1. IHE Quality, Research and Public Health – QRPH domain November 05, 2008 Changing the Way Healthcare Connects Ana ESTELRICH, GIP-DMP, FRANCE

2. IT Infrastructure Planning Committee Description of the domain Newest IHE domainNewest IHE domain Quality Reporting for accreditationQuality Reporting for accreditation Public Health Case ReportingPublic Health Case Reporting Public Health ImmunizationPublic Health Immunization BiosurveilanceBiosurveilance Case Reporting to CDC with EMR AlertCase Reporting to CDC with EMR Alert Cancer RegistryCancer Registry Patient Safety ReportingPatient Safety Reporting Drug Safety ReportingDrug Safety Reporting

3. IT Infrastructure Planning Committee Overview of the domain Quality – Repurposing of dataQuality – Repurposing of data Clinical Research – Secondary use of dataClinical Research – Secondary use of data Public Health – Population base surveillancePublic Health – Population base surveillance Focuses on the workflow cycle of queries for data and selection of population cohorts from within the clinical record.Focuses on the workflow cycle of queries for data and selection of population cohorts from within the clinical record. Incorporation of output from the query specification within the clinical system workflow to enable clinical decision support.Incorporation of output from the query specification within the clinical system workflow to enable clinical decision support. Defining profiles for adverse event reporting especially with reference to medication-related adverse outcomesDefining profiles for adverse event reporting especially with reference to medication-related adverse outcomes.

4. IT Infrastructure Planning Committee Quality Exchanging data between concurrent and retrospective data collection initiativesExchanging data between concurrent and retrospective data collection initiatives Exchanging data according to and beyond the core measures of:Exchanging data according to and beyond the core measures of: Joint Commission (The Joint Commission is a private sector United States-based non-profit organization)Joint Commission (The Joint Commission is a private sector United States-based non-profit organization) CMS Core Measures (Centers for Medicare and Medicaid Services)CMS Core Measures (Centers for Medicare and Medicaid Services) Quality standardsQuality standards AccreditationAccreditation CertificationCertification Determining site standards in data exchange models when sites are participating at different levels in different programsDetermining site standards in data exchange models when sites are participating at different levels in different programs

5. IT Infrastructure Planning Committee Quality Monitors patients co-morbidities in disease driven effortsMonitors patients co-morbidities in disease driven efforts Do we have the right measure for the reporting effort in hospital-level quality improvement initiative?Do we have the right measure for the reporting effort in hospital-level quality improvement initiative?

6. IT Infrastructure Planning Committee Public Health, Biosurveillance Patient B gets treated by Hospital A for certain symptoms, corresponding to a potential reportable condition.Patient B gets treated by Hospital A for certain symptoms, corresponding to a potential reportable condition. This will be captured in the document/submission set/folder metadata eventCodeListThis will be captured in the document/submission set/folder metadata eventCodeList Hospital A sends a required report to the appropriate Public Health agency P, and also sends an ED Encounter Summary (EDES) to the local XDS repository.Hospital A sends a required report to the appropriate Public Health agency P, and also sends an ED Encounter Summary (EDES) to the local XDS repository. Public Health determines that a review of recent ED encounters for patients with similar symptoms is necessary.Public Health determines that a review of recent ED encounters for patients with similar symptoms is necessary. A list of patients with the appropriate symptoms will be obtain, their potential contacts and other associated documentsA list of patients with the appropriate symptoms will be obtain, their potential contacts and other associated documents Public Health Officials will decide how to handle the situationPublic Health Officials will decide how to handle the situation

7. IT Infrastructure Planning Committee Public Health, Biosurveillance Patient B gets treated by Hospital A for certain symptoms, corresponding to a potential reportable condition.Patient B gets treated by Hospital A for certain symptoms, corresponding to a potential reportable condition. This will be captured in the document/submission set/folder metadata eventCodeListThis will be captured in the document/submission set/folder metadata eventCodeList Hospital A sends a required report to the appropriate Public Health agency P, and also sends an ED Encounter Summary (EDES) to the local XDS repository.Hospital A sends a required report to the appropriate Public Health agency P, and also sends an ED Encounter Summary (EDES) to the local XDS repository. Public Health determines that a review of recent ED encounters for patients with similar symptoms is necessary.Public Health determines that a review of recent ED encounters for patients with similar symptoms is necessary. A list of patients with the appropriate symptoms will be obtain, their potential contacts and other associated documentsA list of patients with the appropriate symptoms will be obtain, their potential contacts and other associated documents Public Health Officials will decide how to handle the situationPublic Health Officials will decide how to handle the situation

8. IT Infrastructure Planning Committee Clinical Research QRPH implementation profiles could be employed in clinical trialsQRPH implementation profiles could be employed in clinical trials Selected patients are grouped based on certain criterias, such as pathologySelected patients are grouped based on certain criterias, such as pathology Pharmaceuticals trialsPharmaceuticals trials

9. IT Infrastructure Planning Committee llustration

10. IT Infrastructure Planning Committee Public Health Information Affinity Domain Public Health Information Affinity Domain (PHIAD)?

