1. Query Health Technical WG 8/2/2012

2. Agenda TopicTime Slot Announcements2:05 – 2:10 pm Specification, RI and Pilot Updates2:05 – 2:20 pm Comparison between existing Query Health Schema and HQMF Ballot Schema 2:20 – 2:40 pm Intermediate Model updates discussion2:40 – 2:50 pm

3. Announcements HQMF R2 DSTU open for ballot Recommend community members to provide comments

4. Specification Updates HQMF Under HL7 ballot QRDA Started requirements discussion of Category III reports on Tuesdays HL7 Wiki: http://wiki.hl7.org/index.php?title=Quality_Reporting_Document_Architecture_Category_3 http://wiki.hl7.org/index.php?title=Quality_Reporting_Document_Architecture_Category_3 S&I Framework Wiki: http://wiki.siframework.org/Query+Health+SDWG+Joint+Workgroup http://wiki.siframework.org/Query+Health+SDWG+Joint+Workgroup

5. RI Update PopMedNet I2b2 – POPMedNet Integration Complete. PopMedNet HQMF Translator work started Started generating HQMF from PMN Query Builder and integrating HQMF to Intermediate Translator. i2B2 Working on completing the CEDD ontology to align with CCDA Working on HQMF Generator and Translator using the CEDD. hQuery Address complex code generating issues associated with complex HQMF criteria elements

6. Pilot Updates MDPHNet Latest PMN code installed for pilot. Most of the Query Envelope in use currently. CEDD implementation started. NYDOH Portal for Pilot up and running VM that contains the PMN Data Mart Client + i2b2 stack for the data source created Integration with the test site to be started next week FDA Portal for Pilot up and running Waiting on approval from IRB for the data source integration Waiting on approvals to integrate data mart client with PMN Portal. CQM Pilot (AllScripts) Pilot profile being updated. Technical discussions to start next week.

7. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Existing Query Health Schema: http://code.google.com/p/query-health/source/browse/#hg%2FStandards%2Fhqmf%2Fschemas HQMF R2 Ballot Schema: Download from HL7 Changes are driven by: Existing Query Health schema was based on HL7 Data Types R1.1 HQMF R2 Ballot Schema based on HL7 Data Types R2 Support for Continuous, Ratio Measures and computation Elimination of some query health defaults

8. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d 1. Data Type ST inheritance hierarchy has changed. Used for “Title”, “LocalVariableName” etc Old XML: Sample Quality Measure Document ageBetween17and21 New XML: 2. Author/Custodian Changes: Author/Custodian now represented using author.responsibleParty and custodian.responsibleParty Old XML: New XML: 3. Code Element Display Name is now an element instead of an attribute Old New

9. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d 4. Data Criteria’s “Id” element Used to uniquely identify data criteria entries. The “data criteria id element” data type has changed from II to DSET_II Note: There are other places where the id has been retained like it was before. For e.g References, Definitions etc. Old XML: New XML: 5. Data Criteria: TemporallyRelatedInformation Pause Quanitity Pause Quantity changed from PQ to IVL_PQ Old XML: New XML:

10. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d 6. ClassCode, MoodCode, TypeCode Defaults removed Defaults for Criteria Elements, Definition Elements, Reference Element, Excerpts, PopulationCriteriaElements, Preconditions Old XML …. New XML …. * This is not consistent for all preconditions, top level preconditions with population criteria don’t require it, but inner preconditions require it

11. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d 7. Temporal Relationship vs Excerpt Ordering Reversed from earlier, repeat number changed Old XML AmbulatoryEncounter New XML

12. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d 8. Population Criteria Element Changes Common changes to numerator, denominator etc. Old XML New XML Entry  Changed to Component Code and isCriterionInd Elements are now required. Each of the logical operators now have an id element Inner Preconditions typecode not defaulted, but outer ones defaulted

13. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d 9. Measure Period IVL_TS change from R1.1 to R2 Old XML MeasurePeriod New XML Was not able to add width….This needs to be rectified.

14. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d 10. Value Sets to use IHE SVS or CTS2 Value Sets in previous version within data criteria section, now moved to Document Level Old XML …. New XML NEED to change ED Data type in R2 datatypes to accomplish this. Add to the definition

15. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d 11. Validation Changes at the Document Level Emeasure XSD validations did not include defintions, and MeasurePeriod. Added these examples. New NQF59 Sample is based at: http://code.google.com/p/query-health/source/browse/Standards/hqmf/samples/NQF59New_WithBallotSchema.xml

16. Intermediate Translator Model Updates Discussion Quality MeasureDocument – Effective Time New Attribute which specifies the time period over which the measure is valid. Not used in computation, so not adding to the model. Value Sets Ballot Schema includes support for Hierarchichal value sets A Value set contains other value sets. The Translator can deal with this complexity as needed Currently not supported by translator. Intermediate model not affected by change. Added QueryAttribute to reflect MeasureAttribute Types of things being counted MeasureScoring (Continuous / Ratio / Proportion)

17. MeasurePopulation is required to support Continuous/Ratio Measures Added this to the data types. MeasureObservationDefinition Required to create the derivation expression and perform the required functions. Important Parameters: Method Code Count, Sum, Average, Std Dev, Variance etc. Derivation Expression List of Attributes, Criteria String Value of the Derivation (Need to determine the best way to model this concept in a b-tree like structure for evaluation or use JS like function) Intermediate Translator Model Updates Discussion

18. Data Criteria Attributes Status Code Activity Time Encounter Criteria Attributes Length of Stay Admission Time – low of effective Discharge Time – high of effective Need to add facility Type, Arrival, Departure Time Typically designated using outbound relationship Add the additional types of population criteria. Numerator Exclusion Criteria Denominator Exclusion Criteria Measure Population Criteria Intermediate Translator Model Updates Discussion

19. Intermediate Translator Updates Procedure Method Code Approach Site Code Target Site Code SBADM / Supply Attributes Method Code, Approach Site, Target Site, route, doseQuantity rateQuantity, doseCheckQuantity, maxDoseQuantity, administration unit code

20. Next Steps Change Intermediate XSD and XSL to conform to the new Ballot schema. Specifications Participate in the resolution of QRDA discussions HL7 SDWG / QH TWG Joint WG