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Quality Reporting Document Architecture (QRDA) Overview

Quality Reporting Document Architecture (QRDA) Overview. Gaye Dolin, RN, MSN Russ Ott. CDA, C-CDA, CCD, QRDA, HL7, and Health Level Seven are registered trademarks of Health Level Seven International Registered in US Patent and Trademark Office. Agenda. QRDA Background

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Quality Reporting Document Architecture (QRDA) Overview

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  1. Quality Reporting Document Architecture (QRDA) Overview Gaye Dolin, RN, MSN Russ Ott

  2. CDA, C-CDA, CCD, QRDA, HL7, andHealth Level Sevenare registered trademarks ofHealth Level Seven InternationalRegistered in US Patent and Trademark Office

  3. Agenda • QRDA Background • QRDA and Meaningful Use Stage 2 (MU2) • QRDA Details • What is QRDA? • Base Standard • Categories of QRDA • Quality Data Model (QDM) and QRDA • Relationship between QRDA and other MU2 standards • Consolidated Clinical Document Architecture (C-CDA) • eMeasure

  4. Agenda • QRDA Background • QRDA and MU2 • QRDA Details • What is QRDA? • Base Standard • Categories of QRDA • QDM and QRDA • Relationship between QRDA and other MU2 standards • C-CDA • eMeasure

  5. What is QRDA? Quality Document Reporting Architecture (QRDA) is a CDA-based standard for reporting the healthcare quality measurement data associated with the originating query. • QRDA Category I (Single-patient Report) Individual patient-level report with the full clinical data defined in the measure. • QRDA Category II (Patient List Report) Multi-patient report across a defined population that may or may not identify individual patient data within the summary. • QRDA Category III (Calculated Report) Aggregate quality report with a result for a given population and period of time.

  6. Agenda • QRDA Background • QRDA and MU2 • QRDA Details • What is QRDA? • Base Standard • Categories of QRDA • QDM and QRDA • Relationship between QRDA and other MU2 standards • C-CDA • eMeasure

  7. QRDA as it Relates to MU 2014 References two QRDA specifications: • QRDA Category I (Patient-level Report) § 170.205(h) Clinical quality measure data import, export, and electronic submission. Standard. HL7 Implementation Guide for CDA® Release 2: Quality Reporting Document Architecture(incorporated by reference in § 170.299) • QRDA Category III (De-identified/Aggregate Report) § 170.205(k) Clinical quality measure aggregate electronic submission. Standard. Quality Reporting Document Architecture Category III, Implementation Guide for CDA Release 2 (incorporated by reference in § 170.299)

  8. QRDA as it Relates to MU 2014 Three MU 2014 Clinical Quality Measures (CQMs) require use of QRDA Category I and/or QRDA Category III: • CQM Capture and Export – § 170.314(c)(1) Requires QRDA Category I – § 170.205(h) • CQM Import and Calculate - § 170.314(c)(2) Requires QRDA Category I – § 170.205(h) • CQM Electronic Submission – § 170.314(c)(3) Requires QRDA Category I and QRDA Category III – § 170.205(h)+(k)

  9. CQMs for MU 2014 and Beyond • CQM reporting is no longer a core objective for Eligible Professionals (EPs,) Eligible Hospitals (EHs), and Critical Access Hospitals (CAHs). • All providers are still required to report on CQMs in order to demonstrate MU. Beginning in 2014, all providers, regardless of their stage of MU, will have standard CQM reporting requirements: • EPs must report on 9 out of 64 total CQMs. • EHs and CAHs must report on 16 out of 29 total CQMs. • All providers must select CQMs from at least 3 of the 6 key healthcare policy domains recommended by US Department of Health and Human Services (HHS) National Quality Strategy: • Patient and Family Engagement • Patient Safety • Care Coordination • Population and Public Health • Efficient Use of Healthcare Resources • Clinical Processes/Effectiveness

  10. MU 2014 Electronic Reporting Requirements – EPs Beginning in 2014, all Medicare-eligible providers beyond their first year of demonstrating MU must electronically report their CQM data to Centers for Medicare & Medicaid Services (CMS). • Medicaid EPs and hospitals that are eligible only for the Medicaid EHR (Electronic Health Record) Incentive Program will electronically report their CQM data to their state. • EPs can electronically report CQMs either individually or as a group using the following methods: • Physician Quality Reporting System (PQRS) • Electronic submission of samples of patient-level data in QRDA Category I format • EPs can also report as group using the PQRS Group Practice Reporting Option (GPRO) tool. EPs who electronically report using this PQRS option will meet both their EHR Incentive Program and PQRS reporting requirements. • CMS-designated Transmission Method Electronic submission of aggregate-level data in QRDA Category III format

  11. 2014 CQMs and Electronic Reporting Requirements – EHs and CAHs • Eligible hospitals and CAHs will electronically report their CQMs in QRDA Category I format through infrastructure similar to the EHR Reporting Pilot for hospitals. • This will be the basis for an EHR-based reporting option in the Hospital Inpatient Quality Reporting program. • They may also submit aggregate-level data in QRDA Category III format. • Refer to the 2014 Clinical Quality Measures Tip Sheet for additional information on 2014 CQMs and electronic reporting options.