11. IT Infrastructure Planning Committee The relationship between QRPH and other domains Form Manager Form Receiver Form Archiver Form Filler Patient Encounter Source Patient Encounter Consumer Data Repository Clinical Data Consumer Information Source Display Document Registry Document Consumer Document Repository Document Source Enterprise Report Repository Report Creator Care Delivery Information System Actors` Actors Grouped for Options Document Source Document Recipient Monitoring Agent / Destination Agency  Submit Report [Reserved]  Provide and Register Document Set [ITI-14]  Retrieve Document [ITI- 17]  Registry Stored Query [ITI-18]  Retrieve Document for Display [ITI-12]  Retrieve Specific Info for Display [ITI-11]  Patient Encounter Management [ITI-31]  Query For Existing Data [PCC-nn]  Retrieve Form [ITI-34]  Submit Form [ITI-35]  Archive Form [ITI-36]  Submit Aggregate Data [reserved]  Provide and Register Document Set [ITI-14]  Measure Definition [reserved] Patient Admin Management (PAM) Query for Existing Data (QED) Retrieve Into for Display (RID) Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Reliable Interchange (XDR) Retrieve Form for Data Capture (RFD) Key Actors from Other Profiles

12. IT Infrastructure Planning Committee Work accomplished by the domain Clinical Research Data CaptureClinical Research Data Capture –describes the content and format to be used within the Prepopulation Data transaction described within the RFD Integration Profile. –The purpose of this profile is to support a standard set of data in CCD format which the Form Filler provides for use in Clinical Research. –In addition this profile will reference the ability to convert this output into a standard case report form (Standard CRF) consisting of ODM and CDASH

13. IT Infrastructure Planning Committee Work accomplished by the domain Drug Safety ContentDrug Safety Content –describes the content and format to be used within the Prepopulation Data transaction described within the RFD Integration Profile. –supports a standard set of data in the Continuity of Care Document (CCD) format which the Form Filler provides for use in reporting adverse events as it relates to Drug Safety. –C-76 by HITSP. –In addition, as potential reference implementation this profile will reference the ability to convert this output into the ICH E2B M standard.

14. IT Infrastructure Planning Committee Work accomplished by the domain Performance Measurement Data Element Structured for EHR ExtractionPerformance Measurement Data Element Structured for EHR Extraction –describes mechanisms to communicate patient-level data to local or third-party analyzer systems for management, aggregation and reporting of quantitative quality indicators or measurements to destination systems. –describes a data set for the measurement of a quality indicator defined by the American Heart Association (AHA) and American College of Cardiology (ACC). –This quality indicator is based on the prescription of an Angiotensin Converting Enzyme Inhibitor or Angiotensin Receptor Blocker on discharge for a patient with an episode of Acute Myocardial Infarction, who exhibits Left Ventricular Systolic Dysfunction.

15. IT Infrastructure Planning Committee Work accomplished by the domain Performance Measurement Data Element Structured for EHR ExtractionPerformance Measurement Data Element Structured for EHR Extraction –describes the content and format to be used within the Prepopulation Data transaction described within the RFD Integration Profile. –supports a standard set of data in the Continuity of Care Document (CCD) format which the Form Filler provides for use in reporting adverse events as it relates to Drug Safety. –C-76 by HITSP. –In addition, as potential reference implementation this profile will reference the ability to convert this output into the ICH E2B M standard.

16. IT Infrastructure Planning Committee Work considered for the new cycle Chronic Disease Management Reporting (CDMR)Chronic Disease Management Reporting (CDMR) Cross-system protocol insertion (CSPI)Cross-system protocol insertion (CSPI) Maternal Child Health – coordination with PCCMaternal Child Health – coordination with PCC Diabetes Care ManagementDiabetes Care Management New-born screening – passed onto Planning committeeNew-born screening – passed onto Planning committee Performance Quality ReportPerformance Quality Report Maintenance work:Maintenance work: –Update of the CRD based on the CDASH v 1.0 –Update of the technical framework PEQD –Drug Safety Profile - work following public comments ITIITI –ITI Pseudonymization –Muliple Patient Queries

17. IT Infrastructure Planning Committee Infrastructure used in CRDC - RFD RFD - Retrieve Form for Data CaptureRFD - Retrieve Form for Data Capture –provides a method for gathering data within a user’s current application to meet the requirements of an external system. –supports the retrieval of forms from a form source, display and completion of a form, and return of instance data from the display application to the source application. –relies upon XForms technology to support negotiation between the form display and form provider systems form selectionform selection completion of a series of formscompletion of a series of forms partial completion of formspartial completion of forms returning to forms partially filled out in earlier sessions.returning to forms partially filled out in earlier sessions. supports archiving a copy of the completed form.supports archiving a copy of the completed form.

18. IT Infrastructure Planning Committee Infrastructure used in QRPH – Publish and Subscribe Publish and subscribePublish and subscribe –Allows for event-based notifications –Currently an implementable white paper for XDS-based Pub/Sub –XDS-based pub/sub uses Stored Query as the topics of subscription, currently limited to single patients –With the proposed multi-patient stored query, more general topics will be available –This year a generalized pub/sub infrastructure is being proposed in ITI

19. IT Infrastructure Planning Committee Content Profiles used in QRPH PCCPCC PathologyPathology LaboratoryLaboratory RadiologyRadiology ALL….ALL…. An umbrella or a means of coordination for:An umbrella or a means of coordination for: –Secondary use of data –Population safety –Repurposing of data

20. IT Infrastructure Planning Committee Questions? ana.estelrich@sante.gouv.fr