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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
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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. From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute NOTE: This meeting is being recorded and will be posted on the Meeting Minutes Wiki page after the meeting
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
S&I Framework Phases & Data Access Framework Activities We are Here
Notional Project Timeline S&I Lifecycle (Discovery Pilot & Evaluation) Jan 2014 July 2013 Sept Nov Today 9/18 Pre-Discovery, Call for Participation Kick-off (7/16) Use Case 1 Consented 10/29 Technical Project Outline (11/14) UC 1: Local Data Access: Intra-Organizational Query Discovery Implementation Define Use Case & Functional Requirements Harmonized Specifications Standards Gap Analysis Charter Review & Consensus Technology Evaluations Local Data Access User Story SWG (8/29) Use Case 2 Consented 11/29 UC 2: Targeted Data Access: Inter-Organizational Query Implementation Discovery Define Use Case & Functional Requirements Standards Gap Analysis 6
Local Data Access Use Case Section Review 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
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
Document Metadata Based Document Metadata based accessA1. 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 • 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.
Data Element Based 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.
Quality Measures Votes 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.
Next Steps • Please note our All Hands meeting will becancelled 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
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 • GayathriJayawardenagayathri.jayawardena@esacinc.com
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
Some Previous and Ongoing S&I Use Cases (not a complete list)
