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Since last September, a public-private collaborative launched by ONC and consisting of about 100 organizations has been working on Query Health. A number of EHR vendors have committed to using the resultant distributed query standards, including Allscripts, Cerner, eClinicalWorks, Epic, GE Healthcare, Greenway Medical, Healthland, McKesson, Medicomp, MedPlus, NaviNet, NextGen, and Siemens.
The Primary Care Information Project (PCIP) of the New York City Department of Health and Mental Hygiene aims to begin its Query Health pilot in May, according to Michael Buck, director of the pilot and clinical work leader for Query Health. Buck, who is also the biomedical informatics R&D manager at the city health department, told InformationWeek Healthcare that the pilot will run through September, with updates being provided periodically to the Query Health workgroups.
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The pilot will focus on four regional healthcare information organizations (RHIOs) that serve New York, including the outer boroughs. (RHIO is an older term for a public health information exchange, or HIE.) Buck said that Axolotl and Intersystem, which provide the technical infrastructure for the RHIOs, are building platforms to aggregate the data they route between disparate EHRs.
"That's what we'll base our system on," he said. "It's a matter of mapping both of those platforms to the Query Health standard."
Initially, he said, PCIP will start asking questions based on "highly iterative" data sets such as diagnoses, procedures, and medications. That would allow PCIP to give the health department far better data than it now has for purposes of population health analysis. For example, it could find out how many diabetic patients are being treated with a particular medication in a certain area of the Bronx.
"We're working with the rest of the teams in the health department from chronic disease management to HIV programs, so they're better informed about the current state of health in the community," he said. "That way, when they do their interventions, they can reach out to the appropriate neighborhoods."
PCIP already does a version of distributed health queries, using the eClinicalWorks EHR that the city provided for free to 450 mostly small primary care practices in underserved areas. Analyzing the EHR data it collects from each of these practices, PCIP feeds back reports to providers to help them manage their patient populations, Buck said.
The Query Health approach will allow PCIP to expand this approach from ambulatory care clinics to hospitals. It will also permit the program to query any EHR that is connected to a RHIO.
Including the New York HIT regional extension center, which PCIP administers, the project has helped 750 practices and 4,200 providers adopt EHRs, Buck said. But only about 10% to 15% of these practices have connectivity with a RHIO.
The Query Health collaborative is working on uniform standards and data mapping methods that will eventually allow researchers to query EHRs directly without going through HIEs, Buck said. Partners Healthcare in Boston, which provided the basic methodology for Query Health, has already mapped applications from Epic, Cerner, and GE to a common standard for such queries, he pointed out.
Someday, he said, "Places that are already running this [kind of system] could be plugged into more of a national framework, so you could take queries from somewhere else and run them in your organization."
It would be ideal, he said, if EHR vendors imbedded Query Health standards in their software. PCIP has discussed this with eClinicalWorks, he said, and that will be part of the Query Health pilot. In addition, NextGen has a contract with the New York REC to build a distributed population query system. "We've suggested that they build Query Health in," said Buck. "But that's not going to be in the pilot timeframe."
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