Query+Health+Expanded+Analysis+User+Story

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= The content within this page has been incorporated into the Query Health Use Case which has now been approved through consensus. =

** Expanded Analysis for Diabetic Care in an Outpatient Setting **

__Actors and Roles__
This section describes the Business Actors that are participants in the information exchange for each scenario. Roles are abstractions, played by IT system applications that Stakeholders use in the exchange of data needed to complete Use Case actions. The specific actors, roles, and systems used in this user story are listed below:

__NOTE: __// A role can be carried out by actors not included in this table; however, for the purposes of this Use Case, we are focusing on the content within the table below. In addition, the same actor may perform a combination of roles. Note also that the term Aggregator is applied to the initial data source function of extracting and totaling data from individual patient records. The term Collector/Combiner is the function in which aggregated results from multiple data sources are totaled and/or summarized across the larger population. //


 * **Business Actor** ||  **System**  ||  **Role**  ||
 * Provider/Provider Organization __**OR**__ Health Information Exchange (HIE)/Regional Health Information Organization (RHIO) || Health IT System || Data Source/Aggregator, Query Request Receiver, Network Data Partner, Information Collector/Combiner ||
 * Query & Results Reviewer || Workflow System || Network Data Partner, Query Request Receiver, Results Receiver ||
 * Public Health Agency (i.e. Department of Public Health) || Health IT System || Query Source, Results Receiver, Information Collector/Combiner ||

__User Story Specific Assumptions__

 * Provider/Provider Organization has an Electronic Health Record System.
 * HIE/RHIO for this User Story has a data repository (non-federated model).
 * As part of Meaningful Use Stage 1 requirements, eligible Providers/Provider Organizations at the minimum must populate or enter structured clinical data into an EHR for medications, laboratory orders/results, diagnoses/problem lists, allergies, demographic information, and vital signs. This data is sent to the Health HIE/RHIO
 * A “cluster” is multiple quality metrics for a single condition, (i.e. diabetes, hypertension, etc.) While this User Story focuses on diabetes the same approach can be used for other conditions.
 * A “galaxy” is multiple clusters for the same ¡ patient, i.e., diabetes, hypertension, lipids, CHF, etc
 * Not all queries require the use of a numerator and denominator. Depending on the context of the question, the query may not include a denominator.
 * Query results are numeric results (counts, sums, averages, etc.). The Query Results can be interpreted as a numerator and or denominator count as needed.
 * A Query Result could return multiple counts that could be interpreted as multiple numerators and denominators in the same result set.
 * For this User Story we are interpreting the counts in a numerator and denominator format; however alternative inpretations of a count are possible.
 * In some cases there can be multiple numerators over one denominator depending on the context of the question.

**__User Story__**
A Public Health agency wants to understand how care is being managed in a select area.

A Public Health agency is interested in learning more about the management of diabetic care in a select region. The region under observation has a network of Provider/Provider Organizations with Electronic Health Record Systems or an central HIE/RHIO where the local Provider/Provider Organizations send their patients clinical data for population care management purposes under business associate and appropriate data use agreements. When the HIE/RHIO thus takes on the role of data source it determines what data should be disclosed. The data source formats and loads the clinical data into the Clinical Information Model/Repository.

A Public Health agency (Information Requestor) initiates a query, as a query source, to learn more about diabetic care management for a given population. More specifically, the agency would like to receive counts of patients based on a number of condition specific data points, which are also considered the denominator options. In addition, a query will also be sent to find the overall risk stratification score for different populations. The specific questions asked as part of the query will be based on the numerator and denominator counts options listed below.

The query specifies a date range of care encounters for inclusion. The reporting format for this example is specified to be aggregated by provider (see cross-tab report format below). The following data elements are to be included in the response.


 * Numerator Counts** //(for each characteristic listed below the query should be based on same population)//
 * Counts of Patients based on the Quality Measures (which are listed in Appendix A)
 * Risk Stratification Sum
 * Risk Stratification will require the sum the following, which result in a score from 0 - 6 which will represent how many risk factors have been identified. This result will also provide you with the numbers of each patient within a given population with each score
 * HbA1c > 9.0%
 * Blood Pressure ≥ 140/90 mm hg
 * LDL ≥ 130 mg/dl
 * Smoking Status
 * BMI ≥ 25
 * Microalbumin > 30 micrograms/mg Creatinine
 * Denominator Counts:**
 * Age (in ranges)
 * Zip Code (at three digit levels or specified groupings)
 * Ethnicity
 * Race
 * Gender
 * Date of last inpatient encounter
 * Date of last outpatient encounter
 * Not Deceased (as of query date)
 * Diagnosis Code (type I, type II)
 * Insurance Coverage (Y/N)
 * Insurance Type (Commercial, Federal, State)
 * Practice
 * Number of Visits (within a specified time period)
 * Medication by Class (Statin, Aspirin, Ace Inhibitor/ARB)

To facilitate this request the Public Health agency sends a query request, selecting numerator and denominator counts (where applicable), directly to the data source. The purpose and frequency of the request are also included as part of the query request.

The Provider/Provider Organization or HIE/RHIO acts as a query and results reviewer and examines the query request. After validating the query request the Electronic Health System/Health IT system utilizes the clinical information model to extract the data of interest. The data is further refined to determine the specific count and/or risk stratification score for the desired population. Upon receiving the query, based on the specific type of query or jurisdiction requirements the Provider/Provider Organization or HIE/RHIO verifies patient consent if required.

The data source extracts the data for each result type requested in the query. The extracted data is aggregated and fed into an intermediate data structure, which leverages the data stored in the Clinical Information Model/repository which includes both numerator and denominator counts. The analysis results make up the query result.

An audit log is created for all patient level data used to create the results. The final Result Set from the Provider/Provider Organization or HIE/RHIO (data source) is sent back to the Information Requestor (query source).

An example result set format is shown below. This table is for illustrative purposes only and shows that can be used to show the care for diabetic patients within a specific region over a given time period.

//Table 1: Example result set.//

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