  12. Agenda • QRDA Background • QRDA and MU2 • QRDA Details • What is QRDA? • Base Standard • Templated CDA • Categories of QRDA • QDM and QRDA • Relationship between QRDA and other MU2 standards • C-CDA • eMeasure

  13. What is QRDA? QRDA is a specification of Health Level Seven (HL7) CDA for reporting quality measure data out of an EHR. QRDA Release 2 Category I Constraints for reporting Clinical Care Document(CCD) Constraints for CCD Base CDA Specification

  14. Agenda • QRDA Background • QRDA and MU2 • QRDA Details • What is QRDA? • Base Standard • Templated CDA • Categories of QRDA • QDM and QRDA • Relationship between QRDA and other MU2 standards • C-CDA • eMeasure

  15. What is CDA? • CDA is a document markup standard for the structure and semantics of an exchanged “clinical document.” • A CDA document is a defined and complete information object that can exist outside of a message; it can include text, images, sounds, and other multimedia content. • CDA documents are encoded in Extensible Markup Language (XML). • CDA is derived from HL7's central Reference Information Model (RIM), thereby enabling data reusability - with lab or pharmacy messages, claims attachments, clinical trials, etc. • The CDA specification is richly expressive and flexible. Templates, conformance profiles, and implementation guides (IGs) can be used to constrain the generic CDA specification. 15

  16. Agenda • QRDA Background • QRDA and MU2 • QRDA Details • What is QRDA? • Base Standard • Templated CDA • Categories of QRDA • QDM and QRDA • Relationship between QRDA and other MU2 standards • C-CDA • eMeasure

  17. HL7 QRDA Category I QRDA is a CDA-based IG designed to have those data elements needed for quality measurement. A QRDA document using C-CDA templates plus others A CDA document using CCD templates CCD Chief Complaint DischargeDiagnosis Mode ofTransport Surgical Finding New Template… Discharge Diet Family History Medications Problems Payer Allergies Social History Vital Signs Demographics . . . . CDA

  18. Agenda • QRDA Background • QRDA and MU2 • QRDA Details • What is QRDA? • Base Standard • Templated CDA • Categories of QRDA • QDM and QRDA • Relationship between QRDA and other MU2 standards • C-CDA • eMeasure

  19. Categories of QRDA QRDA Category I – Single-patient Report • A QRDA Category I report is an individual-patient-level quality report. • Each report contains quality data for one patient for one or more quality measures, where the data elements in the report are defined by the particular measure(s) being reported on. • A QRDA Category I report contains raw applicable patient data. When pooled and analyzed in a report, this quality data is used to calculate population measure metrics. • Category I was published November 2012 and is required in MU2 (§ 170.205(h)).

  20. Categories of QRDA QRDA Category II – Patient List Report • A QRDA Category II report is a multi-patient-level quality report. Each report contains quality data for a set of patients for one or more quality measures, where the data elements in the report are defined by the particular measure(s) being reported on. • QRDA Category II is not yet an HL7 standard; it was a “for comment only” chapter in the 2008 QRDA ballot. • There is currently no community demand for bringing this report to ballot.

  21. Categories of QRDA QRDA Category III – Calculated Report • A QRDA Category III report is an aggregate quality report. Each report contains calculated summary data for one or more measures for a specified population of patients within a particular health system over a specific period of time. • Data needed to generate QRDA Category III reports must be included in QRDA Category I reports. • Category III was published November 2012 and is required in MU2 (§ 170.205(k)).

  22. Agenda • QRDA Background • QRDA and MU2 • QRDA Details • What is QRDA? • Base Standard • Templated CDA • Categories of QRDA • QDM and QRDA I • Relationship between QRDA and other MU2 standards • C-CDA • eMeasure

  23. QDM-based QRDA (Category I) • Clinical measureable parameters are assembled into quality measures, which are then expressible as eMeasures. • The eMeasures guide the collection of EHR data and other data, which are then assembled into QRDA quality reports and submitted to quality or other organizations. • While there is no prerequisite that a QRDA document must be generated based on an eMeasure, the QDM-based QRDA standard is written to tightly align with Health Quality Measures Format (HQMF).

