Example+User+Story+–+Case+Control,+Statin+Efficacy







__NOTE:__ //In this User Story the analysis of a Query Result occurs at the Provider/Provider Organization and the Query Result is sent via an Intermediary, such as an HIE or HISP (the Intermediary is playing the role of “Network Data Partner” in this User Story).//

In order to meet Stage 1 Meaningful Use Quality Measure requirements, an Eligible Provider enters key clinical information including details on those patients who have been diagnosed with Coronary Artery Disease (CAD) and if they are taking lipid lowering medications/statins (NQF 0074) as part of routine patient care, into the EHR system (//data source/aggregator)//. This data is included in reports to CMS for Clinical Quality Measure compliance and it also feeds into a clinical information model repository.

The //Information Requestor// creates and sends a query, via the Intermediary (//Network Data Partner)//, to determine the number of individuals over 18 years old who have been diagnosed with CAD, and whether or not they are taking a statin. The Intermediary distributes the query to the Query & Results Reviewer who examines the query on behalf of the data source. After validating the query the Query and Result Reviewer distributes the query appropriate Provider/Provider Organizations. After receiving the query request, the Electronic Health Record system utilizes the clinical information model to extract the data on those individuals over 18 years of age, who have been diagnosed with CAD and whether or not they are taking a statin. The data is further refined to determine those patients who are on a statin regimen, those who are not, and those who are hyperlipidemic. At this time the Electronic Health Record System also checks for patient consent and creates a file or audit log of all patient level data used to create the query result.

The extracted data is aggregated and fed into an intermediate data structure. In order to determine if taking a statin helps control hyperlipidemia, a 2x2 observational analysis may be performed. The analysis results (the number of individuals who take and do not take a statin, and the number of these respective individuals who are hyperlipidemic) make up the query result. //Table 1. Structure of 2x2 Analysis//

These aggregated results are formatted and sent as a query result to the Query & Results reviewer who reviews the query results and approves the aggregated query result for distribution on behalf of the Provider(s)/Provider Organizations. After the review and approval are complete the Query and Results Reviewer sends the Intermediary //(Information Collector/Combiner)// who collects and combines the aggregated data from multiple sources. The Intermediary de-identifies the query result where applicable and distributes the combined results to the appropriate Information Requestors.

Upon receiving the query result, the Information Requestor refines the original query to determine the efficacy of the statins; thus, medication A versus medication B. This determination is based on those patients who take each medication and whether or not they remain hyperlipidemic. The query requestor refines the query and sends it out via the Intermediary //(Network Data Partner)//. The Intermediary distributes the query to the Query & Results Reviewer who examines the query on behalf of the data source. After validating the query the Query and Result Reviewer distributes the query appropriate Provider/Provider Organizations. After receiving the query, the data source utilizes the clinical information model to extract the data on all individuals who are taking medication A or medication B and whether or not they remain Hyperlipidemic. The extracted data is aggregated and fed into an intermediate data structure. A 2x2 matrix analysis analysis is performed for each medication. The analysis results are then compared against each other to determine the efficacy of the medications.

//Table 2. Structure of 2x3 Analysis for Medication A vs. Medication B//

The aggregated query result is then sent back to the Query & Results reviewer who reviews the query results and approves the aggregated query result for distribution on behalf of the Provider(s)/Provider Organizations. After the review and approval are complete the Query and Results Reviewer sends the query result to the Intermediary who collects and combines the data from multiple sources. The Intermediary de-identifies the query result where applicable and distributes the results to the appropriate Information Requestor(s).