Distributed population queries - a national priority

 By Rich Elmore, Initiative Coordinator

Office of the National Coordinator for Health Information Technology

This August, ONC will be sponsoring the “Summer Concert Series” on the state-of-the-art of distributed population queries. The “Summer Concert Series” webinar presentations will provide tremendous insight from a real-world perspective to interested stakeholders on practitioners’ experience with distributed queries.     

Distributed population queries can be applied to public health surveillance, research, quality measures, chronic disease stratification and many other purposes.  These queries return aggregate information from a standard clinical information model, leaving protected health information safely behind the health care organizations’ firewalls. 

The use of distributed population queries for clinical insight has been hindered by organizational limitations on data sharing, inconsistencies in the expression of clinical concepts and lack of standards for distributed queries.  This has ultimately limited their use, with a few notable exceptions, to large healthcare organizations with more sophisticated IT infrastructures and deeper research budgets. 

One may ask “Why not just centralize the data?”  Well for one, for non-regulated purposes many healthcare organizations will choose not to loosen their control over their data.  Also, as a matter of principle, patient level data shouldn’t be exchanged when aggregate level information will do.  Finally, keeping data close to the source may improve adaptability to dynamic information needs and responsiveness to patient information sharing preferences. 

As we approach critical mass of deployments of certified and standardized Electronic Health Record (EHR) systems, we may for the first time be able to consider broader use of distributed population queries.  EHR certification standards require greater adherence to standardized vocabularies and information exchange structures.  While challenges with comparative data will remain, Meaningful Use Stage 2 will likely further improve vocabulary, message and transport standards.  

As an example of distributed queries, Wes Rishel recently explored the changing public health reporting needs during an epidemic.  He suggested use of distributed population queries to “send questions to the data.”  

For another example, until recently the most extensive research to identify comorbidities for autism patients was a multi-year study on 163 patients.  Zak Kohane’s new work on autism patients and comorbidities used distributed queries across the i2b2 SHRINE network linking 4 Boston hospitals.  By tapping into a much larger patient population, his analysis provided greater insight into the comorbidities.  The time required to conduct the research was 3 weeks.   Distributed queries delivered these deeper insights  by reaching an order of magnitude more patients and did so in two orders of magnitude less time. 

Query Health, a public/private partnership project, will be launched in September to take some practical first steps towards this national priority.  The ultimate goal of the Query Health initiative will be to define the standards and services to better enable the use of this distributed approach. 

Please mark your calendars for the “Summer Concert Series” in August and the Query Health project launch on September 6^th at 3 PM ET.  Visit the Query Health web site for more information on these events.