@@ Line 1: / Line 1: @@
-=Introduction=
+#redirect [[PCC TF-1/QED]]
-''This is a draft of the Query for Existing Data Profile (QED) supplement to the Patient Care Coordination Technical Framework.  This draft is a work in progress, not the official supplement or profile.''
-{{Note|Appendix D of Volume II and Appendix O of the ITI Technical Framework Volume II overlap in content. If you are reviewing this profile, we would like your feedback on the content of this appendix and of the ITI Appendix O.  That appendix can be found in the PIX/PDQ Version 3 Profile Supplement|For Public Comment}}
-{{Note|The WSDLs provided in Appendix E of this Profile Supplement are intended to conform to Appendix V of Volume II of the ITI Technical Framework.  If you are reading this profile, you should also read that appendix.  Please comment on any discrepancies that you may find.|For Public Comment}}
-__TOC__
-==Profile Abstract==
-The Query for Existing Data Profile (QED) supports dynamic queries for Clinical Data.
-A wide variety of systems often need access to dynamic clinical information stored and maintained in an EMR system or other clinical data repository.  This profile makes the information widely available to other systems within and across enterprises to support provision of better clinical care.  The information made available by this profile can be used to support clinical care, quality reporting, financial transactions, public health reporting, clinical trials, drug interaction checking, and patient qualification for various protocols.
-==Glossary==
-; Clinical Data Repository : A Clinical Data Repository (CDR) is a database of clinical information on patients, often optimized for access by individual patients.
-=Volume I=
-<pre>Add the following bullet to the list of profiles</pre>
-* Query for Existing Data - This profile (QED) supports dynamic queries for Clinical Data. A wide variety of systems often need access to dynamic clinical information stored and maintained in an EMR system or other clinical data repository. This profile makes the information widely available to other systems within and across enterprises to support provision of better clinical care. The information made available by this profile can be used to support clinical care, quality reporting, financial transactions, public health reporting, clinical trials, drug interaction checking, and patient qualification for various protocols.
-===Dependencies===
-<pre>Add the following row(s) to the list of dependencies</pre>
-{|style='background-color:#7f7f7f;' align='center' border='1' cellspacing='0'
-!Integration Profile
-!Dependency
-!Dependency Type
-!Purpose
-|- style='background-color:#ffffff;' align='center'
-|Query for Existing Data
-|[[Audit Trail and Node Authentication]]
-|Each actor in this profile shall be grouped with the ATNA [[Secure Node]] or [[Secure Application]] actor.
-|Required to manage audit trail of exported PHI, node authentication, and transport encryption.
-|- style='background-color:#ffffff;' align='center'
-|Query for Existing Data
-|[[Consistent Time]]
-|Each actor in this profile shall be grouped with the [[Time Client]] Actor
-|Required to manage and resolve conflicts in multiple updates.
-|-
-|}
-==Query for Existing Data Profile (QED) ==
-The Query for Existing Data Profile (QED) supports dynamic queries for clinical data. A wide variety of systems often need access to dynamic clinical information stored and maintained in an EMR system or other clinical data repository. This profile makes the information widely available to other systems within and across enterprises to support provision of better clinical care. The information made available by this profile can be used to support clinical care, quality reporting, financial transactions, public health reporting, clinical trials, drug interaction checking, and patient qualification for various protocols.
-===Classification of Information===
-The QED profile classifies information into six different categories for the purpose of determining where it might be found.
-; Common Observations : These are a collection of simple measurements or reported values that can be determined using simple measuring devices (e.g., Height, Weight), or which can be reported by the patient (date of last menstrual period).  These measurements do NOT include anything that might be recorded as a problem, allergy, risk, or which requires interpretation, clinical decision making, or diagnostic quality equipment or procedures for performing the measurement.
-; Diagnostic Results : These are a collection of observations made or performed using laboratory testing equipment, imaging procedures, vision examinations, et cetera.
-; Problems and Allergies: These are a collection of diagnoses, clinical findings, allergies, or other risk factors that are recorded for the patient.  The information may be obtained from patient reports, or through clinical decision making.  It includes such information as would be found in social and family history sections of clinical reports.  This classfication can be further subdivided into three groups.
-<dl><dd>
-; Conditions: This is a collection of disease conditions for the patient.
-; Intolerances: This is a collection of the patient's allergies and other intolerances.