  24. QDM-based QRDA (Category I) Criteria are written against MU capabilities.

  25. Coupling Between eMeasure and QRDA eMeasure Data Criteria National Quality Forum (NQF) Instantiate (e.g., vocabulary binding) Quality Data Element QDS Pattern Library Quality Data Element QDM QDS Element Quality Data Type Pattern QDS Element Quality Data Element Quality Data Type Pattern Quality Data Type Pattern CDA Template Library Population Criteria Quality Data Type Pattern Type Pattern Quality Data Type Pattern Denominator QRDA Template Numerator QRDA Template Initial Patient Population QRDA Template

  26. Coupling Between eMeasure and QRDA

  27. Coupling Between eMeasure and QRDA

  28. Value Set Referencing • The Quality Data Types in the eMeasure are bound to a value set with a value set ID to create the Quality Data Elements (QDE) for that measure. • The measure is referenced in the QRDA (Measure Reference QDM Template in the Measure Section). • The QDE value set ID is in the QRDA instance and is bound to the mapped QRDA Template.

  29. Example Healthy Term Newborn QDE Found in EHR Diagnosis, Active: Gestational age >= 37 weeks using Gestational age >= 37 weeks Grouping Value Set (2.16.840.1.113883.3.666.5.1596) Encounter, Performed: Encounter Inpatient using Encounter Inpatient SNOMED-CT Value Set (2.16.840.1.113883.3.666.5.307) Diagnosis, Active: Liveborn Born In Hospital using LivebornBorn In Hospital SNOMED-CT Value Set (2.16.840.1.113883.3.117.1.7.1.29) Diagnosis, Active: Single Live Birth using Single Live Birth SNOMED-CT Value Set (2.16.840.1.113883.3.117.1.7.1.25) Diagnosis, Active: Single Liveborn Newborn Born in Hospital“ using "Single Liveborn Newborn Born in Hospital Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.26) Patient Characteristic Payer using Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.560.101.1“) QDM-based QRDA Data Criteria Section

  30. Quality Data Type Pattern bound with value set in eMeasure

  31. Corresponding CDA Template Instance in QRDA

  32. Referencing a Quality Measure

  33. Agenda • QRDA Background • QRDA and MU2 • QRDA Details • What is QRDA? • Base Standard • Templated CDA • Categories of QRDA • QDM and QRDA I • QRDA Category III • Relationship between QRDA and other MU2 standards • C-CDA • eMeasure

  34. What is QRDA III? • A way of expressing aggregated calculation data for Clinical Quality Measure (CQM) calculation Just the results; no patient data included • Contains data for one or more Measures • XML document CDA-based

  35. QRDA Category III Document • An aggregate quality report that contains calculated summary data for one or more measures for a specified population of patients within a particular health system over a specific period of time. • Refers to these identifiers in an eMeasure or other query. • Communicates data residing in health information systems that is stripped of all patient identifiers, protecting patients and healthcare providers from the risks of inadvertent leakage of private information.

  36. Document Header Notes QRDA III is designed for reporting aggregate data about any quality measure. The QRDA Category III report format matches the QRDA Category I report where appropriate. RecordTarget is a required element in CDA. QRDA III reports data on groups of patients, thus the recordTargetID contains a nullFlavor.

  37. Measure Section Contents

  38. Measure Date Contents

  39. Relationship to PQRS • PQRS is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals. • The PQRS program has developed an XML specification to send aggregated quality data – known as the PQRI XML. • The PQRI specification is analogous to QRDA Category III in that they both report aggregate data. • The data elements currently sent in the PQRS 2012 Data Submission Vendor XML Specification have been represented in this QRDA III specification.

  40. Agenda • QRDA Background • QRDA and MU2 • QRDA Details • What is QRDA? • Base Standard • Templated CDA • Categories of QRDA • QDM and QRDA I • QRDA Category III • Relationship between QRDA and other MU2 standards • C-CDA • eMeasure

  41. MU2 and Quality Reporting eMeasure patient data Patient data Informs Informs Individual quality Report Individual quality Report Individual quality report(s) Aggregate quality report EHR Calculation engine Patient data Other systems Patient data calculate data capture export report 43

  42. MU3 and Quality Reporting eMeasure Informs patient data Patient data Informs Individual quality Report Individual quality Report Individual quality report(s) Aggregate quality report Assembler EHR Calculation engine Patient data Other systems Patient data assemble export calculate data capture report 44

  43. QRDA and Consolidated CDA • QRDA I reuses but tightens C-CDA templates for quality reporting purposes. • QRDA contains some new templates. QRDA R2 Cat I Constraints for reporting C-CDA C-CDA Base CDA Specification

  44. QRDA and eMeasures The eMeasures guide the collection of EHR data and other data, which are then assembled into QRDA quality reports and submitted to quality or other organizations.

  45. eMeasure – Colorectal Cancer Screening

  46. QRDA Category I Incidence Report

  47. Category III – ProperAnticoagulation Therapy

  48. Agenda • QRDA Background • QRDA and MU2 • QRDA Details • What is QRDA? • Base Standard • Templated CDA • Categories of QRDA • QDM and QRDA I • QRDA Category III • Relationship between QRDA and other MU2 standards • C-CDA • eMeasure • QRDA and MU Objectives

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