Date post: | 29-Jan-2016 |
Category: |
Documents |
Upload: | estella-norris |
View: | 224 times |
Download: | 0 times |
Data Access Framework (DAF)Relationship to
Other ONC Initiatives
1
2
Data Access Framework (DAF)Data Access Framework (DAF) Methods for standards based access to clinical documents and discrete data for individual patients,
multiple patients or aggregations of patients for patient care and for research from local, targeted and multiple sources In Phase 1 and 2 for patient care, DAF adopted IHE standards for document query and emerging
HL7 FHIR for data element query DAF Phase 3 for Research focuses on meeting needs of clinical outcomes research communities
(PCORI) although its modular design should be extensible to other secondary uses DAF Phase 3 for Research intends to adopt HL7 FHIR to standardize query, data extraction using
APIs, mapping/formatting and results reporting Initially DAF will only query for common clinical data set as defined by ONC collected during
routine clinical workflow and as represented in FHIR resources and profiles Security & Privacy: DAF Phase 1 & 2 reference defined standards and profiles in the DSTUs. DAF
Phase 3 has not referenced standards yet, but is working with HEART
Status of Standards and Implementation Guides: Data Access Framework (DAF) Data Elements-based Query FHIR Profile
Published under HL7 on September 23, 2015 DAF FHIR Implementation Guide
Published under HL7 on September 23, 2015 The Data Access Framework (DAF) Document Metadata Based Access Implementation Guide
Published under IHE on September 24, 2015
3
Query Health (QH)Query Health (QH) QH is the predecessor of DAF, SDC, and CQF initiatives, providing valuable
lessons-learned for those subsequent efforts
Methods for distributing queries and retrieval of results for patient or population level data of interest from multiple sources QH attempted to address requirements of multiple secondary users
including quality measures, population health, public health, et.al. QH could not standardize methods to extract or map query data from
diverse data sources but rather focused on the query envelope and results container
QH did not restrict or standardize types of data or information models to be queried
4
Structured Data Capture (SDC)Structured Data Capture (SDC) Methods for distributing patient level data collection forms with semi-automated populated
and manually entered data and returning completed forms to central repository from multiple sources SDC specifies methods for forms creation, distribution, filling and reporting and has
adopted HL7 FHIR resources and profiles SDC does not restrict data elements beyond FHIR resources but secondarily defines a
data element dictionary method for standardizing metadata Security & Privacy: SDC may be limited in the short term by HL7's SMART on FHIR
OAuth scopes as well as unresolved HL7 purpose-of-use definition issues
Status of Standards and Implementation Guides: Structured Data Capture (SDC) FHIR Profile
Published under HL7 on September 23, 2015 Structured Data Capture (SDC) FHIR Implementation Guide
Published under HL7 on September 23, 2015 Structured Data Capture (SDC) Data Element Exchange Implementation Guide
Published under HL7 on September 23, 2015 Structured Data Capture (SDC) (Technical Framework Supplement)
Published under IHE on September 5, 2014
5
Clinical Quality Framework (CQF)Clinical Quality Framework (CQF) Methods for developing patient level queries for electronic quality measures,
including the Quality Data Model and Clinical Quality Language (CQL) for complex queries, to be used in reporting (eClinical Quality Measures) eCQMs from multiple sources and as a basis for Clinical Decision alerts concerning compliance CQF provides tools, methods and a standard QM model for quality measure
developers to author quality measure definitions and calculations including complex QM queries and their standard reports
CQF uses FHIR resources and profiles although it also supports legacy standards including QRDA
CQF provides methods for distributing and incorporating clinical decision support based on eCQM compliance
Security & Privacy: CQF is in the same arena as DAF Phase 3, but has not directly referenced HEART's work yet
Status of Standards and Implementation Guides (HL7): Quality Information and Clinical Knowledge (QUICK) model Clinical Quality Expression Language Clinical Quality Common Metadata Decision Support Service Implementation Guide, DSTU Updates
6
DAF Points of ComparisonDAF Points of Comparison
DesignDesign DAF was designed for use of multiple stacks to support evolving
technologies and standards
DAF uses existing and does not define data elements or information models
DAF could be used to extract and populate SDC forms
DAF could be used to query for completed SDC forms as document
DAF might be extended to query for eCQM data and use CQL for more complex queries
7
DAF Points of Comparison DAF Points of Comparison
Patient Care and Secondary UsePatient Care and Secondary Use Only DAF explicitly supports queries for documents or data elements for
individual patient care DAF uses IHE XD* stack for querying for clinical documents (potential
to also use FHIR based MHD) although CQF support for CDS is directed at individual patients
DAF Phase 3 for Research and the other three initiatives are focused on secondary use of data SDC and QH are designed to support broader communities including
public health, clinical research, population health as well as quality measures
DAF Phase 3 for Research is specifically focused on PCORI communities, as CQF is focused on eCQM developers
*IHE XD set of profiles (i.e. XDS, XDR, XDM, etc.)
