1. Background
Health information exchanges (HIEs) are becoming Qualified Clinical Data Registries (QCDRs) to measure and report quality performance
Both providers and payers are interested in HIE quality calculations
For “formal reporting”, QRDA1 & QRDA3 are appropriate formats (e.g. this would be submission to CMS or other payer programs)
For information shared during routine data exchange, there is a desire to share quality calculations. This document contains a proposal for how to report these “informal” measure calculations in document types that are routinely exchange (e.g. Continuity of Care Document from C-CDA).
“Informal” measure calculation includes a section that complies with quality measurement standards (QRDA1) but is not suitable or fully complete for “formal reporting.” If current year time period is used, this could be a basis for identifying a “gap” in clinical care.

2. “Informal” Channel
In dialogues with clients, this informal channel for quality measurement information would:
Use existing information pipes with EHRs / HIEs
Ideally leverage existing standards rather than create something new
Show a quality outcome calculation for a patient along with other relevant data for care transition/management (i.e. “one-stop-shop”)

3. Proposed Approach
C-CDA documents are the most common document format of patient-specific information (e.g. via XDS.b or XCA connections)
Take the measure calculation from QRDA 1 and insert as section in C-CDA (documents are open-template)
Share Clinical Data
Health Information Exchange +
Qualified Clinical Data Registry
Share Clinical Data + Quality Calculation
Single document that has care transition info + quality calculations

4. Proposed Approach in C-CDA
Typical sections of C-CDA documents
QRDA 1 Measure Section
Above measures (and table format) are illustrative only
Measures for Inclusion would be defined by use case (i.e. quality programs)

5. Proposed Approach in C-CDA
C-CDA Template
Header information not shown
Other clinical content sections not shown
QRDA 1 Section
Measure Identifier
Measure Calculation

6. Links & Next Steps Links to example XML
Section Only: CDAR2.1/QUALITY_Measures_in_CCDA/QUALITY_Measures_in_CCDA.xml
Full Example: CDAR2.1/QUALITY_in_ONC_CCD.xml
Plan to proceed with approval as example
Use format aligned with The Joint Commission QRDA 1 reporting (Yan Heras feedback)
Human readable format that aligns with prior QRDA development (Gay Dolin feedback)
Plan to review with Examples Task Force and move forward with approval as a convention. This is not currently planned for a balloted standard (but welcome as other pursue)
This example would be a supplement to required formats of data reporting for quality payment programs. It demonstrates versatility of open-templates in C-CDA