HL7 Quality Reporting Document Architecture DSTU CDA Release 2, US Realm Pele Yu, MD MS FAAP HL7 September 2008 WGM (Vancouver, BC, Canada)

Quality Reporting Document Architecture To develop an electronic data standard for exchange of patient-level quality measurement data between healthcare information systems.

Future of Quality Measure Reporting Status Quo in Quality Measure Reporting Feedback to clinicians Data Entry 100% manual process: data abstraction and data mining Prepare data for analysis Paper Medical Records Requestors of Quality Data Quality Improvement Organizations Accrediting Organizations, Medical Societies, The Alliance Payers Key-boarding or manual entry Point of Care clinicians Electronic Health Records Proprietary data formats QRDA Complete?

AHIC, HITSP Use Cases Coordination with Related Efforts NQF, NCQA, AMA, APQ.... Measure definition Measure Development HITEP AHIC, HITSP Use Cases The Collaborative eMeasure specification Data Elements for Quality eMeasure Specification ok? ok? ok? HIMSS IHE: Multi-party choreography using HL7 messages, services feedback QRDA QRDA QRDA Aggregators, Requestors

QRDA Project History Phase 1: September 07 – January 08 Proof of concept, use CDA for quality reporting HAI reports for CDC (SDTC) SDTC interest in CDA based non-clinical reporting documents – Structured Documents Architecture (SDA) Domain Analysis Requirements Analysis Phase 2: May 2008 to present DSTU Ballot QRDA Implementation Guideline for 2 Pediatric Measures (CHCA) QRDA Reporting Categories (MedAllies) NHIN Trial Implementation demonstration project in NY Summary patient record exchange using CDA

QRDA Draft Standard 2008 Category 1 – Patient-Level Reports For DSTU Ballot Category 2 – Summary Reports Informational, for Comments Category 3 – Calculated Reports

QRDA Category 1 Specifications Header US Realm Unique CDA template ID, LOINC code, and Title Participants Target  a single patient Author  one or more entities (person, organization, device) Informant  one reporting entity (person, organization) Custodian  one custodian (person, organization) Legal Authenticator  one legal authenticator (person, organization) Body One body One or more sections, subsections (Measure Set, Measure) Section Measure Set Section (measure set name, version, OID, description) Measure Section (measure name, version, OID, description) Reporting Parameters Section (applicable reporting period) Patient Data Section (Re-use of CCD and CDA, if applicable)

QRDA Specifications – RIM Constructs Header US Realm Unique CDA template ID, LOINC code, and Title Participants Target  a single patient Author  one or more entities (person, organization, device) Informant  one reporting entity (person, organization) Custodian  one custodian (person, organization) Legal Authenticator  one legal authenticator (person, organization) Body One body One or more sections, subsections (Measure Set, Measure) Section Measure Set Section (measure set name, version, OID, description) Measure Section (measure name, version, OID, description) Reporting Parameters Section (applicable reporting period) Patient Data Section (Re-use of CCD and CDA, if applicable) QRDA Phase 1

QRDA Deliverable Implementation Guides for QRDA Category 1 Pediatric Measures VON Neonatal Admission Hypothermia Measure Outcome measure CHCA Body Mass Index (BMI) Process measure Rationale Few data points, well-defined Pilot potential Pediatric measures on NQF Roadmap Relevant to project stakeholder (CHCA)

Implication of DSTU QRDA is feasible Ready for industry use RIM adaptable CDA adaptable Strong HL7 support Industry awareness achieved Ready for industry use HITSP IHE Pilot efforts Barriers for adoption and progress Lack of continuity in effort Lack of formal project management structure

Next Steps QRDA DSTU Ballot reconciliation next few months Resolve issues without substantive change and publish DSTU, or Resolve issues w/ substantive changes, then re-ballot Implications QRDA Phase 3 Funding for future development to refine DSTU leading to Normative Standard Category 1  DSTU Category 2 and 3  include in next ballot cycle/s, if enough work is done (MedAllies, etc) Create solid links with industry Harmonize efforts (IHE, Collaborative, JCAHO, HEDIS, etc) Engage vendors and MDOs Pilot and demonstration projects Vendors, hospitals, QIOs