1

Data Access Framework (DAF)

Kickoff 7/16/2013

July 16th, 2013

Doug Fridsma, MD, PhD, FACP, FACMIChief Science Officer & Director, Office of Science & TechnologyJohn Feikema – Initiative CoordinatorMera Choi – ONC Lead

Meeting Etiquette

• As a reminder all participants on this call are muted. If you want to ask questions or make comments please use the “Chat” feature on the web meeting

• Send your “chat” to All Panelists in order to ensure the comments are addressed publically

From S&I Framework to Participants:Could you please explain how the terminologies are used in this instance?

All Panelists

To find the chat feature look for the chat bubble at the top of the meeting window

3

• Opening Remarks - Doug Fridsma, MD, PhD Director, Office of Standards and Technology, ONC

• The Standards & Interoperability Framework

• Initiative Introduction

• Data Access Framework Initiative

o History

o Importance

o Scope

o Expected Outcomes

o Timeline

• Next Steps/Call for Participation

• Questions & Answers

• Resources

Agenda

4

Office of Science and Technology(OST)

Promote compliance with validated information exchange standards, services and policies to assure interoperability between validated systems

S&I Framework Overview

• Specific health interoperability initiatives guide the design and development of a fully integrated and connected health information system.

• An S&I Initiative focuses on a single challenge with a set of value-creating goals and outcomes, and the development of content, technical specifications and reusable tools and services.

• Call for Participation: The overall success of the S&I Framework is dependent upon volunteer experts from the healthcare industry and we welcome any interested party to get involved in S&I Framework Initiatives, participate in discussions and provide comments and feedback by joining the Wiki: http://wiki.siframework.org

5

S&I Framework Coordination

6

ONC Programs & Grantees

Community S&I Framework

FACAs

SDOs

• State HIE Program & CoPs• SHARP Program• REC Program & CoPs• Beacon Program

• Technology Vendors• System Integrators• Government Agencies• Industry Associations• Other Experts

• HL7• IHE• CDISC• NCPDP• ASC X12• ASTM• WEDI

• HIT Standards Committee• HIT Policy Committee• Tiger Team

• ISO/TC 215• IHTSDO• NLM• NQF• Regenstrief• Other health IT

standards related organizations

ONC Standards and Interoperability (S&I) Framework Lifecycle

Our Missions» Promote a sustainable ecosystem that drives increasing interoperability and standards adoption» Create a collaborative, coordinated, incremental standards process that is led by the industry in

solving real world problems» Leverage “government as a platform” – provide tools, coordination, and harmonization that will support

interested parties as they develop solutions to interoperability and standards adoption.

7

Tools and ServicesTools and Services

Use Case Development

and Functional Requirements

Use Case Development

and Functional Requirements

Standards DevelopmentSupport

Standards DevelopmentSupport

Certificationand TestingCertificationand Testing

Harmonization ofCore Concepts

Harmonization ofCore Concepts

Implementation Specifications

Implementation Specifications

Pilot Demonstration Projects

Pilot Demonstration Projects

Reference Implementation

Reference Implementation

Architecture Refinement and ManagementArchitecture Refinement and Management

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

8

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

9

A Brief History of the 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

10

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

11

• 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

12

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 >

8% 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

13

DAF – Challenge…

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

Data Access Mechanism (Query) FormatsDocument based

accessData element based access

Data Access using quality measures

Granularity of Data being accessed

Patient Level Data

Get me the latest C-CDA or lab result for a patient so that I can check if their HbA1c > 9%

Retrieve dates where the patients HbA1c > 9%

Get patient data for patients between 18 to 75 with HbA1c > 9% during a time frame.

Population Level Data

Get me the latest C-CDA’s for all patients.

Identify and retrieve patients age >=65 who are due for annual Influenza immunization.

Use Quality Measure to retrieve the percentage of diabetic patients with HbA1c > 9% from the population of all diabetics.

14

DAF – Challenges Cont’d

• To support the various user stories and access mechanisms there is a need to create a modular and substitutable framework that can be 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

15

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 – Modularity and Substitutability Challenge

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

16

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

17

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 FACA and OPP to coordinate policy issues

Organization Entity A

Sends: Data Query

Receives: Patient(s) Data or Document

Information Requester

Internal Information

System

Scenario Example: Information Requester sends a data query to his/her Internal Information System requesting information about one or more patient(s). The Internal Information System returns the requested patient data or document to the Information Requester.

DAF - Local Data Access Workstream via Intra-Organizational Query

18

Fire

wal

l

DAF - Targeted Data Access Workstream via Inter-Organizational Query

Organization Entity A

Originating Request System

Data Source System

Sends: Data Query

Receives: Patient(s) Data or Document

Organization Entity B

Scenario Example: Originating Request System from Org A sends a data query to a known external organization requesting information for a known patient to Data Source System from Org B. The Data Source System from Org B returns the requested patient data or document to the Originating Request System in Org A.

19

Notional Project Timeline

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

Participation

Jan 2014

Nov

Discovery

S&I Lifecycle(Discovery Pilot & Evaluation)

20

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 10/22

UC

1: L

ocal

Dat

a Ac

cess

: Int

ra-

Org

aniz

ation

al

Que

ry

UC

2: T

arge

ted

Dat

a Ac

cess

: Int

er-

Org

aniz

ation

al Q

uery

Discovery

Define Use Case & Functional Requirements

Implementation

Standards Gap Analysis

Use Case 2 Consented 11/29

Charter Review & Consensus

21

Logistics

• We will be meeting as a community every week on Wednesdays

• This will be a 60 minute meeting

• Community Meeting Time

• Wednesdays 12:00-1:00 EST

• All Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Use Case, Project Charter and General Data Access Framework information will be posted on the Data Access Framework Wiki page

• Join us for our next meeting July 24th, 2013

• See the wiki page for the meeting updates

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

22

Data Access Framework Wiki Page

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

Data Access Framework Wiki Page

Next Steps – Sign Up• The ONC Data Access Framework Initiative is open for anyone

to join.

• This community will meet frequently by webinar and teleconference

• We use Wiki pages to facilitate discussion.

• Information on how to join the Community can be found on the Data Access Framework Sign Up Wiki: http://wiki.siframework.org/Data+Access+Framework+Join+the+Initiative

• In order to ensure the success of our initiative and the subsequent pilot, we encourage broad and diverse participation from the community.

• This is your chance to have an impact on the creation and implementation of a pilot program in this important area of health IT development.

23

24

Next Steps – Getting Started

• Details on the Data Access Framework launch including this

presentation are posted on the wiki: http

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

• Please feel to review and comment on the Proposed Project Charter

• To review the Data Access Framework Project Charter go to the Charter wiki

page:

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

• Complete the Data Access Framework Project Charter Comment Form: http

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

(you will need to select the “Click Here to Provide Comments” in the Project

Charter Comments Section)

• Join us for our next meeting July 24th, 2013 from 12-1 pm EST

• All meeting updates, call in number and web meeting details can be found

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

Resources and Questions• Please feel free to reach out to any member of the Data Access

Framework Initiative team:• 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 and Gayathri Jayawardena gayathri.jayawardena@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

25