-; Risk Factors: This is a collection of the patients significant risk factors, as might be established based on a review of family history, social history, occupational exposures, et cetera.  By themselves, they may not be indicitave of a disease condition, but could contribute to one.</dd></dl>
-; Medications : This is a collection of the medications that a patient is or has been taking for treatment of one or more conditions.
-; Immunizations : This is a collection of immunizations that have been given, or which are planned to be given to the patient.
-; Professional Services  : This is a collection of procedures and/or encounters which the patient has participated in, or is expected to participate in.
-Each of these major classifications of information can often be found in distinct repositories of information.  For example, patient vital signs, problems and allergies may be recorded in simple EHR sytem; diagnostic results in a laboratory or radiology information system; medications in a pharmacy information system, immunizations in an immunization registry, and professional services in a practice management system.
-===Actors/Transaction===
-There are six actors in this profile, the Clinical Data Consumer, and five different repositories of clinical data, including vitals, problems and allergies, diagnostic results, medications, and immunizations.
-[[image:Qcd.png|frame|center|Query for Existing Data Actor Diagram]]
-{{Note|The Vital Signs Data Repository should probably become the Common Observations Data Repository, because it should be able to contain more than just vital signs measurements.|For Public Comment}}
-The table below lists the transactions for each actor directly involved in the Query for Existing Data Profile. In order to claim support of this Integration Profile, an implementation must perform the required transactions (labeled 'R'). Transactions labeled 'O' are optional. A complete list of options defined by this Integration Profile and that implementations may choose to support is listed below under [[#Options | Options]].
-{|style='background-color:#D9D9D9;' align='center' border='1' cellspacing='0'
-!Actor
-!Name
-!Optionality
-!Transaction
-|+Query for Existing Data Actors and Transactions
-|- style='background-color:#ffffff;' align='center'
-| rowspan='5'|Clinical Data Consumer
-| [[#Query Vital Signs | Query Vital Signs]]
-| O<sup>1</sup>
-| PCC-1
-|- style='background-color:#ffffff;' align='center'
-| [[#Query Problems and Allergies | Query Problems and Allergies]]
-| O<sup>1</sup>
-| PCC-2
-|- style='background-color:#ffffff;' align='center'
-| [[#Query Diagnostic Data| Query Diagnostic Data]]
-| O<sup>1</sup>
-| PCC-3
-|- style='background-color:#ffffff;' align='center'
-| [[#Query Medications | Query Medications]]
-| O<sup>1</sup>
-| PCC-4
-|- style='background-color:#ffffff;' align='center'
-| [[#Query Immunizations | Query Immunizations]]
-| O<sup>1</sup>
-| PCC-5
-|- style='background-color:#ffffff;' align='center'
-| Vital Signs Data Repository
-| [[#Query Vital Signs | Query Vital Signs]]
-| R
-| PCC-1
-|- style='background-color:#ffffff;' align='center'
-| Problems and Allergies Repository
-| [[#Query Problems and Allergies | Query Problems and Allergies]]
-| R
-| PCC-2
-|- style='background-color:#ffffff;' align='center'
-| Diagnostic Data Repository
-| [[#Query Diagnosic Data | Query Diagnosic Data]]
-| R
-| PCC-3
-|- style='background-color:#ffffff;' align='center'
-| Medications Repository
-| [[#Query Medications | Query Medications]]
-| R
-| PCC-4
-|- style='background-color:#ffffff;' align='center'
-| Immunizations Repository
-| [[#Query Immunizations | Query Immunizations]]
-| R
-| PCC-5
-|}
-Note <sup ID=note1>1</sup>: The Actor shall support at least one of these transactions.
-=== Options ===
-{|style='background-color:#ffffff;' border='1' cellspacing='0'
-!align='center' style='background-color:#cfcfcf;' |Actor
-!align='center' style='background-color:#cfcfcf;' |Option
-|+Query for Existing Data Options
-|-
-|Vital Signs Data Repository
-|rowspan=5|''None Defined''
-|-
-|Problems and Allergies Data Repository
-|-
-|Diagnostic Data Repository
-|-
-|Medications Data Repository
-|-
-|Immunizations Data Repository
-|-
-|rowspan='5'|Clinical Data Consumer
-|[[#Vital Signs Option|Vital Signs Option]] (1)
-|-
-|[[#Problems and Allergies Option|Problems and Allergies Option]] (1)
-|-
-|[[#Lab Results Option|Diagnostic Data Option]] (1)
-|-
-|[[#Medications Option|Medications Option]] (1)
-|-
-|[[#Immunizations Option|Immunizations Option]] (1)
-|}
-(1) At least one of these options shall be supported by a Clinical Data Consumer Actor
-==== Vital Signs Option ====
-A Clinical Data Consumer that implements the Vital Signs Option implements the Query Vital Signs transaction.