8
DAF Points of Comparison DAF Points of Comparison
Industry UptakeIndustry Uptake DAF profiles have been referenced by Argonaut, which is a project that will
accelerate current FHIR development efforts to provide practical and focused FHIR profiles and implementation guides to the industry
DAF Document Metadata IG profiles will be tested at the 2016 IHE NA Connectathon
SDC has tested its IHE Profile at the 2015 IHE NA Connectathon
9
DAF Points of Comparison DAF Points of Comparison
Standards Standards DAF, SDC, and CQF use emerging standard FHIR resources and profiles,
while QH began before availability of FHIR Lacking core standards, QH faced multiple challenges in meeting
diverse user needs for queries, diverse data formats for extraction and mappings to diverse models
While DAF, SDC and CQF use FHIR core resources and transports, each has defined their own profiles and extensions
10
DAF Points of Comparison DAF Points of Comparison
Data Definition and ModelsData Definition and Models Except for DAF, the other three initiatives can define new data elements to
be queried DAF currently restricts data element queries to the common clinical
data elements as collected in routine clinical workflow (which are also available to the other three initiatives)
SDC and CQF imply a pre-coordinated definition of the data of interest while DAF and QH are directed to queries for data already captured
11
DAF Points of Comparison DAF Points of Comparison
Policy IssuesPolicy Issues None of the initiatives explicitly address policy issues concerning access,
use and disclosure of patient data Local and Targeted DAF for individual patient’s data generally are
within the scope of HIPAA treatment, payment and operations rules
As policy issues are resolved to technical requirements, all the initiatives should be capable to implement these albeit with different methods but with likely preference to FHIR based initiatives such as HEART
12
DAF Points of Comparison DAF Points of Comparison
SummarySummaryDAF QH SDC CQF
Purpose Standards based access to clinical documents and discrete data for individual patients, multiple patients or aggregations of patients for patient care and for research
Distributing queries and retrieval of results for patient or population level data of interest from multiple sources
Distributing patient level data collection forms with semi-automated populated and manually entered data and returning completed forms to central repository from multiple sources
Developing patient level queries for electronic quality measures, including the Quality Data Model and Clinical Quality Language (CQL) for complex queries, to be used in reporting eCQMs from multiple sources and as a basis for Clinical Decision alerts concerning compliance
Design Designed for use of multiple stacks to support evolving technologies and standards
Could not standardize methods to extract or map query data from diverse data sources but rather focused on the query envelope and results container
Methods for forms creation, distribution, filling and reporting
Tools, methods and a standard QM model for quality measure developers to author quality measure definitions and calculations including complex QM queries and their standard reports
Patient Care
Explicitly supports queries for documents or data elements for individual patient care
Potential CDS for individual patients to support compliance
Secondary Use
DAF Phase 3 for Research is specifically focused on PCORI communities,
Designed to support broader communities including public health, clinical research, population health as well as quality measures
Designed to support broader communities including public health, clinical research, population health as well as quality measures
CQF is focused on eCQM developers
13
DAF Points of Comparison DAF Points of Comparison
Summary Summary CONTINUEDCONTINUED
DAF QH SDC CQF
Secondary Use
DAF Phase 3 for Research is specifically focused on PCORI communities,
Designed to support broader communities including public health, clinical research, population health as well as quality measures
Designed to support broader communities including public health, clinical research, population health as well as quality measures
CQF is focused on eCQM developers
Standards FHIR for Data Elements and Research (XD* for Documents)
Various, including HQMF and QRDA
FHIR FHIR
Data Definition
and Models
Query for existing data – does not define new data or models
Query for existing data Can define new data elements
Uses QDM and can define new data elements for eCQM
Policy Issues Patient care queries covered by HIPAA TPODoes not address policy issues for Research
Policy issues minimally addressed with sand box
Does not expressly address policy issues for secondary use
Does not expressly address policy issues for eCQM
Cross-Overs • DAF could be used to extract and populate SDC forms
• DAF could be used to query for completed SDC forms as document
• DAF might be extended to query for eCQM data and use CQL for more complex queries
Current approaches might be transition to DAF Research
Data Dictionary might be shared with other initiatives
14
DAF Points of Comparison DAF Points of Comparison
Summary Summary CONTINUEDCONTINUED
DAF QH SDC CQF
Status of Standards and
Implementation Guides
HL7
Data Access Framework (DAF) Data Elements-based Query FHIR Profile
DAF FHIR Implementation Guide
IHE
The Data Access Framework (DAF) Document Metadata Based Access Implementation Guide
N/A HL7
Structured Data Capture (SDC) FHIR Profile
Structured Data Capture (SDC) FHIR Implementation Guide
Structured Data Capture (SDC) Data Element Exchange Implementation Guide
IHE
Structured Data Capture (SDC) (Technical Framework Supplement)
HL7
Quality Information and Clinical Knowledge (QUICK) model
Clinical Quality Expression Language
Clinical Quality Common Metadata
Decision Support Service Implementation Guide, DSTU Updates
Security and Privacy
DAF Phase 1 & 2 reference defined standards and profiles in the DSTUs. DAF Phase 3 has not referenced standards yes, but is working with HEART
N/A SDC may be limited in the short term by HL7's SMART on FHIR OAuth scopes as well as unresolved HL7 purpose-of-use definition issues
CQF is in the same shape as DAF Phase 3, but has not directly referenced HEART's work yet