting Tasks Review & Comments

due Monday COB

1 8/14 Use Case Kick-Off & UC Process Overview Review: In/Out of Scope and Assumptions sections

2 8/21 Review: In/Out of Scope and Assumptions Review: In/Out of Scope and Assumptions Review: In/Out of Scope and Assumptions

Sections, User Stories

3 8/28Review: In/Out of Scope and Assumptions, Context Diagram, User Stories

Finalize: In/Out of Scope and Assumptions, Context DiagramReview: Pre/Post Conditions

Review: User Stories, Context Diagram, Pre/Post ConditionsNote- Separate User Story SWG will launch on 8/29

4 9/4 Review: Pre/Post Conditions, Actor and Roles

Review: Pre and Post Conditions and Actors & Roles

Review: User Stories, Pre/Post Conditions, Base Flow and Activity Diagram

5 9/11 Review: Activity Diagram and Base Flow

Review: Base Flow, Activity DiagramFinalize: Pre and Post Conditions and Actors & Roles

Review: Activity Diagram, Base Flow and Functional Requirements

6 9/18 Functional Requirements,Sequence Diagram

Finalize: User StoriesReview: Functional Requirements, Sequence Diagram

Review: Functional Requirements, Sequence Diagram

7 9/25 HL7 WGM

8 10/2 Data Requirements Finalize: Functional Requirements, Sequence Diagram Review: Data Requirements

9 10/9 Data Requirements Finalize: Data Requirements Review: Data Requirements

10 10/16 Full Review & Finalize Data Requirements End-to-End Review (10/16-10/22)

11 10/23 End-to-End Comments Review End-to-End Review comments due 10/15

12 10/30 Consensus Voting 10/23 – 10/30 Cast consensus vote

FINAL CONSENSUS (10/30)

Local Data Access Use Case Section Review

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Note - Below sections will be reviewed within the separate UC word document 1. Discuss and Finalize user story voting outcomes for Local DAF Use Case 2. Time permitting, introduce and discuss draft content for:

– Functional Requirements• Information Interchange Requirements• System Requirements• Sequence Diagram

Local DAF User Story Ranking

• Draft Local DAF User Stories were posted here for community review and vote from 9/13-9/17– Total of 8 votes were submitted per User Story

• User stories have been ranked on a scale of 1-3– 1 = Highest priority ranking– 2 = Medium priority ranking– 3 = Lowest priority ranking

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User Stories

• Definition - User Stories summarize the interaction between the actors of the Use Case, and specify what information is exchanged from a contextual perspective. Furthermore, the User Stories describe the real world application as an example of the generic scenario that has a broader applicability for DAF

• User Stories selected by the community will be included in the Use Case. Others that were not selected, but still relevant, can be included in the appendix as examples/reference material

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Document Metadata Based

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Patient or Population Level Query

Brief Description Select to present at All Hands 9/18 (1-3 Rank)

Patient Level Query

1. A Provider accesses clinical summary documents on an ad hoc basis for a new diabetic patient with documented poor glucose control.

1 = 6 votes2 = 1 votes3 = 1 vote

Population Level Query

2. A provider needs to access information for one of his patients’ who recently moved to a new state and that has a new care team (patient portability)

1 = 4 votes2 = 3 votes3 = 1 vote

Population Level Query

3. PCP searches for office visit summaries in local EHR system to further analyze them using 3rd party software system (external to EHR) to understand severity of illness in patient population (analytics)

1 = 2 votes2 = 2 votes3 = 2 vote

Document Metadata based accessA1. Patient Level Query #1A Provider accesses clinical summary documents on an ad hoc basis for a new diabetic patient with documented poor glucose control • A new patient arrives to a small family practice in Boston, MA. The PCP sees a 48 year-old male, with