-==== Problems and Allergies Option ====
-A Clinical Data Consumer that implements the Problems and Allergies Option implements the Query Problems and Allergies transaction.
-==== Diagnostic Data Option ====
-A Clinical Data Consumer that implements the Diagnostic Data Option implements the Query Diagnostic Data transaction.
-==== Medications Option ====
-A Clinical Data Consumer that implements the Medications Option implements the Query Medications transaction.
-==== Immunizations Option ====
-A Clinical Data Consumer that implements the Immunizations Option implements the Query Immunizations transaction.
-=== Grouping ===
-==== Clinical Data Repositories ====
-Any of the repository actors of this profile can be grouped with other repository actors.  For example, an EMR might implement all of the repository actors of this profile, while a pharmacy system might implement only the Immunizations and Medications Repository actors.
-When actors are grouped in this fashion, it is expected that they will provide appropriate '''join''' fields to show relationships between different records.  For example, when a EMR groups together the Medication Data Repository and Problems and Allergies Data Repository, and recieves a request for Medications, it should also return the Problems, and internal references to those problems that are the reason for prescribing the medication.
-==== [[Audit Trail and Node Authentication]] and [[Consistent Time]] ====
-All actors of this profile shall be grouped with either the [[Secure Node]] or the [[Secure Application]] actor, to ensure the security of the information being exchanged.  These actors shall also implement [[Time Client]] to ensure that consistent time is maintained across systems.
-''TBD -- what specifically are the logging requirements under this profile''
-* Login/Logout
-* Actor Start/Stop
-* Query
-* Import (if the reciever imports the queried data)
-* Export
-==== [[Retrieve Form for Data Capture]] ====
-A Clinical Data Consumer actor may be grouped with an [[Form Filler]] or [[Form Manager]] actor to appropriately populate forms with recently gathered clinical data.
-==== [[Cross Enterprise Document Sharing]] ====
-A Repository actor may be grouped with a Cross Enterprise Document Repository actor.  Data gathered from clinical documents submitted to the [[Document Repository]] can be a source of information returned by the [[#Clinical Data Source | Repository]] actor.  Information returned by the Repository shall include references to all documents used in generating the results.
-==== Content Integration Profiles ====
-A Content Creator may be grouped with a Clinical Data Consumer to obtain some or all of the information necessary to create a Medical Summary based on information found in a Repository.
-A Content Creator may be grouped with a Data Repository.  When grouped with a Data Repository, the Data Repository Actor shall respond to queries containing the relevant vocabulary codes used by the Content Creator.
-{{Note|The assumption is that if a system can create content using a particular code, then it should also be able to respond to queries using that same code.|For Public Comment}}
-==== Patient Identity Cross Referencing and Patient Demographics Query ====
-A clinical data consumer may be grouped with a [[Patient Identifier Cross-reference Consumer]] or a [[Patient Demographics Consumer]] actor to resolve patient identifiers prior to submitting queries to a Repository.
-Within an enterprise, the need to cross-reference patient identifiers may not be necessary.  However, once enterprise boundaries are crossed, these identifiers will need to be resolved.  In that case either PIX or PDQ shall be used.
-=== Process Flow ===
-[[Image:Qcdseq.png|frame|center|Query for Existing Data Process Flow]]
-==== Clinical Trials ====
-A patient participating in a clinical trial arrives for a trial-related visit to a physician office. The physician completes a report in his/her EMR gathering information relevant to the trial. Upon completion of the visit, a research assistant gathers the data relevant to the trial and submits it to the clinical trial information system.  Among the data needed to gather are the patient's current medications.
-The research assistant logs into the clinical trial information system, and enters data about the patient visit pertinent to the trial.  The clinical trial information system performs a query of the EMR using [PCC-4] where the patient data is stored, and obtains the list of the patient's current medications.
-==== Claims  ====
-A claims administrator begins a claim for treatment of a patient who is pregnant.  They log into their practice management system to begin processing the claim.  Since this claim is for services provided during pregnancy, a patient measurement is needed to complete the claim.  The practice management / billing system queries the EMR for the date of last menstruation for the patient using [PCC-1], and completes the claim.
