Quality Reporting HIT Standards Project The Quality Reporting Document Architecture: Phase I

Alliance for Pediatric QualityQuality Reporting HIT Standards Project

The Quality Reporting Document Architecture: Phase I

September 2007

2www.kidsquality.org

1. Overview2. Sample3. Project proposal

with SDTC


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.

QRDA: Project Goal


Founders

Primary BenefactorFor Phase One

HL7 Sponsor

Project Management

PeDS SIG

Participants: A Private Collaborative

PeDS SIG


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

HospitalHospitalCommunityCommunity

PhysicianPhysicianCommunityCommunity

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

Alliance for Pediatric Quality


Alliance Goals & Strategies

1. 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

2. 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

3. Explore opportunities for collecting and sharing data

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


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


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

Paper Medical Records

Electronic Medical Records

Proprietary data formats

Status Quo in Quality Measure Reporting

Data Entry100% manual process:

data abstraction and data mining

Prepare data

for analysis

Requestors of Quality Data

QualityImprovementOrganizations

AccreditingOrganizations

Payers

Key-boarding or manual entry




QRDA

Data Entrysemi-automated: data abstraction and data mining

Prepare data

for analysis




Payers


Semi-automated data entry; single, open data format for collection and analysis; compatible with EMR exchange documents

(CCD, CDA); point-of-collection validation

QRDA Immediately Simplifies Quality Measure Reporting

QRDA-compatible

valid?

QRDA




Data Entrysemi-automated: data abstraction and data mining

Prepare data

for analysis




Payers

Fully-automated data entry, ready for collection and analysis

Future: QRDA Streamlines Quality Measure Reporting

QRDA


QRDA-compatible

QRDA


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

Leverage and Harmonize With Others


Related Efforts

Measure Development

eMeasure Definition

Aggregators, Requestors

ok? ok? ok?

The Collaborative:

eMeasure definition

NCQA, AQA, APQ....:

measure definition

IHE:

multi-party choreography using HL7 messages, services

AH

IC,

HIT

SP

Use

Cas

es

QRDA QRDA QRDA

feed

back


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

Related Efforts


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

QRDA Project Overview

3 months TBD

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


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

Benefits of Standardized Electronic Quality Measurement Data 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 Proposal: Quality Reporting Document Architecture


Project Fit With Alliance Mission

Alliance for Pediatric Quality

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

Lead, shape and accelerate recognition and adoption of quality improvement

Promotes improvement priorities Provides specific data elements for pediatric quality measures

Maps data elements to HL7 RIM Develops HL7 v3 Implementation Guideline for measure/s using

QRDA standard

VendorEMR 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

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 DataOr other central quality

assurance bodies such as CHCA, NACHRI, etc.

Accepts QRDA data-submissions for benchmarking

CCHIT Vendor certification of compliance to standards


Phase One: Volunteers

Volunteer Roles Expertise Volunteers To Date

Technical Content Experts (Source Organizations) hospitals & physician offices adult and pediatric

Understanding of how quality measurement data is collected and sent to receiving organizations

Feliciano Yu, MD., Children’s Hospital of Alabama Crystal Kallem, American Health Information

Management Association (AHIMA) Dexter D’Costa, St. Louis Children’s Hospital John Dzivak, Cook Children’s Hospital

Technical Content Experts (Receiver Organizations)

Understanding of how quality measurement data is captured and reported

Bob Underwood, Child Health Corporation of America

Rick Moore, National Association of Children’s Hospitals and Related Institutions

Chad Bennett, Iowa Foundation for Medical Care

Clinical Content Experts Familiar with clinical content of some or all of the sample quality measures being used in this project

Barry Cannon, RN, Children’s Hospital Central California

Greg Omlor, MD, Akron Children’s Hospital

HL7 Experts Interested in learning the HL7 method for developing future vendor implementation guides for quality measures using QRDA

Bob Underwood, Child Health Corporation of America

Mitra Rocca, Novartis Pharmaceuticals Corp.

Connectors Understand related activities within other organizations

Primary project contacts Others TBD


Chad BennettIowa Foundation for Medical CareThe Collaborative for Performance Measure Integration with EHR [email protected]

Crystal KallemAmerican Health Information Management Association (AHIMA)HL7 Structured Documents Technical [email protected]

Joy KuhlAlliance for Pediatric QualityHL7 Pediatric Data Standards Special Interest [email protected]

Feliciano Yu, MDHL7 Pediatric Data Standards Special Interest GroupThe Children’s Hospital of [email protected]

Primary Project Contacts

Alliance for Pediatric QualityQuality Reporting HIT Standards Project

The Quality Reporting Document Architecture: Phase I FOR DISCUSSION WITH PedsSIG

September 2007


Strawmen samples

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 samples


Strawman samples


DISCUSSION POINTS: Clinical Content-related Issues 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 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 workHL7 Structured Docs

CDA-report CDA-R2 SPL

Q report HAI

DMIM

2 RMIMs MR

CCD H&P

AdmitH&P

1. R2-body based CDA-reporting

2. DMIM for SD/R2

3. CDA-R3

BSI SSI PedH&P

Rules:

1. Relationship between DMIM/RMIMs:

1. blown out

2. constrained

2. where can XML change?

3. what can extend/constrain a model?

diabetic asthma


future workHL7 Structured Docs

CDA-report CDA-R3 SPL

Q report HAI

DMIM

RMIMs MR

CCD H&P

AdmitH&P1. R2-body based CDA-

reporting

2. DMIM for SD/R2

3. CDA-R3

or

1. DMIM

2. CDA-R3

3. CDA-report

BSI SSI PedH&P

Rules:

1. Relationship between DMIM/RMIMs

2. where can XML change?

3. what can extend/constrain a model?

diabetic asthma