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Quality Reporting HIT Standards Project The Quality Reporting Document Architecture: Phase I September 2007. Overview Sample Project proposal. with SDTC. QRDA: Project Goal. Quality Reporting Document Architecture.

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Quality Reporting HIT Standards Project

The Quality Reporting Document Architecture: Phase I

September 2007


with SDTC


Quality reporting document architecture

QRDA: Project Goal

Quality Reporting Document Architecture

Develop an electronic data standard report for healthcare information systems to use in communicating patient level quality measurement data across disparate systems.


Participants: A Private Collaborative

Founders

Primary Benefactor

For Phase One

HL7 Sponsor

Project Management


HospitalCommunity

PhysicianCommunity

Alliance for Pediatric Quality

Four national pediatric organizations aligned to improve the qualityof health care for America’s children.

  • 200+ children’s hospitals and 60,000 pediatricians using the same play book to improve care

  • Alignment of physicians and hospitals is essential to improvement progress

  • Combined expertise and spheres of influence will accelerate improved quality for children


Alliance goals strategies
AllianceGoals & Strategies

Our Strategies

  • Work for consensus – speak with one voice for improvement in quality for children; advance pediatric improvement initiatives, measures and data/health information technology

  • Endorse and promote projects that advance pediatric quality and health information technology

  • Convene stakeholders

  • Advocate in media and legislature

  • Promote meaningful pediatric improvement and measures

    • Promote initiatives using measures for improvement

    • Spread use of measures for improvement and public reporting

    • Develop a comprehensive catalogue of pediatric improvement priorities and measures

  • Ensure health information technology works for children

    • Seek industry-wide adoption of data standards for pediatrics

    • Promote integration of child health EHR-S standards into vendor systems

    • Endorse pediatric data standards that make comparability possible

  • Explore opportunities for collecting and sharing data


Using data for quality performance measurement
Using Data for Quality Performance Measurement

Problem*

  • Time-consuming and problematic operations for data acquisition from electronic systems

  • Multiple and disparate systems within health care organizations complicate data mining and coordination of efforts

  • Resource-intensive data mapping efforts to link systems and performance measurement data requirements

  • Conflicts or differences between administrative data sets

  • Physicians and providers struggle to meet increasing demands for performance data

    *Source: Agency for Healthcare Research & Quality

Opportunity

  • Support efficient collection, aggregation and reporting of quality measurement information

    • Among providers within a healthcare system

    • Among providers from different healthcare systems

    • Among providers and requestors of quality data (e.g. quality improvement organizations, payers, accrediting orgs, etc.)

  • Support adoption of quality measurement

    • Among developers of health information technology systems

    • Among providers and payers


Status Quo in Quality Measure Reporting

Requestors of Quality Data

Prepare

data

for analysis

Data Entry

100% manual process:

data abstraction

and data mining

QualityImprovement

Organizations

Accrediting

Organizations

Payers

Paper Medical Records

Key-boarding or manual entry

Proprietary data formats

Electronic Medical Records

Provider sends patient level measure data in multiple formats; data prepared for analysis and submitted in multiple formats


QRDA Immediately Simplifies Quality Measure Reporting

Requestors of Quality Data

Prepare

data

for analysis

Data Entry

semi-automated:

data abstraction

and data mining

QualityImprovement

Organizations

Accrediting

Organizations

Payers

Paper Medical Records

Key-boarding or manual entry

QRDA

QRDA-compatible

QRDA

valid?

Electronic Medical Records

Semi-automated data entry; single, open data format for collection and analysis; compatible with EMR exchange documents (CCD, CDA); point-of-collection validation


Future: QRDA Streamlines Quality Measure Reporting

Requestors of Quality Data

Prepare

data

for analysis

Data Entry

semi-automated:

data abstraction

and data mining

QualityImprovement

Organizations

Accrediting

Organizations

Payers

Paper Medical Records

Key-boarding or manual entry

QRDA

QRDA-compatible

QRDA

Electronic Medical Records

Fully-automated data entry, ready for collection and analysis


Leverage and Harmonize With Others

Collaborative for Performance Measure Integration with EHR Systems (The Collaborative)

