At a very high level, one can visualize SCOOP as having five conceptual components:
- EMR (Electronic Medical Record)
- EMR Adapter
- Local Reflector
The EMR, EMR Adapter and End Point are all under the practitioner’s control.
EMR – Electronic Medical Record
The EMR is the point of service system that the practitioner uses as part of their day to day work. Here is where they document care and manage their practice. It is the source of truth for care.
The EMR has its own data store and is the medico-legal record of the practice. It will include data such as laboratory results, problem lists, medications, allergies, and encounter notes.
We will expect that for most questions asked in SCOOP that the EMR content will not be changed. We realize that there may be times where specific data may be needed. These will be addressed carefully with the EMR products.
Data from the EMR is sent to the EMR Adapter.
This component will be EMR specific as required. It accepts (or collects) data from the EMR. The goal for this component is to ensure that the data is transmitted to the Endpoint in a standardized format to that it is consistently stored.Thus, the EMR Adaptor can also do some level of transformation and mapping of data from the EMR. The EMR Adaptor will not store patient data but be purely a conduit. The EMR Adaptor will be configurable for each EMR product and will, likely, need to be modified for EMR updates as well.
The Endpoint component will contain patient data, transformed into a standard network format designed to rapidly answer questions. The Endpoint will be within each practice’s control and no data will leave the practice. Endpoints will have the same structure throughout the network, facilitating the querying from the Network Hub. Endpoints can be extended over time, as the range of data is extended. The intent is to keep the structure the same, although not all practices may be able to share the same data from their EMRs (i.e. there may be gaps)
Some may think of this as the “edge server approach”.
The Local Reflector is the component that manages the question / answer process for the practice. The user interface for the Local Reflector will let the Practice Question Manager review questions and decide which questions to allow to be answered.
The Local Reflector connects to the Network Hub(s) to receive questions and to reply with answers. It will then handle the receiving of questions from the hub, alerting of questions to the practitioner, and returning of answers to the hub.
Over time, the Local Reflector also let the practitioner ask specific questions of the Endpoint of their own data / practice. This could be helpful for reviewing data quality, creating reports and recall lists that are specific to the practice and not being generated by either their EMR or their network.
The Network Hub is where questions are managed. No patient data is stored here. The Hub connects to multiple end points in the network. Through its web interface, questioner encoders can set up and deploy questions across the network. The hub will handle the (asynchronous) return of answers to the questions and compile the answers in a manner that is helpful to the questioner. The hub cannot ask questions of an end point, unless the practitioner trusts the hub and the questioner.
The hub is under control of the questioner.
SCOOP Minimum Functionality for each Iteration by Component
The functions in the table below are a summary and are cumulative (i.e. iteration 2 includes iteration 1) unless otherwise stated.
|Iteration||EMR(1)||EMR Adapter||EndPoint||Endpoint Manager||Network Hub|
|1||No Change||Handles basic patient ID, age, and current medications||Stores patient information from adapter and responds to HUB queries||No UI||Allows user log in. One role security. Asks questions re medication and basic age distribution.|
|2||Add gender, problem list||Can generate rank lists of common correlations.||Supports provider to review which questions are answered.||Able to ask questions to discover common correlations (e.g. between medication and diagnosis)|
|3||Includes patient lab data in model||Supports questions that include lab data, can aggregate similar test results across LOINC codes||Supports provider UI to accept / refuse questions.||Provides user interface for querying with laboratory test results.|
Other iterations to be added as we plan deeper (i.e. as we learn through our actions in iterations)
- Basic EMR will have limited changes outside of the adapter. Things that will be added will be:
- Patient level opt out flag (i.e. do not include me in the network, ever).
- For OSCAR – specific interventional documentation for specific prospective studies (to be carefully decided).