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

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

3. 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?

4. 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

5. 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

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

7. 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)

8. 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

9. 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)

12. 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

13. 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