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Alliance for Pediatric Quality Reporting HIT Standards Project The Quality Reporting Document Architecture: Phase Alliance for Pediatric Quality Reporting HIT Standards Project The Quality Reporting Document Architecture: Phase I September 2007

with SDTC 1. Overview 2. Sample 3. Project proposal www. kidsquality. org 2 with SDTC 1. Overview 2. Sample 3. Project proposal www. kidsquality. org 2

QRDA: Project Goal Quality Reporting Document Architecture Develop an electronic data standard report for QRDA: Project Goal 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. www. kidsquality. org 3

Participants: A Private Collaborative Founders Primary Benefactor For Phase One HL 7 Sponsor Project Participants: A Private Collaborative Founders Primary Benefactor For Phase One HL 7 Sponsor Project Management www. kidsquality. org 4

Alliance for Pediatric Quality Four national pediatric organizations aligned to improve the quality of Alliance for Pediatric Quality Four national pediatric organizations aligned to improve the quality of health care for America’s children. Physician Community Hospital Community § 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 www. kidsquality. org 5

Alliance Goals & Strategies 1. Promote meaningful pediatric improvement and measures Our Strategies § Alliance Goals & Strategies 1. Promote meaningful pediatric improvement and measures Our Strategies § 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 www. kidsquality. org § 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 6

Using Data for Quality Performance Measurement Problem* § Time-consuming and problematic operations for data 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 www. kidsquality. org 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 7

Status Quo in Quality Measure Reporting Data Entry 100% manual process: data abstraction and Status Quo in Quality Measure Reporting Data Entry 100% manual process: data abstraction and data mining Prepare data for analysis Requestors of Quality Data Quality Improvement Organizations Accrediting Organizations Paper Medical Records Payers Key-boarding or manual entry Proprietary data formats Electronic Medical Records Provider sends patient level measure data in multiple formats; data prepared for analysis and submitted in multiple formats www. kidsquality. org 8

QRDA Immediately Simplifies Quality Measure Reporting Data Entry semi-automated: data abstraction and data mining QRDA Immediately Simplifies Quality Measure Reporting Data Entry semi-automated: data abstraction and data mining Paper Medical Key-boarding or Records manual entry Prepare data for analysis Requestors of Quality Data Quality Improvement Organizations Accrediting Organizations QRDA Payers QRDA-compatible Electronic Medical Records QRDA valid? Semi-automated data entry; single, open data format for collection and analysis; compatible with EMR exchange documents (CCD, CDA); point-of-collection validation www. kidsquality. org 9

Future: QRDA Streamlines Quality Measure Reporting Data Entry semi-automated: data abstraction and data mining Future: QRDA Streamlines Quality Measure Reporting Data Entry semi-automated: data abstraction and data mining Paper Medical Key-boarding or Records manual entry Prepare data for analysis Requestors of Quality Data Quality Improvement Organizations Accrediting Organizations QRDA Payers QRDA-compatible QRDA Electronic Medical Records Fully-automated data entry, ready for collection and analysis www. kidsquality. org 10

Leverage and Harmonize With Others Collaborative for Performance Measure Integration with EHR Systems (The Leverage and Harmonize With Others 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 www. kidsquality. org 11

Related Efforts NCQA, APQ. . : Measure Development e. Measure Definition The Collaborative: e. Related Efforts NCQA, APQ. . : Measure Development e. Measure Definition The Collaborative: e. Measure definition ? feedback multi-party choreography using HL 7 messages, services ? ok IHE: ? ok QRDA AHIC, HITSP Use Cases measure definition Aggregators, Requestors www. kidsquality. org 12

Related Efforts § § Coordination Points: preliminary work shows that • QRDA maps to Related Efforts § § 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 www. kidsquality. org 13

QRDA Project Overview Phase One: Phase Two: ü Define project opportunity ü Select standards QRDA Project Overview Phase One: Phase Two: ü Define project opportunity ü Select standards development expert for support ü Secure endorsement and funding ü Recruit volunteers ü Develop prototype QRDA-compliant reports ü Describe relationship to other projects § Make recommendations for moving forward § Secure endorsement and funding for Phase Two § Ballot and publish QRDA Draft Standard for Trial Use through HL 7 § Training material and support for vendors adopting the QRDA for pilot measures; Guidelines on prioritized reporting measures § Conduct proof of concept demonstrations 3 months TBD www. kidsquality. org 14

Benefits of Standardized Electronic Quality Measurement Data Transmission § § § Leverage existing electronic Benefits of Standardized Electronic Quality Measurement Data Transmission § § § 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 www. kidsquality. org 15

Project Proposal: Quality Reporting Document Architecture § § “Health care institutions routinely collect and Project Proposal: Quality Reporting Document Architecture § § “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 www. kidsquality. org 16

