Quality Case Reporting Workflow

1. Quality Case Reporting Workflow Brief Profile Proposal for 2012/13 presented to the Quality, Research & Public Health (QRPH) Planning Committee Patty Craig, The Joint Commission October 26, 2012

2. The Problem • The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) have identified HL7s Health Quality Measures Format (HQMF) as the standard for representing a health quality measure as an electronic document. An HQMF is also known as an eMeasure.

3. The Problem • CMS and ONC have also identified HL7s Quality Reporting Data Architecture (QRDA) as the standard for communicating health care quality measurement information. Specifically: • QRDA Category I for communicating patient-level data • QRDA Category III for communicating a provider’s aggregate data

4. The Problem • By the Connectathon in January 2014, most, if not all, of the EHR vendors desiring to support Stage 2 of Meaningful Use will have been certified by ONC certification bodies.

5. The Problem • IHE can add to the research surrounding the issues and successes of embedding eMeasures into certified Complete EHR and EHR Module software: • The ability to identify the correct patients and their data to generate a QRDA Category I • The ability to calculate the measure results and generate a QRDA Category III

6. The Problem • Out of Scope: • The dissemination of the HQMF specifications and associated value sets • The specific transport method by which the QRDA files will be transmitted to the receiver as the government has not yet specified a standard • Types of measures not in Meaningful Use Stage 2: • Risk-adjusted outcome measures • Ratio measures

7. Use Case • Use Case #1: A patient is discharged from an acute inpatient hospital. The patient is evaluated against the Stage 2 eligible hospital eMeasures: • By evaluating the patient population specifications in all of the Stage 2 eligible hospital HQMFs, the EHR determines that the patient is in the population of at least one of the measures. • The EHR populates the patient-level quality reporting form (QRDA Category I) with the data required by the appropriate measures.

8. Use Case • Use Case #2: A patient is discharged from an acute inpatient hospital. The patient is evaluated against the Stage 2 eligible hospital eMeasures: • By evaluating the patient population specifications in all of the Stage 2 HQMFs, the EHR determines that the patient is in the population of at least one of the measures • The EHR processes all of the identified patients against the appropriate HQMFs and derives a measure result (e.g., in denominator, in numerator) • Once all of the patients for the appropriate time period have been processed, the EHR aggregates the hospital’s data and populates the aggregate-level quality reporting form (QRDA Category III)

9. Use Case • Use Case #3: A patient is seen by an eligible provider. The patient is evaluated against the Stage 2 eligible provider eMeasures: • By evaluating the patient population specifications in all of the Stage 2 eligible provider HQMFs, the EHR determines that the patient is in the population of at least one of the measures. • The EHR populates the patient-level quality reporting form (QRDA Category I) with the data required by the appropriate measures.

10. Use Case • Use Case #4: A patient is seen by an eligible provider. The patient is evaluated against the Stage 2 eligible provider eMeasures: • By evaluating the patient population specifications in all of the Stage 2 HQMFs, the EHR determines that the patient is in the population of at least one of the measures • The EHR processes all of the identified patients against the appropriate HQMFs and derives a measure result (e.g., in denominator, in numerator) • Once all of the patients for the appropriate time period have been processed, the EHR aggregates the hospital’s data and populates the aggregate-level quality reporting form (QRDA Category III)

11. Use Case • Use Case #5: Export and Import of a QRDA Category I file • A Complete EHR or Module EHR is able to export a QRDA Category I file after completing Use Cases #1 and 3 (identify patient) • A Complete EHR or Module EHR is able to receive a QRDA Category I file and either: • Generate a QRDA Category I file, or • Complete Use Cases #2 and 4 (derive measure results, aggregate results, and generate a QRDA Category III (aggregate) file, or • Perform a hybrid and derive the measure results and generate a QRDA Category I file, including the measure results

12. Use Case Supports MU2 • The work flow process #1 involved in quality case reporting are (Use Cases #1 and #3): • 1. Disseminate the eMeasure specifications (HQMF) and associated value sets – out of scope • 2. eMeasure Specification (HQMF) is Manually Embedded or Electronically Consumed by a Complete EHR or EHR Module • 3. Identification of Cases in the eMeasure Population • 4. Generate Patient-level Quality Reporting Form (QRDA Category I) • 5. Submit Quality Reporting Form – out of scope

13. Use Case Supports MU2 • The work flow process #2 involved in quality case reporting are (Use Cases #2 and #4): • 1. Disseminate the eMeasure specifications (HQMF) and associated value sets – out of scope • 2. eMeasure Specification (HQMF) is Manually Embedded or Electronically Consumed by a Complete EHR or EHR Module • 3. Identification of Cases in the eMeasure Population • 4. Execution of eMeasure Specifications (HQMF) • 5. Aggregate Provider’s Data • 6. Generate Aggregate-Level Quality Reporting Form (QRDA Category III) • 7. Submit Quality Reporting Form – out of scope

14. Use Case Supports MU2 • The work flow process #3 involved in quality case reporting are (Use Case #5) • 1. Import a Patient-level Quality Reporting Form (QRDA Category I) • 2. Generate Patient-Level Quality Reporting Form (QRDA Category I) • 3. Submit Quality Reporting Form – out of scope

15. Use Case Supports MU2 • The work flow process #4 involved in quality case reporting are (Use Case #5) • 1. Import a Patient-level Quality Reporting Form (QRDA Category I) • 2. Execution of eMeasure Specifications (HQMF) • 3. Aggregate Provider’s Data • 4. Generate Aggregate-Level Quality Reporting Form (QRDA Category III) • 5. Submit Quality Reporting Form – out of scope

16. Use Case • The work flow process #5 involved in quality case reporting are (Use Case #5) • 1. Import a Patient-level Quality Reporting Form (QRDA Category I) • 2. Execution of eMeasure Specifications (HQMF) • 3. Generate Patient-level Quality Reporting Form (QRDA Category I), including measure results • 4. Submit Quality Reporting Form – out of scope Supports The Joint Commission

17. Proposed Standards & Systems • Health Quality Measures Format (HQMF) or eMeasures • Eligible Professional eMeasures • Eligible Hospital and Critical Access Hospital eMeasures • Quality Reporting Data Architecture (QRDA) Category I (patient-level data) • Quality Reporting Data Architecture (QRDA) Category III (aggregate data) • Certified Electronic Health Record Systems (EHR) and Certified Quality Modules

18. Proposed Standards & Systems • Terminology standards: National Vocabularies as identified by ONC, including LOINC, SNOMED-CT, RxNorm, ICD-9, CPT • Workflow profiles, transaction profiles, and transport mechanisms are out of scope

19. Discussion • We propose to test the government identified implementation specifications for the execution of eMeasures and the submission of patient-level and aggregate eMeasure data to quality receivers. This test will take into account the minimum necessary data that is required to be transmitted to all quality receivers and the additional data that might optionally be needed. This will help demonstrate the ability of certified EHRs and certified EHR Modules to submit eMeasure data to multiple quality receivers using the standardized, interoperable implementation standard.

20. Discussion • Level of Effort: Medium • Editor / Quality Expert: Patty Craig, The Joint Commission ?, ? • Editor / IHE Expert: ???