-==== Drug Safety  ====
-Medication is about to be administered at a modality.  Prior to administration, the modality queries the EMR for current problems and allergies and medications using PCC-3 and PCC-4 to enable display of this information to the operator, or to send to a decision support system to determine if this medication is OK to administer.
-A CPOE system needs to generate a medication order for a patient for a medication whose dosage is based on weight. Prior to generating the order, the system will query the EMR for the most recent weight measurements of the patient to determine the correct dose using [PCC-1]. The system also request information about the patient's current problems and allergies using [PCC-3], and medications using [PCC-4] to perform drug interaction checking before completing the order.
-==== Public Health, Biosurveillance, and Disease Registries  ====
-During a routine pediatric visit, an EMR queries an immunization registry for the immunization history for the patient using [PCC-5].  Upon review of the information, it appears that on a recent visit, the patient was scheduled for immunization, but the immunization was not given due to a current fever. The fever ius not longer present, so the immunization is given to the patient.
-Upon completion of the visit, a reporting application is notified.  The reporting application queries the EMR visit data to see if any immunizations were given during the just completed visit using [PCC-5].  If an immunization was given during the visit, the reporting application collects the appropriate data and submits it to an immunization registry.
-====Identifying Qualifying Patients====
-Decision support systems can query the EMR to obtain specific data elements for a patient, and use that information to determine if the patient qualifies for a clinical trial, or if the visit is one that requires additional reporting.
-Upon completion of a visit, the EMR activates a decision support system.  The decision support system queries the EMR for patient diagnoses using PCC-3. Upon determining that the patient has been diagnosed with Diabetes, the decision support system notifies the EMR that it needs to activate protocols for diabetic care.  This use case could be continued as described in the section below.
-==== Quality Reports and Disease Management ====
-Upon completion of a visit, certain quality measures need to be gathered in order to produce an aggregate measure.  A quality system can query the EMR to determine for each patient the values that need to be measured.
-A diabetic patient completes a routine visit.  The EMR queries a Lab Result Repository using PCC-2 to determine if a recent HgA1C result is available from the last six months using [PCC-2].  Upon failing to find one the EMR system notifies the physician that an updated HgA1C test is required.
-====Disease Management ====
-A physician wants to monitor a patient's blood sugar levels and body mass index. She requests a graph of the patient's blood sugar lab results (lab) and BMI (vital signs) for the past 9 months from a desktop application.  The desktop application queries the EMR for the selected vital signs for the indicated time period using PCC-1, and graphs the data appropriately.
-== Actor Definitions ==
-; Clinical Data Consumer : A clinical data consumer makes use of clinical patient data.
-; Vital Signs Data Repository : A Vital Signs Data Repository maintains patient vital signs data.
-; Problems and Allergies Repository : A Problems and Allergies Repository maintains patient problem and allergy data.
-; Diagnostic Data Repository : A Diagnostic Data Repository Repository maintains results from diagnostic tests (e.g., Lab, Imaging, or other test results).
-; Medications Data Repository : A Medications Data Repository maintains patient medication data.
-; Immunizations Data Repository : An Immunizations Data Repository maintains patient immunization data.
-== Transaction Definitions ==
-; Query Vital Signs : Request information about recent patient measurements, usually used to obtain vital signs measurements.  The query may request all measurements, or those taken for a specific encounter, or date range, or may be for a specific set of measurements.
-; Query Problems and Allergies  : Request information about problems or allergies known for a patient, usually to determine the patients current problems and allergies.  The query may request information about all problems, all allergies, or may request information on a specific problem or allergy entry, entered during a specific encounter or date range.
-; Query Diagnostic Data : Request information about diagnostic results known for a patient.  The query may request information about all diagnostic results, or may request information on a specific diagnostic result entry, or one entered for a specific encounter or date range.
-; Query Medications : Request information about medications given to, or being taken by a patient.  The query may request information about all medications or may request information on a specific kind of medication or immunization, or one entered for a specific encounter or date range.
-; Query Immunizations  : Request information about immunizations given to a patient.  The query may request information about all immunizations, all immunizations or may request information on a specific kind of medication or immunization, or one entered for a specific encounter or date range.
-=Volume II=
-{{:PCC-1}}
-{{:PCC-2}}
-{{:PCC-3}}
-{{:PCC-4}}
-{{:PCC-5}}
-{{:Sending HL7 Version 3 Messages}}

Difference between revisions of "Query for Existing Data"

Latest revision as of 22:17, 14 June 2007

Navigation menu

Search