Project Fit With Alliance Mission Alliance for Pediatric Quality § § § Lead, shape Project Fit With Alliance Mission Alliance for Pediatric Quality § § § 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 HL 7 RIM Develops HL 7 v 3 Implementation Guideline for measure/s using QRDA standard Vendor § § § Adopts HL 7 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 CCHIT § Vendor certification of compliance to standards Reporting Facility § § § Purchases vendor that complies with HL 7 standards Receives functionality through vendor system Participates in reporting to Improvement Organization(s) § Accepts QRDA data-submissions for benchmarking HL 7 Pe. DSSIG With other HL 7 committees, organizations and vendors within the HL 7 enterprise EMR systems and other systems Practice/Healthcare Institution Requestors of Quality Data Or other central quality assurance bodies such as CHCA, NACHRI, etc. www. kidsquality. org 17

Phase One: Volunteers Volunteer Roles Expertise Volunteers To Date Technical Content Experts (Source Organizations) 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 HL 7 Experts Interested in learning the HL 7 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 www. kidsquality. org 18

Primary Project Contacts Chad Bennett Iowa Foundation for Medical Care The Collaborative for Performance Primary Project Contacts Chad Bennett Iowa Foundation for Medical Care The Collaborative for Performance Measure Integration with EHR Systems [email protected] org Crystal Kallem American Health Information Management Association (AHIMA) HL 7 Structured Documents Technical Committee crystal. [email protected] org Joy Kuhl Alliance for Pediatric Quality HL 7 Pediatric Data Standards Special Interest Group joy. [email protected] com Feliciano Yu, MD HL 7 Pediatric Data Standards Special Interest Group The Children’s Hospital of Alabama [email protected] uab. edu www. kidsquality. org 19

Alliance for Pediatric Quality Reporting HIT Standards Project The Quality Reporting Document Architecture: Phase Alliance for Pediatric Quality Reporting HIT Standards Project The Quality Reporting Document Architecture: Phase I FOR DISCUSSION WITH Peds. SIG September 2007

Strawmen samples § DOQ-IT CAD-1 -7 --- Adult, ambulatory • • Sample 1: Single 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 Hb. A 1 c result Sample 3: Single visit, second visit Sample 4: Both visits § JCAHO asthma measure (CAC) --- Pediatric, inpatient • Sample 5: www. kidsquality. org 22

Strawmen samples www. kidsquality. org 23 Strawmen samples www. kidsquality. org 23

Strawman samples www. kidsquality. org 24 Strawman samples www. kidsquality. org 24

DISCUSSION POINTS: Clinical Content-related Issues § Organization of clinical data • • • § DISCUSSION POINTS: Clinical Content-related Issues § Organization of clinical data • • • § • • 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 single visit? series? “episode”? Update/replace • • § discussion What is “the encounter”? discussion: discuss further: w/Collaborative, vendors, accepting systems’ guidelines • • • § useful to show as observation/result Code “test has been ordered” as a result set; provide results as available? Focus on pediatric use case: • § If multiple, organize by finding or chronology? Order/results • § as data set/list comparable to source documents alternate? Single/multiple visits per document? defer to discuss w/Collaborative, vendors • § both useful; develop alt QRDA stylesheet where needed replace vs append useful to provide as-is, and update not resolved www. kidsquality. org Link to source document(s) / observations not discussed 25

DISCUSSION POINTS: Technical Issues § § TECHNICAL ISSUES: Templates • • • § § DISCUSSION POINTS: Technical Issues § § TECHNICAL ISSUES: Templates • • • § § § discussion: develop alt stylesheet need for QRDA-specific display? Validation • • discussion: provide translation examples industry vs quality reporting Display • § document (report) level section level entry level Code sets • discussion: need to refine usage model (what templates are reusable) 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? www. kidsquality. org 26

current work HL 7 Structured Docs CDA-report Q report diabetic asthma HAI BSI CDA-R current work HL 7 Structured Docs CDA-report Q report diabetic asthma HAI BSI CDA-R 2 CCD SSI DMIM 2 RMIMs SPL MR H&P Admit. H&P Ped. H&P Rules: 1. 1. 2. constrained 2. where can XML change? 3. DMIM for SD/R 2 3. blown out R 2 -body based CDAreporting 2. Relationship between DMIM/RMIMs: CDA-R 3 what can extend/constrain a model? www. kidsquality. org 27

future work HL 7 Structured Docs CDA-report Q report diabetic asthma HAI BSI CDA-R future work HL 7 Structured Docs CDA-report Q report diabetic asthma HAI BSI CDA-R 3 CCD SSI SPL DMIM RMIMs MR H&P Admit. H&P Ped. H&P 1. 2. Rules: 1. Relationship between DMIM/RMIMs R 2 -body based CDAreporting DMIM for SD/R 2 3. CDA-R 3 or 1. 2. where can XML change? 3. what can extend/constrain a model? www. kidsquality. org DMIM 2. CDA-R 3 3. CDA-report 28