Diabetes Mellitus Type I (DM I) diagnosis since age 12. The patient has a history of myocardial infarction (MI) at age 37 and a stroke at age 43. The patient admits that he often forgets to take his medication as prescribed and often forgets to check his blood sugar levels throughout the day. The patient travels for works and has been admitted to different ER’s numerous times for acute complications due to elevated blood sugar levels. All healthcare facilities where the patient was admitted generated clinical summaries and sent the information to patient’s new physician at the patient’s request. The clinical summaries have been stored in the local document repository database within the organization. For today’s visit, the physician generates an ad-hoc query within the EHR to access all clinical summary documents produced locally and those received from other healthcare facilities, so that he can check if the patient’s HbA1c levels were greater than 7% and if the glucose levels were greater than 100mg/dL over the past 5 years the EHR system queries the document repository database to retrieve the requested information and sends back multiple clinical summary documents to the physician for additional review. This information provides the physician required context to understand the severity of circumstances that led to the patient’s ER admission, the severity of the patient’s non-adherence to medications and formulate a plan to improve the patient’s lifestyle and adherence to medications to mitigate future ER visits and reduce or prevent the progression of established comorbidities.

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Patient or Population Level Query

Brief Description Select to present at All Hands 9/18 (1-3 Rank)

Patient Level Query 1. A Provider accesses clinical summary documents on an ad hoc basis for a new diabetic patient with documented poor glucose control.

1 = 6 votes2 = 1 votes3 = 1 vote

Document Metadata Based

Data Element Based

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Patient or Population Level Query

Brief Description Select to present at All Hands 9/18 (1-3 Rank)

Population Level Query

1. PCP searches for office visit summaries in local EHR system to further analyze them using 3rd party software system (external to EHR) to understand severity of illness in patient population

1 = 2 votes2 = 2 votes3 = 4 vote

Patient Level Query

2. PCP querying lab data results over past 12 months for a patient whose HbA1c is >7%

1 = 2 votes2 = 4 votes3 = 2 vote

Patient Level Query

3. Two applications share data during a hospital visit to coordinate information about diagnoses, medications and treatments and queuing of appropriate patient education and instruction material.

1 = 4 votes2 = 0 votes3 = 4 vote

Population Level Query

4. Physician conducts ad hoc query to determine percent of Hepatitis C patients for research at an organization under treatment with no fasting glucose lab tests (EHR to CDR).

1 = 2 votes2 = 2 votes3 = 4 vote

Patient Level Query

5. Physician referral to Endocrinologist within the same organization using different EHRs with system alerts for patient protected information

1 = 6 votes2 = 2 votes3 = 0 vote

Patient Level Query

6. Ancillary to EHR Query and Update (Pull and push) 1 = 3 votes2 = 2 votes3 = 3 vote

B2. Patient Level Query #1Physician referral to Endocrinologist within the same organization using different EHRs with system alerts for patient protected information• In accordance with best practice, the Gastroenterologist orders fasting glucose lab tests for new or

current Hepatitis C.  The Gastroenterologist’s EHR receives results from source systems based on automated queries, and alerts him when a patient’s fasting glucose lab results are between 100 mg/dL and 125 mg/dL. During an initial encounter with a VA patient for Hep-C, the Gastroenterologist is alerted that the patient’s glucose intolerance lab results are very high. The Gastroenterologist wants to refer the patient to an Endocrinologist in his practice. In preparation for the referral, the Gastroenterologist queries the repository for all of the patient’s records including sensitive records disclosed him by the VA per the patient’s consent. He is alerted that information related to the patient’s Hep-C, which was diagnosed during substance abuse treatment, is protected under Title 38, and may not be disclosed without patient consent. Before making the referral, the Gastroenterologist asks the patient whether she consents to disclose protected information to the Endocrinologist.  The patient agrees, and signs an electronic consent directive. The Gastroenterologist’s EHR updates the security labels on this patient’s protected information authorizing the Endocrinologist to query for her records. When the Endocrinologist’s EHR system queries Gastroenterologist’s EHR, it is authorized to receive the patient’s records including the Title 38 protected information. When researchers within the Endocrinologist’s practice query for Hepatitis C patients, they will not receive the results for patients who have not consented to disclosure for research , because they are not authorized. 16

Patient or Population Level Query

Brief Description Select to present at All Hands 9/18 (1-3 Rank)

Patient Level Query 5. Physician referral to Endocrinologist within the same organization using different EHRs with system alerts for patient protected information

1 = 6 votes2 = 2 votes3 = 0 vote

Data Element Based

Quality Measures Based

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Patient or Population Level Query

Brief Description Select to present at All Hands 9/18 (1-3 Rank)

Population Level Query

1. A pediatrician queries for immunization reports within his local EHR system to identify patients with missing vaccinations based on Quality Measures.

