Query+Health+Technical+Approach+Risk+Assessment

include component="page" wikiName="siframework" page="Query Health Header" The purpose of this page is to serve as a forum for discussing the risks associated with the Query Health Technical Approach. This discussion is based on the Technical Approach Primer that was presented to the Operations Workgroup on February 2nd, 2012. This page will examine each step of the Technical Approach and provide a place for the community to document any risks, issues, or concerns.

__Reference Documents__

 * [|OWG Technical Approach Primer 02012012 v2.2.pptx](Presented to Operations Workgroup on 02/02/2012)
 * [|HQMF_QRDA_20120231.pptx] (Presented to Operations Workgroup on 02/09/2012 and 02/16/2012)

__Technical Approach- General Concerns__

 * **Step** || **Policy** || **Privacy** || **Security** || **Other** || **Name** ||
 * **Overall** || This cannot be implemented from the word 'go.' There is a significant amount of start up time before queries can become automated and easy. ||  ||   ||   || Rob McClure ||



The New York State Department of Health must create a query using one of three possible ‘Query Builders’ (hQuery, i2b2, or HQMF) These builders were chosen so that requestors do not have to be technical experts to create a query. Instead, they can create queries using common clinical language in a user-friendly interface.
 * **Step** || **Policy** || **Privacy** || **Security** || **Other** || **Name** ||
 * **1** ||  ||   || Required Authentication to ask a query ||   || Natalie Menser ||
 * ||  ||   || Required Authorization to ask a query ||   || Natalie Menser ||



The query is sent in the format of Modified HQMF* to the PopMedNet Portal.PopMedNet has a user-friendly web-based portal, where queries are submitted. *HQMF is a standard for representing health quality measures as an electronic document. The Query Health initiative is making modifications to the standard to suit the needs of Query Health.
 * **Step** || **Policy** || **Privacy** || **Security** || **Other** || **Name** ||
 * **2** || Queries must be sent in a format that is understandable for those orgs that do not want to or cannot implement automation and have to run the queries manually. ||  ||   ||   || Rob McClure ||



The PopMedNetPortal sends the query, via Query Envelope, to the PopMedNet Data Client. • The Query Envelope is designed to be query and content agnostic and ensure enforcement of privacy and security requirements. • The PopMedNet Data Client is the counterpart of the PopMedNet Portal where queries are received by (Beth Israel Hospital).
 * **Step** || **Policy** || **Privacy** || **Security** || **Other** || **Name** ||
 * **3** ||  ||   ||   ||   ||   ||



PMN Data Client sends the Query to the Procedural Translator which creates specific directions on how to run the query. The Procedural Translator takes the message in HQMF (declarative language) and translates it to JavaScript or SQL(procedural languages).Note: In this step, Responding Organizations, like Beth Israel, have the right to reject any query.
 * **Step** || **Policy** || **Privacy** || **Security** || **Other** || **Name** ||
 * **4** ||  ||   ||   || The use of some sort of Data Dictionary will be critical here to make sure translations are consistent. || Thompson Boyd ||

The Procedural Translator sends the query to the Execution Engines. • They query is now in JavaScript or SQL (procedural languages). • The Execution Engines run the queries while matching the concepts (e.g. “diabetes” and/or codes (e.g. an ICD 9 code) to the Data Sources using the CIM(CEDD). -Clinical Information Model (CIM)/Clinical Elements Data Dictionary (CEDD) is a dictionary that is an ‘overlay’ on the Data Source. It is a translation tool. -Example: A query may ask for the number of people taking a particular medication. The system will use the CIM/CEDD as a reference to identify the number of patients who have that medication listed in their ‘active medications list.’   • All of this occurs behind Beth Israel’s firewall, thus maintaining patient privacy and security of data. 1 - Create a safeguard so that the parts of your database that contain behavioral health data cannot be queried. AND/OR 2- Prevent queries that ask about behavioral health data from ever being created. (See Step 1). ||  ||   || Question: Erin Fitzsimmons Response: Scott Wenstein Bobby Lee ||
 * **Step** || **Policy** || **Privacy** || **Security** || **Other** || **Name** ||
 * **5** || Initial concept mapping for new participants will take significant time and effort ||  ||   ||   || Rob McClure ||
 * ||  || How do we protect behavior health data like substance abuse?



The Execution Engines take the results, which are still in JavaScript or SQL and send them to the QRDA Translator, to be changed to QRDA.  • QRDA is a document format that will provide a standard structure with which to report results.  • Remember: The Department of Health does not necessarily understand the coding language of Beth Israel Hospital (JavaScrip or SQL).  • Therefore results must be translated in a standard way before they can be sent back to the Department of Health.  • The standard selected by the Technical Workgroup for expressing query results is QRDA Category III*. *QRDA Category III was selected because it allows for returning aggregate or summary level results.
 * **Step** || **Policy** || **Privacy** || **Security** || **Other** || **Name** ||
 * **6** ||  ||   ||   ||   ||   ||



The QRDA Translator sends the results back to the PopMedNet Data Client, which routes them back to the PopMedNet Portal.  • The PopMedNet Data Client is the last stop at Beth Israel before the results are sent back to the Department of Health.
 * **Step** || **Policy** || **Privacy** || **Security** || **Other** || **Name** ||
 * 7 ||  ||   ||   ||   ||   ||

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<span style="color: #7f7f7f; display: block; font-family: arial; font-size: 12px; text-align: left; vertical-align: baseline;">The PopMedNet Data Client sends the results, now in QRDA, back to the Department of Health through the PopMedNet Portal using the Query Envelope. <span style="color: #7f7f7f; display: block; font-family: arial; font-size: 12px; text-align: left; vertical-align: baseline;"> • The Query results are now in the hands of the Department of Health. • Reminder: The Query Envelope is designed to be query and content agnostic and ensure enforcement of privacy and security requirements.
 * **Step** || **Policy** || **Privacy** || **Security** || **Other** || **Name** ||
 * **8** ||  ||   || Does the Query Envelope act as a substitute for encryption? Is there any risk of security breaches due to human error? ||   || Linda Martino ||

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<span style="color: #7f7f7f; display: block; font-family: arial; font-size: 12px; text-align: left; vertical-align: baseline;">The PopMedNet Portal now sends the results to the Results Viewer, a specific interface designed for reviewing query results. Now an individual at the Department of Health can review the results.
 * **Step** || **Policy** || **Privacy** || **Security** || **Other** || **Name** ||
 * **9** ||  ||   ||   || One needs to be able to view the questions that were asked along with the query results; otherwise one will not understand the ratio that is sent back; this will provide a way to ensure that the data you get back is accurate and matches the query. || Rob McClure/Susan Campbell ||

__HQMF - General Concerns__

 * **Standard** || **Policy** || **Privacy** || **Security** || **Other** || **Name** ||
 * **HQMF** ||  ||   ||   ||   ||   ||
 * **HQMF** ||  ||   ||   ||   ||   ||

__QRDA - General Concerns__

 * **Standard** || **Policy** || **Privacy** || **Security** || **Other** || **Name** ||
 * **QRDA** || QRDA Category II indicates that patient level data may or may not be used. Query Health should be more restrictive in saying that patient level data will NEVER be used. ||  ||   ||   || Rob McClure ||
 * **QRDA** ||  ||   ||   ||   ||   ||

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