Overview HQMF Characteristics HQMF Structure and sections – About the ‘measure’ (MeasureAttributes) – Data Definitions – Logic Traditional usage in ‘quality’ – Numerator – Denominator – Exclusions (num, den)

Public Health eMeasure Framework Policy Development Policy eMeasure Specification Provider (EMR), Lab (LIMS), Information Exchange Analytics (HIE) Report Public Health Program Feedback

HQMF Characteristics Structured Documents – CDA Parent Not Patient-specific Written with Quality Measures in mind Human readable – Include measure attributes describing rule – Include data definitions – Include Reporting Requirements (Patient Population Rules) Machine Readable – Include data definitions – Include Reporting Requirements (Patient Population Rules) Can support expression of computable public health reporting requirements

HQMF Structure and sections Measure Information Measure Sets Pertussis Lab Pertussis Clinician Identifiers Titles Effective dates Available dates

HQMF Structure and sections About the ‘measure’ (MeasureAttributes) Author Verifier Description Measure type Guidance Measurement Period Transmission Format Notice of Use Topic Type

HQMF Structure and sections Data Definitions – Data definitions and logic for representing reporting criteria – Short name – Description Example: – "Laboratories: facilities that are permitted to perform laboratory analytical services" – "Isolation/detection of B. pertussis by culture: Isolation or detection of B. pertussis from any Culture method; and not preliminary results” – "Positive Bordetella pertussis Culture: Isolation of Bordetella pertussis from a clinical specimen" – "Positive B. pertussis by PCR: Positive B. pertussis nucleic acid by PCR" – "Positive B. Pertussis IgM by serology: Positive B. Pertussis IgM by serology" – "Positive B. Pertussis IgA by serology: Positive B. Pertussis IgA by serology" – "Positive B. Pertussis Ag by DFA: Positive B. Pertussis Ag by DFA" – "Care provided in Jurisdiction (Colorado): patient was treated by a provider in Colorado" – "Patient Resides in Jurisdiction(Colorado): patient lives in Colorado"

HQMF Structure and sections Population Criteria (Logic) – Combination logic describing a record of interest – Example AND: Laboratory AND: OR: Isolation/detection of B. pertussis by culture OR: Positive B. pertussis by PCR OR: Positive B. Pertussis IgM by serology OR: Positive B. Pertussis IgA by serology OR: Positive B. Pertussis Ag by DFA AND: OR: Patient Sought Care in Jurisdiction (Colorado) OR: Patient Resides in Jurisdiction(Colorado)

Ratio Measures (quality)

Table 1: Population Criteria Definitions for Proportional Measures PopulationDefinition Initial Patient Population (IPP ) All patients to be evaluated by a specific performance eMeasure who share a common set of specified characteristics within a specific measurement set to which a given measure belongs. Denominator (DENOM ) The same as the initial patient population or a subset of the initial patient population to further constrain the population for the purpose of the eMeasure. Denominator Exclusions (DENEX) Patients who should be removed from the eMeasure population and denominator before determining if numerator criteria are met. Denominator exclusions are used in proportion and ratio measures to help narrow the denominator. Numerator (NUMER) The processes or outcomes expected for each patient, procedure, or other unit of measurement defined in the denominator Of a proportion measure. Denominator Exceptions (EXCEP) Those conditions that should remove a patient, procedure, or unit of measurement from the denominator only if the numerator criteria are not met. Denominator exceptions allow for adjustment of the calculated score for those providers with higher risk populations.

Continuous Variable Measure

HQMF Examples HL7 Comments/Document update – Need 1 or more complete examples – Need to provide contextual examples throughout – Need to verify applicability to public health – Originally working with PHER for industry examples for each part of the document, but not as an integrated full example IHE PHrpt – Need examples – Need details for updated context

HQMF Implemented Sample Conditions NY Lead – demonstrates thresholds Tuberculosis – Aligns with PHDSC CDA for Public Health Pilot Pertussis – Aligns with PHDSC CDA for Public Health Pilot – Colorado Pertussis (was first available Pertussis) – Use case update for HIMSS – Atlas provisional HIMSS Public Health – San Diego Pertussis Report type of XD*Lab Report type of Pertussis CDA Case Report

HL7 HQMF Scoping and Additions Add capabilities for public health to express needs Base standard – does it prevent a public health requirement in the current standard Specifics of how to use HQMF for public health is an Implementation Guide or Profile Public Health ‘measure type’? – May be the same as a Continuous Variable Measure – Reporting criteria – Public Health ‘Policy’ descriptions – If a new measure type, it impacts several areas of HQMF draft

HQMF Public Health Profile or IG Typical Data Definitions – Measure Attributed Transmission Format – more structured – lab result Positive Result Preliminary/final Organism Result Susceptibility Method – Problems Suspected confirmed – Vaccine History Administration – Cause of Death Suspected confirmed – Jurisdiction – etc

Value Sets (pending in sample) – PHIN-VADS references (or example) – Embedded value set (examples) – Dynamic, Static references – Approaches for state vs national value set reference/maintenance Inheritance Subsets Extensions Drawn out example – Describe details of each section with PH example HQMF Public Health Profile or IG

Review Sample