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Query Health Technical WG 6/14/2012

Query Health Technical WG 6/14/2012. Agenda. Announcements. None. Specification Updates. HQMF Query Health TWG and HL7 SDWG Joint WG meetings every Tuesday, Wednesday http :// wiki.siframework.org/Query+Health+SDWG+Joint+Workgroup Started Analysis of Ballot requirements

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Query Health Technical WG 6/14/2012

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  1. Query HealthTechnical WG6/14/2012

  2. Agenda

  3. Announcements • None

  4. Specification Updates • HQMF • Query Health TWG and HL7 SDWG Joint WG meetings every Tuesday, Wednesday • http://wiki.siframework.org/Query+Health+SDWG+Joint+Workgroup • Started Analysis of Ballot requirements • Will be discussing specific requirements that need more targeted discussions starting next week • Use the Joint WG going forward for all HQMF Issues discussion surrounding the standard • Discuss implementation specific issues in the TWG and provide feedback to the Joint WG if necessary • QRDA • Implementation Guide Updates based on Category I is in progress • http://wiki.siframework.org/Query+Health+-+Results+Format • Discussion of Category II and Category III Requirements and representation …in a few minutes

  5. RI Update • PopMedNet • Query Envelope gaps Implementation started (Target completion – June) • Continue Working on i2B2 – PMN Integration (Target completion – July) • i2B2 • Started integration of translators into i2b2 code base • Working with NY to baseline the Ontology / CEDD for Pilot • hQuery • Working on identifying more subset operators required for some of the complex quality measures • Started working on generating HQMF v2 using JSON hQuery Model

  6. QRDA Requirements Discussion • QRDA Category II and III Common Requirements • Link QRDA to the HQMF query (document) • Capture the data source providing the response • Capture the time the result was created • Capture the reporting period that was used to create the result • Capture results uniquely for each Population Criteria section in the HQMF • HQMF will have at least one Population Criteria section • Each Population Criteria section will have at most one IPP, One Denominator, One Numerator, One Exclusions, One Exceptions section. • There can be multiple Stratifiers within the Population Criteria section • Support Specific Stratification criteria • For e.g Count of patients with diabetes stratified by the following age groups • Age between 14 and 21 • Age between 21 and 30 etc. • Support generic Stratification criteria • For e.g Count of patients with diabetes stratified by Zip Codes (The Query does not enumerate all the Zip codes)

  7. QRDA Requirements Discussion Cont’d • QRDA Category II and III Common Requirements Cont’d • Capture what is being counted (e.g patients, encounters, procedures) • Category III Specific requirements • Supports only Aggregate information and no patient level information. • Category II Specific requirements • Support Patient level information • Only an Identifier for the patient for follow up • Unlike Category I, the patient information in Category II must not contain any of the detailed information present in the medical record. • So the CCDA Templates and the QDM Data Type Patterns are not applicable for Category II or III • Must include all patients who qualify for IPP

  8. QRDA II and III Representation • Background: • QRDA is based on the CDA document. • Schemas used are the baseline CDA schemas (CDA.xsd) • QRDA Category I currently in ballot QRDA II and III Header Reporting Parameters Measure Section For Query Health, the results for all the Population Criteria sections would be present within one Measure Section.

  9. QRDA II and III Representation – Header • Header Elements: (Common to both Category II and III) • realmCode • typeId • templateId - Changes based on Category II or III • Id • Code • Title • EffectiveTime – Time when the report is generated • Confidentiality Code – Could change if the Data Source chooses to • Language Code • RecordTarget • External Document Id Reference (New in Category I) • Author • Informant • Custodian • LegalAuthenticator Proposing these to be the same for each data source

  10. QRDA II and III Representation – Header Cont’d • Header Elements XML: (Common to both Category II and III) <realmCode code="US"/><typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/><!-- QRDA Category III template ID. --><templateId root="2.16.840.1.113883.10.20.14"/><id root="88414c01-715a-45bb-83bb-db7ac860fe9d"/><!-- QRDA document type code (yet to be created). --><code code="55184-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Quality Measure Report"/><title>QRDA Calculated Summary Report</title><effectiveTime value="20120301"/><confidentialityCodecodeSystem="2.16.840.1.113883.5.25" code="N"/><languageCode code="en-US"/> <reference typeCode="REFR"> <externalDocumentclassCode="DOC" moodCode="EVN"> <!-- This is the NQF Number, root is an NQF OID for eMeasure Number and extension is the eMeasure's NQF number --> <id root="2.16.840.1.113883.3.560.1" extension="0301"/> </externalDocument> </reference><!-- This is an aggregate summary report. Therefore CDA's required patient identifier is nulled. --><recordTarget> <patientRole> <id nullFlavor="NA"/> </patientRole></recordTarget>