1 = 5 votes2 = 2 votes3 = 1 vote

B3- Population level query #2A pediatrician queries for immunization reports within his local EHR system to identify patients with missing vaccinations based on Quality Measures.• A pediatrician runs a small practice in a small town and uses a vendor’s EHR product to maintain

general health information about his patient population and another 3rd party’s application to document immunization activities for his patients. He wants to ensure that he follows vaccination schedules as required by the Centers for Disease Control (CDC) and maintain documentation on reasons why vaccines were not administered. His 3rd vendor’s application is certified for 2014 Edition Certification requirement: "§170.314(c) Clinical Quality Measures" and can therefore capture, calculate and electronically transmit aggregated and patient-specific vaccination reports for his patient population based on Quality Measure CMS_117v2 (NQF 0038). He wants to obtain a list of patient names from his patient population with incomplete vaccination schedules so that his nurse can contact these patients and schedule a visit to receive missed vaccines. He creates a query request using his EHR system that queries 3rd party’s application and retrieves an aggregated report for all patients aged ten years or younger that do not meet the NQF quality measures outlined above. The report shows that 15% of his patients have not been vaccinated according to the CDC guidelines. The physician then creates a second query to obtain the list of patients missing vaccinations and associated individual vaccination records for those patients. The physician and his nurse then contact these patients and schedule a visit for them to receive missed vaccines.

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Quality Measures VotesPatient or Population Level

QueryBrief Description Select to present at All Hands

9/18 (1-3 Rank)Population Level Query 1. A pediatrician queries for immunization reports within his local

EHR system to identify patients with missing vaccinations based on Quality Measures.

1 = 5 votes2 = 2 votes3 = 1 vote

Next Steps• Please note our All Hands meeting will be cancelled next

Wednesday September 25th, 2013 due to HL7

• Attend our next All Hands call on Wednesday October 2nd, 2013 12:00 PM EST to continue developing the Local DAF Use Case

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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: – Jamie Parker jamie.parker@esacinc.com

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

• Use Case Development: – Presha Patel presha.patel@accenture.com

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

• Project Support– Gayathri Jayawardena gayathri.jayawardena@esacinc.com

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Data Access Framework (DAF) Resources• DAF Wiki Homepage

– http://wiki.siframework.org/Data+Access+Framework+Homepage

• Become a Community Member– http://

wiki.siframework.org/Data+Access+Framework+Join+the+Initiative

• DAF Charter– http://

wiki.siframework.org/Data+Access+Framework+Charter+and+Members

• Standards and Interoperability(S&I) Framework– http://wiki.siframework.org/Introduction+and+Overview

• S & I Calendar of Events– http://wiki.siframework.org/Calendar

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Appendix B: Additional Use Case Reference Material

S&I Community Enabling Toolkit (CET)Use Case Overview

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Some Previous and Ongoing S&I Use Cases (not a complete list)

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Use Case Name (including links) StatusData Access Framework In ProgressTransitions of Care CompleteLab Results Interface CompleteProvider Directory - Certificate Discovery CompleteProvider Directory - Electronic Service Information Discovery CompleteQuery Health CompleteData Segmentation for Privacy CompleteesMD - PPA Provider Registration (UC 1) CompleteesMD - Secure sending and Structure of eMDR (UC 2) CompleteesMD - Author of Record Level 1 CompleteLab Orders Interface CompleteLab Orders Interface - eDOS CompleteHealth eDecisions CDS Artifact Sharing UC 1 CompleteHealth eDecisions CDS Guidance Service UC 2 CompleteStructured Data Capture CompleteLongitudinal Coordination of Care CompletePublic Health Reporting CompleteAutomate Blue Button Initiative CompletePrescription Drug Monitoring Program CompleteesMD – Author of Record Level 2 Complete