  • American Medical Association, National Committee on Quality Assurance

  • Addressing performance measure functionality and integration with EHRs

  • Facilitating integration, calculation and reporting of measures within vendor products for reporting

    American Health Information Community (AHIC), Health Information Technology Standards Panel (HITSP), Certification Commission for Health Information Technology (CCHIT)

  • Promoting automation of quality data reporting

  • Developing quality use cases

  • For possible vendor certification of the QRDA standard

    Integrating the Healthcare Enterprise

  • Building Technical Framework for coordination of quality data submission, aggregation and feedback

  • Driving vendor adoption of standards

    Health Level Seven

  • Vehicle for publishing the QRDA standard

  • Working with Clinical Interoperability Council, Electronic Health Record Technical Committee, Government SIG, Pediatric Data Standards SIG, Structured Documents Technical Committee, and more


Related Efforts

NCQA, AQA, APQ....:

measure definition

Measure Development

AHIC, HITSP Use Cases

eMeasure Definition

The Collaborative:

eMeasure definition

ok?

ok?

ok?

IHE:

multi-party choreography using HL7 messages, services

feedback

QRDA

QRDA

QRDA

Aggregators, Requestors


Related Efforts

  • Coordination Points: preliminary work shows that

    • QRDA maps to The Collaborative Work Group B data export requirements

    • QRDA can be payload in IHE PEQD multi-party choreography

    • Combined efforts of The Collaborative, IHE, QRDA and SDOs support AHIC and HITSP use cases

  • Coordination Priorities: future

    • Electronic measure definitions drive data entry as well as validation

    • Integrate into national exchange framework


QRDA Project Overview

Phase One:

  • Define project opportunity

  • Select standards development expert for support

  • Secure endorsement and funding

  • Recruit volunteers

  • Develop prototype QRDA-compliant reports

  • Describe relationship to other projects

  • Make recommendations for moving forward

  • Secure endorsement and funding for Phase Two

Phase Two:

  • Ballot and publish QRDA Draft Standard for Trial Use through HL7

  • Training material and support for vendors adopting the QRDA for pilot measures; Guidelines on prioritized reporting measures

  • Conduct proof of concept demonstrations

3 months

TBD


Benefits of Standardized Electronic Quality Measurement Data Transmission

  • Leverage existing electronic health record data

  • Improve information technology return on investment

  • Eliminate manual data collection (QRDA-compliant EMRs)

  • Promote adoption of electronic health records

  • Reduce the data collection, aggregation and reporting burden for health care providers


Project Proposal: Quality Reporting Document Architecture Transmission

  • “Health care institutions routinely collect and report performance measure data to improve the quality of care provided to patients. Measure data conforms to the requirements of defined "quality measures" which are written and maintained by institutions concerned about health care quality. This project will define and bring to ballot a set of specifications for reporting quality data in conformance with defined quality measures.”

  • Project initiation: Sept, 2007

  • Initial ballot: Targeted for May, 2008

  • See project proposal document


Project Fit With Alliance Mission Transmission

Alliance for Pediatric Quality

  • Lead, shape and accelerate recognition and adoption of quality improvement

  • Promotes improvement priorities

  • Provides specific data elements for pediatric quality measures

HL7 PeDSSIG

With other HL7 committees, organizations and vendors within the HL7 enterprise

  • Maps data elements to HL7 RIM

  • Develops HL7 v3 Implementation Guideline for measure/s using QRDA standard

Vendor

EMR systems and other systems

  • Adopts HL7 implementation plan through system updates

  • Develops internal logic/algorithms to capture data elements for specific measure/s

  • Validates and tests accuracy of data output for specific measure

CCHIT

  • Vendor certification of compliance to standards

Reporting Facility

Practice/Healthcare Institution

  • Purchases vendor that complies with HL7 standards

  • Receives functionality through vendor system

  • Participates in reporting to Improvement Organization(s)

Requestors of Quality Data

Or other central quality assurance bodies such as CHCA, NACHRI, etc.

