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Data Access Framework (DAF)

HL7

September 2013

John FeikemaCoordinator, Standards & Interoperability FrameworkOffice of the National Coordinator for Health IT

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• Initiative Introduction • Data Access Framework Initiative

o Historyo Importanceo Scopeo Expected Outcomeso Timeline

• Questions & Answers

Agenda

S&I Framework Phases & Data Access Framework (DAF)Activities

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Phase Planned Activities Pre-Discovery Development of Initiative Synopsis

Development of Initiative Charter Definition of Goals & Initiative Outcomes

Discovery Creation/Validation of Use Cases, User Stories & Functional Requirements Identification of interoperability gaps, barriers, obstacles and costs Review of Vocabulary

Implementation Creation of aligned specification Documentation of relevant specifications and reference implementations such as

guides, design documents, etc. Validation of Vocabulary Development of testing tools and reference implementation tools

Pilot Validation of aligned specifications, testing tools, and reference implementation tools Revision of documentation and tools

Evaluation Measurement of initiative success against goals and outcomes Identification of best practices and lessons learned from pilots for wider scale

deployment Identification of hard and soft policy tools that could be considered for wider scale

deployments

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Background to Data Access Framework (DAF)

• BlueButton initiatives enabled patients to access to their own data

• DAF is a similar concept, except it is focused on enabling providers to access their patient’s data both within and across organizations– Current industry standards are not modular enough to

allow the different types of data access desired by Providers

– NwHIN targeted and distributed queries– Multiple ONC initiatives Query Health, Innovation

projects identified multiple data access challenges within and across organizations

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• DAF will identify/create/modify standards to solve basic data access issues faced by providers

• within their own organization and across organizations in a modular and substitutable fashion.

• DAF is focused on enabling providers, their tools and applications to access their patient’s data

• Through new or modified standards DAF will allow providers to use new and innovative applications

• improve and fill gaps (such as medication tracking, long term care needs) in patient care

What is DAF?

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Data Access FrameworkProblems to Solve• Data Portability

– Patient moving from one provider to a new provider• Quality Improvement

– A need for customized “small data analytics” for quality improvement

– NwHIN/Targeted Query• Remote “chart pulls”

• Public Health– Common framework needed

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DAF - Example Real World Scenarios

• A provider wants to access data about a particular population within his/her practice using quality measures

• For example the provider wants to know all diabetic patients with HbA1c > 7% within their organization

• A provider wants to access the complete medical history of a patient to improve care and use new tools and applications to improve care

• Tools include predictive modeling, comparison with existing data sets etc. • Enable applications such as Medication Adherence and Tracking to be

used by patients and care givers.• Enable social workers and other care givers to consume the patient

information and determine the next steps in providing care. These may include determining what kind of long term care facility best suits the patient based on their demographics, diagnosis, medications etc.

• Build an Extraction capability (such as an API) from EMRs

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DAF – Challenges

• Data Access Framework has to support a wide variety of user stories (samples illustrated below)

Data Access Mechanism (Query) Formats

Document based access

Data element based access

Data Access using quality measures

Granularity of Data being accessed

Patient Level Data

Get me the latest lab report for a patient so that I can check if their HbA1c > 7%

Retrieve lab information for a patient for the past year where HbA1c > 7%

Use a Quality Measure such as NQF 0059 to retrieve patient data for diabetic patients with HbA1c > 7%

Population Level Data

Retrieve population level information about patients who had a surgical procedure within the last 3 days to prepare for their care transition.

Retrieve population level information about patients with age >=65 and HbA1c>7% stratified by ethnicity and preferred language to determine planning needs for the population.

Use Quality Measure such as NQF0059 to retrieve population level information about diabetic patients with HbA1c>7%.

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DAF – Modularity• To support the various user

stories and access mechanisms there is a need to create a modular and substitutable framework that can evolve with the industry over time:– Modular framework can be

best visualized as a stack of standards with multiple layers independent of each other

– Substitutable standards will provide the ability to replace standards for a single layer and reuse standards from the other layers

Basic Transport Protocols

Application Transport Protocols

Query Structure

Query Vocabularies and Value Sets

Authentication/Authorization

Result Structure

Result Vocabularies and Value Sets

Information Models

Transport Layer

Security Layer

Query Structure

Query Results

Data Model to support queries

Data Access Framework

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Basic Transport Protocols

Application Transport Protocols

Query Structure

Query Vocabularies and Value Sets

Authentication/Authorization

Result Structure

Result Vocabularies and Value Sets

Information Models

DAF – Substitutability

Transport Layer

Security Layer

Query Structure

Query Results

Data Model to support queries

Data Access Framework Initial Candidate Standards

HTTP SMTP

SOAP(IHE SOAP)

RESTful(IHE mHealth)

Direct

TLS+SAML TLS+OAuth2 S/MIME

ebRIM/ebRS HL7 FHIR HL7 HQMF

C-CDA HL7 v2.5.1 QRDA I, II, III

MU2 ModSpec RTM

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Basic Transport Protocols

Application Transport Protocols

Query Structure

Query Vocabularies and Value Sets

Authentication/Authorization

Result Structure

Result Vocabularies and Value Sets

Information Models

Subway™ can do it!

Bread Layer

Meat Layer

Cheese Layer

Veggie Layer

Condiment Layer

Build your own Sub

Italian Herbs and CHeese

Pastrami

9 Grain Wheat

9 Grain Honey Oat

Ham Turkey Roast Beef

Swiss Cheddar Monterey Jack

Lettuce Tomatoes Onions

Italian

Mayo Ranch Mustard

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Data AccessFramework

Local Access viaIntra-Organization Query

Targeted Access viaInter-Organization Query

Multiple Data Source Access via Distributed Query (Query Health) –

Completed Initiative

Standards based approach to enable access at all levels: Local, Targeted, and Distributed

• Create and disseminate queries internal to organization

• Query Structure Layer • APIs

• Receive standardized responses• Query Results Layer

• Create and disseminate queries to external organization

• Query Structure Layer • Transport Layer• Authentication/Authorization Layer

• Receive standardized responses from external orgs• Query Results Layer

• Create and disseminate queries to multiple orgsGoverned by a network

• Receive aggregated or de-identified responses

• Focus on Information Model for the network and leverage standards from earlier phases.

DataSource

DataSource

DataSource

Query Request

Query Response

X Hospital System X Hospital System

Y Hospital System

DAF – Overall Context

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DAF – Scope

• The work of this initiative will be done in 2 phases:• Phase 1 is focused on Local Access via Intra Organization Query• Phase 2 is focused on Targeted Access via Inter Organization Query

• The following capabilities are In-Scope:• Define the modular layers for Data Access Framework to support

identified business and functional requirements.• Identify the existing standards that can be used for each layer of the

Data Access Framework including guidance for substitutability of standards for both Local Access and Targeted Access.

• Define Implementation Guides leveraging existing standards where necessary to structure queries and query results for identified business and functional requirements.

• Identify standardized APIs that allow applications to query data in a consistent manner across EHRs.

• We will work with the FACAs and OPP to coordinate policy issues

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Data Access Framework Wiki Page

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

Data Access Framework Wiki Page