HL7 Quality Reporting Document Architecture (QRDA)

1. HL7 Quality Reporting Document Architecture (QRDA) Project UpdateJanuary 2009

2. Introductions Core Project Team Liora Alschuler Chad Bennett Alschuler Associates, LLC Iowa Foundation for Medical Care (IFMC) Robert Dolin Crystal Kallem Semantically Yours, LLC American Health Information Management Association (AHIMA) Gay Giannone Alschuler Associates, LLC Joy Kuhl Alliance for Pediatric Quality Feliciano Yu The Children’s Hospital of Alabama

3. Objectives • Review QRDA project history • Understand purpose and scope of the QRDA project • Discuss status of the QRDA draft standard for trial use (DSTU) • Understand HITSP and CMS quality use case needs and relationship to QRDA

4. A Collaborative Effort Founders Project Sponsors HL7 Workgroup Sponsors Project Management

5. Volunteer Contributions • The volunteer contributions of the full QRDA committee was instrumental in guiding the project and ensuring alignment between interested organizations. The QRDA committee was made up of representatives from a wide range of stakeholders, including:

6. Quality Reporting Document Architecture Project Goal To standardize the framework of quality reports and to define the way quality measurement data should be structured to create interoperability between reporting and receiving systems.

7. Requestors of Quality Data QualityImprovement Organizations Accrediting Organizations, Medical Societies, Alliances Payers Future of Quality Measure Reporting* Status Quo of Quality Measure Reporting* Feedback to clinicians Data Entry 100% manual process: data abstraction and data mining Prepare data for analysis Paper Medical Records Key-boarding or manual entry Point of Care clinicians Electronic Health Records Proprietary data formats QRDA Complete? *View animation in slide show format

8. Coordination with Related Efforts NCQA, AMA, APQ.... Measure definition ONC/HITSP Quality Use Case Measure Development NQF HITEP The Collaborative, RAND… eMeasure specification Quality Data Set eMeasure Specification HIMSS IHE: Multi-party choreography using HL7 messages, services ok? ok? ok? feedback QRDA QRDA QRDA Aggregators, Requestors

9. QRDA and the Collaborative • Focus of the Collaborative • Develop and maintain national performance measure definitions and specifications • Create standardized measure specifications for EHR vendors (the industry) • XML schema containing measure data elements, code values and measure logic • Focus of QRDA • Standardize the framework of quality reports • Mechanism to communicate patient-level quality measure data • Enable interoperability between reporting and receiving systems

10. QRDA Project History • Phase 1: September 07 – January 08 • Proof of concept, use of CDA for quality reporting • Leveraged lessons learned from Healthcare Associated Infection (HAI) CDA project for CDC • Domain Analysis • Requirements Analysis • Final report http://www.hl7.org/Library/Committees/pedsdata/QRDA%20Phase%20I%20Public%20Report.pdf

11. Key Findings from Proof of Concept • Clinical interoperability • Feasible to re-use templates developed for EHR interoperability • Simplifies data collection processes • Simplifies vendor application development • Promotes flexible workflow • Single- or multiple-visit submissions with updates • Anonymized or patient-identifiable • Internal and/or external reporting • Point of care feedback • Immediate validation that data set is complete • Can support guideline compliance • Reuse of clinical templates lays foundation for decision support • Fits well in interoperability landscape • Supports needs of the ONC/HITSP Quality Use Case

12. QRDA Project History (cont.) • Phase 2: May 2008 to present • Draft standard for trail use (DSTU) ballot • NHIN Trial Implementation demonstration project using QRDA

13. Types of QRDA Reports • Category 1: Single Patient Reports • DSTU ballot • Category 2: Patient List Reports • Informative ballot, for comments • Category 3: Calculated Reports • Informative ballot, for comments

14. Sample QRDA Category 1 Report • Contains raw patient data • No assertion about the status of quality compliance • When pooled and analyzed, each report contributes to quality compliance

15. Sample QRDA Category 2 Report • Proposed as a multi-patient level report • Includes flags for each patient indicating whether the patient qualifies for the numerator, denominator, exclusion

16. Sample QRDA Category 3 Report • Aggregate quality report • Calculated summary data for one or more measures on a population

17. Sample Measures in QRDA DSTU • Two pediatric measures defined and modeled in QRDA format • Vermont-Oxford Neonatal Admission Temperature • CHCA Pediatric Body Mass Index Percentile • Model patterning for various measure types can be refined over time through the balloting of measure-specific guidelines and should become unnecessary after enough measures have gone through the HL7 technical balloting process.

18. Next Steps for QRDA • QRDA Category 1 • DSTU ballot reconciliation complete • Finalizing documentation with plan to publish DSTU in late February 2009 • QRDA Categories 2 and 3 • Plan to address informative comments and support move to DSTU • Would like to collaborate with CMS and other stakeholders to understand if/how these reports would be used • Establish process to model additional measures in QRDA

19. Q&A/Discussion