  • Accepts QRDA data-submissions for benchmarking


Phase One: Volunteers Transmission


Primary Project Contacts Transmission

Chad Bennett

Iowa Foundation for Medical Care

The Collaborative for Performance Measure Integration with EHR Systems

[email protected]

Crystal Kallem

American Health Information Management Association (AHIMA)

HL7 Structured Documents Technical Committee

[email protected]

Joy Kuhl

Alliance for Pediatric Quality

HL7 Pediatric Data Standards Special Interest Group

[email protected]

Feliciano Yu, MD

HL7 Pediatric Data Standards Special Interest Group

The Children’s Hospital of Alabama

[email protected]


Quality Reporting HIT Standards Project Transmission

The Quality Reporting Document Architecture: Phase I

FOR DISCUSSION WITH PedsSIG

September 2007


Strawmen samples
Strawmen samples Transmission

  • DOQ-IT CAD-1-7 --- Adult, ambulatory

    • Sample 1: Single visit, initial submission, first visit

    • Sample 2: Single visit, update, same as Sample 1, adds HbA1c result

    • Sample 3: Single visit, second visit

    • Sample 4: Both visits

  • JCAHO asthma measure (CAC) --- Pediatric, inpatient

    • Sample 5:


Strawmen samples1
Strawmen samples Transmission


Strawman samples
Strawman Transmission samples


Discussion points clinical content related issues
DISCUSSION POINTS: Clinical Content-related Issues Transmission

  • Organization of clinical data both useful; develop alt QRDA stylesheet

    • as data set/list

    • comparable to source documents

    • alternate?

  • Single/multiple visits per document? defer to discuss w/Collaborative, vendors

    • If multiple, organize by finding or chronology?

  • Order/results useful to show as observation/result

    • Code “test has been ordered” as a result set; provide results as available?

  • Focus on pediatric use case: discussion

    • changes to use case? add alternative ICD-9 codes to indicate that also applicable (Greg to supply)

    • PMS Identifier: N/A? ok

    • Procedures: values implicit? ok

    • Contraindications: as JCAHO codes? show alternate representations w/in sample

    • Patient data: take from 1600 form; what is the minimum data required? to be analyzed

  • What is “the encounter”? discussion: discuss further: w/Collaborative, vendors, accepting systems’ guidelines

    • single visit?

    • series?

    • “episode”?

  • Update/replace useful to provide as-is, and update

    • where needed

    • replace vs append not resolved

  • Link to source document(s) / observations not discussed


Discussion points technical issues
DISCUSSION POINTS: Technical Issues Transmission

  • TECHNICAL ISSUES:

  • Templates discussion: need to refine usage model (what templates are reusable)

    • document (report) level

    • section level

    • entry level

  • Code sets discussion: provide translation examples

    • industry vs quality reporting

  • Display discussion: develop alt stylesheet

    • need for QRDA-specific display?

  • Validation many options possible, no further discussion

    • submission data set

    • other: inclusion/exclusion, ?

  • OIDs reviewed usage, application of

  • Link to source document(s) / observations not discussed

  • Display discussion: develop alt stylesheet

    • review: should codes be displayed? (e.g. “ICD-9....”); alternative stylesheets for MDs, for abstractors?


Current work
current work Transmission

HL7 Structured Docs

DMIM

2 RMIMs

CDA-report

CDA-R2

SPL

MR

Q report

HAI

H&P

CCD

AdmitH&P

PedH&P

diabetic

asthma

BSI

SSI

  • Rules:

  • Relationship between DMIM/RMIMs:

    • blown out

    • constrained

  • where can XML change?

  • what can extend/constrain a model?

  • R2-body based CDA-reporting

  • DMIM for SD/R2

  • CDA-R3


Future work
future work Transmission

HL7 Structured Docs

DMIM

RMIMs

CDA-report

CDA-R3

SPL

MR

Q report

HAI

H&P

CCD

AdmitH&P

PedH&P

diabetic

asthma

BSI

SSI

  • R2-body based CDA-reporting

  • DMIM for SD/R2

  • CDA-R3

  • or

  • DMIM

  • CDA-R3

  • CDA-report

  • Rules:

  • Relationship between DMIM/RMIMs

  • where can XML change?

  • what can extend/constrain a model?


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