This past year, I took a leave of absence from Allscripts to serve as the Office of the National Coordinator for Health IT (ONC) coordinator for Query Health, an Open Government Initiative that is establishing standards, policies and services for distributed population queries of clinical records.  It comes at a unique moment in time – at the confluence of broad deployment of Electronic Health Records, the compelling need for standards for secondary use of that healthcare information, and a Stage 3 Meaningful Use strategy that focuses on a “learning health system.”  That is, a system in which the vast array of health data can be  aggregated, analyzed, and leveraged using real-time algorithms and functions.  

I’m thrilled to be back and sharing what I learned about what we can do to implement a learning health system that benefits patients on a national scale.

Our work began in August 2011 in Washington D.C., with a “Summer Concert Series” environmental scan of the best work on distributed queries happening around the country.   I collaborated with some of the top folks in the industry from the more than 100 member organizations. It was energizing to be engaged with colleagues so deeply committed and passionate about improving health care.

My job was to lead the overall initiative representing ONC.  Clinical, operations and technical workgroups, each with around 40 members, delivered the functional and operational requirements, the technical approach, the proposed standards and reference implementations.    We actively engaged with the National Coordinator, the HIT Standards Committee, the HIT Policy Committee and the Privacy and Security Tiger team to ensure that Query Health aligned with broad national priorities and strategies.

Understanding Population Health

Distributed population queries can be applied to a variety of secondary uses.  Distributed population queries enable an understanding of population measures of health, performance, disease and quality, while respecting patient privacy, to improve patient and population health and reduce costs.

Distributed population queries are a central component of ONC’s strategy for a learning health system.  These queries “send questions to the data” and return aggregate population measures that keep patient-level information protected at the source.

We use distributed population queries today for a variety of purposes.  For example, public health tracks diseases, including flu-like illness, and evaluates optimization of scarce resources.  The FDA evaluates signals related to drug safety once drugs are released to the market.  Researchers compare the relative effectiveness of drugs and treatments.

Putting It into Practice

There are five Query Health pilots kicking off this Summer and Fall. 

  1. The New York City and State public health departments are sending questions to both provider practices and RHIOs related to diabetes and hypertension.
  2. The Food and Drug Administration is sending questions to a clinical data source at Beth Israel Deaconess Medical Center to evaluate which post-market drug surveillance questions can be supported by clinical data. 
  3. The Massachusetts Department of Public Health is sending diabetes-related questions to community health centers and provider practices. 
  4. The Centers for Disease Control is applying Query Health standards to its BioSense 2 cloud-based distributed data repository for situation awareness and disease syndromes. 
  5. Allscripts is testing the applicability of Query Health to dynamically query for clinical quality measures. 

Query Health standards are being prepared for standards ballot by HL7 and ONC’s Office of Science and Technology.  The standard for Queries is based on an improved, more parsimonious version of the Health Quality Measure Format or HQMF.  The standard for Results is the Quality Reporting Document Architecture or QRDA (Categories 2 & 3).  The target data is aligned with the S&I Framework Clinical Element Data Dictionary, the National Quality Forum’s Quality Data Model and the HL7 Consolidated CDA. 

You can find more information about the project at

What’s your take on how the Query Health initiative can improve how we use health IT for the benefit of patient and patient populations? Do you have new ideas we haven’t yet considered? Share your thoughts below.

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About the author

As Vice President of Strategic Initiatives for Allscripts, Rich Elmore works on innovations, managing exploration and execution of strategic partnerships and acquisitions. During 2011-12, he took a leave of absence to lead the Query Health initiative for the Office of the National Coordinator for Health IT (ONC), US Department of Health and Human Services. He also led ONC’s initiative for Consolidated CDA and Transitions of Care, served as a workgroup leader for ONC’s Direct Project, and was a founding member of the CCHIT Interoperability workgroup. Previously, Rich ran the Flowcast Hospital business for IDX (before the company’s merger with GE Healthcare) and served on the IDX Corporate Strategy Board. Rich has degrees from Dartmouth College (BA) and New School University (MA Economics). He serves on the Scientific Advisory Group for Innovations in Monitoring Population Health Using Electronic Health Records – a multi-year research initiative of the Primary Care Information Project. He also serves on the advisory board to the Sudan Development Foundation, building health clinics in the world’s newest nation (South Sudan), and is Vice President on the Board of Directors for the King Street Center, serving kids and families in need in Burlington, Vermont.

2 COMMENTS on Toward a learning health system


Nate Evans says:

07/12/2012 at 12:29 pm

The Query Health initiative is a necessary step towards improving population health! How far off is the industry from adopting and implementing a data standard with respect to EHR’s?

Have you heard of the X-Prize ‘Tricorder’ challenge? Was it brought up during your time working with Query Health? Is Allscripts involved in this effort in any way?

A device such as the described ‘tricorder’ will dramatically increase data collection beyond what EHR’s are no doubt already doing. All of this data would benefit health greatly if it was output in a standard way. I imagine companies such as Allscripts would play a role in making sense of that data, particularly in areas where Allscripts EHR’s are in use.

What do you think about X-Prizes vision on a ‘tricorder’?

    Rich.Elmore says:

    07/13/2012 at 12:05 am

    Hi Nate –

    You asked the $64,000 question about data standardization across EHRs. There’s some terrific improvements proposed in ONC’s 2014 Edition standards. These Stage 2 Meaningful Use standards include standardized vocabularies for exchange of health information and more precise specification of the way in which summaries of care are communicated using Consolidated CDA. I recently presented on the data standardization question with Rich Platt (Harvard School of Population Medicine) at the Institute of Medicine ( Our survey work found that it’s difficult to express a clinically intuitive, consistently computable query, due to the lack of semantic equivalency among systems and among users of systems. The HIT Standards Committee has also been focusing on the need to establish value sets that will enable standards for clinical concepts – so we can expect more progress there. There’s also some terrific work that’s been done by Allscripts and Allscripts partners Humedica and dbMotion with their work on data normalization and semantic harmonization.

    The Tricorder X Prize sounds very cool. There are sure to be some great advances that come out of this work. Allscripts is keenly aware of the power of consumer devices and consumer engagement to improve health. You’ve got great insight about the potential of bringing the Tricorder and EHR closer together.

    Thanks, Nate, for your insights. Live long and prosper.


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