  11. QRDA II and III Representation – Header Cont’d • Header Elements XML Cont’d: (Common to both Category II and III) <!-- The author of the CDA document in this example is an IS06 "Processing Entity".--><author> <time value="20120301"/> <assignedAuthor> <id nullFlavor="NA"/> <representedOrganization> <id root="2.16.840.1.113883.19.5"/> <name>Good Health Clinic </name> </representedOrganization> </assignedAuthor></author><!-- The reporting healthcare facility is represented using the CCD "Source of Information" construct, via the Informant participant. --><informant> <assignedEntity> <id nullFlavor="NA"/> <representedOrganization> <id root="2.16.840.1.113883.19.5"/> <name>Good Health Clinic</name> </representedOrganization> </assignedEntity></informant><!-- The custodian of the CDA document is the same as the legal authenticator in this example. --><custodian> <assignedCustodian> <representedCustodianOrganization> <id root="2.16.840.1.113883.19.5"/> <name>Good Health Clinic</name> </representedCustodianOrganization> </assignedCustodian></custodian><!-- The legal authenticator of the CDA document is the same as the custodian in this example. --><legalAuthenticator> <time value="20120301"/> <signatureCode code="S"/> <assignedEntity> <id nullFlavor="NA"/> <representedOrganization> <id root="2.16.840.1.113883.19.5"/> <name>Good Health Clinic</name> </representedOrganization> </assignedEntity></legalAuthenticator>

  12. QRDA II and III Representation – Reporting Parameters <entry> <act classCode="ACT" moodCode="EVN"> <id root="55a43e20-6463-46eb-81c3-9a3a1ad41225"/> <code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/> <effectiveTime> <low value="20110101"/> <!-- The first day of the period reported. --> <high value="20111231"/> <!-- The last day of the period reported. --> </effectiveTime> <!--This example includes an enumeration of the "aggregation-level" data elements here in the Reporting Parameters section.--> <entryRelationshiptypeCode="COMP"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="ageBetween17and21"/> <code nullFlavor="NA"></code> </observation> </entryRelationship> <entryRelationshiptypeCode="COMP"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="genderMale"/> <code nullFlavor="NA"></code> </observation> </entryRelationship> <entryRelationshiptypeCode="COMP"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="NUMERATOR"/> <code nullFlavor=“NA"></code> <value xsi:type="CD" code="223366009" codeSystem="2.16.840.1.113883.6.96" displayName="NUMERATOR"/> </observation> </entryRelationship> <entryRelationshiptypeCode="COMP"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="DENOMINATOR"/> <code nullFlavor=“NA"></code> <value xsi:type="CD" code="223366009" codeSystem="2.16.840.1.113883.6.96" displayName="DENOMINATOR"/> </observation> </entryRelationship> </act></entry> List of Stratifiers from HQMF Query represented as Observations (Ids can be used to link them across QRDA / HQMF if required), Should they be ACT’s ? Present for all Queries (Numerator, Denominator, Exceptions, Exclusions, IPP)

  13. QRDA III Representation – Measure Section <entry typeCode="DRIV"> <act classCode="ACT" moodCode="EVN"> ---- For a Particular Population Criteria Section <id/> <code nullFlavor=“NA"/> <text>The percentage of patients 18-75 years of age with diabetes (type 1 or type 2) who had HbA1c &gt; 9.0%.</text> <statusCode code="completed"/> <entryRelationshiptypeCode="SPRT"> <act classCode="ACT" moodCode="EVN"> <id root="0" extension="ageBetween17and21"/> <code></code> <entryRelationshiptypeCode="SPRT"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="NUMERATOR"/> <code></code> <value xsi:type="INT" value="1"></value> </observation> </entryRelationship> <entryRelationshiptypeCode="SPRT"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="DENOMINATOR"/> <code></code> <value xsi:type="INT" value="2"></value> </observation> </entryRelationship> </act> </entryRelationship> <entryRelationshiptypeCode=“SPRT"> <act classCode="ACT" moodCode="EVN"> <id root="0" extension="genderMale"/> <code></code> <entryRelationshiptypeCode="REFR"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="NUMERATOR"/> ……. </entryRelationship> </act> <act> </act> ------ For the Next Population Criteria Section</entry> Stratifier designated as an ACT and Referencing by id element Aggregate Data Elements represented as Observations supporting the ACT

  14. QRDA II Representation – Measure Section <entry typeCode="DRIV"> <act classCode="ACT" moodCode="EVN"> <id/> <text>The percentage of patients 18-75 years of age with diabetes (type 1 or type 2) who had HbA1c &gt; 9.0%.</text> <statusCode code="completed"/> <entryRelationshiptypeCode="SPRT"> <act classCode="ACT" moodCode="EVN"> <code nullFlavor="NA"></code> <participant typeCode="RCT"> <participantRoleclassCode="PAT"> <id extension="123456789" root="2.16.840.1.113883.19.5"/> </participantRole> </participant> <entryRelationshiptypeCode="SPRT"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="ageBetween17and21"/> <code></code> <value xsi:type="INT" value="0"></value> </observation> </entryRelationship> <entryRelationshiptypeCode="SPRT"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="genderMale"/> <code></code> <value xsi:type="INT" value="1"></value> </observation> </entryRelationship> <entryRelationshiptypeCode="SPRT"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="NUMERATOR"/> <code></code> <value xsi:type="INT" value="0"></value> </observation> </entryRelationship> Patient Information Stratifier’s designated as observations Common Aggregate Data Elements (Numerator, Denominator …)

  15. Next Steps • Specifications • Participate in the resolution of HQMF discussions • hqmf@googlegroups.com • HL7 SDWG / QH TWG Joint WG • Reference Implementation • Looking for volunteers to convert Intermediate HQMF to concrete SQL implementation based on real world schema • Volunteers requiring access to the code repository • Please sign up for a google account at http://code.google.com • Project Repository - http://code.google.com/p/query-health/

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