IHE Quality, Research and Public Health – QRPH domain

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

2. Description of the domain • Newest IHE domain • Quality Reporting for accreditation • Public  Health Case Reporting • Public Health Immunization • Biosurveilance • Case Reporting to CDC with EMR Alert • Cancer Registry • Patient Safety Reporting • Drug Safety Reporting

3. Overview of the domain • Quality – Repurposing of data • Clinical Research – Secondary use of data • Public Health – Population base surveillance • 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. • Defining profiles for adverse event reporting especially with reference to medication-related adverse outcomes.

4. Quality • Exchanging data between concurrent and retrospective data collection initiatives • 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) • CMS Core Measures (Centers for Medicare and Medicaid Services) • Quality standards • Accreditation • Certification • Determining site standards in data exchange models when sites are participating at different levels in different programs

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

6. Public Health, Biosurveillance • 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 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. • 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 documents • Public Health Officials will decide how to handle the situation

7. Public Health, Biosurveillance • 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 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. • 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 documents • Public Health Officials will decide how to handle the situation

8. Clinical Research • QRPH implementation profiles could be employed in clinical trials • Selected patients are grouped based on certain criterias, such as pathology • Pharmaceuticals trials

9. llustration

10. Public Health Information Affinity Domain (PHIAD)? Public Health Information Affinity Domain

11. The relationship between QRPH and other domains Form Filler Key Actors from Other Profiles Retrieve Form for Data Capture (RFD) 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) !Measure Definition [reserved] Monitoring Agent / Destination Agency Document Recipient # Provide and Register Document Set [ITI-14] Form Manager Form Receiver Form Archiver # Submit Aggregate Data [reserved] # Submit Form [ITI-35] # Retrieve Form [ITI-34] # Archive Form [ITI-36] Document Source Actors Grouped for Options Patient Encounter Consumer Clinical Data Consumer Display Document Consumer Document Source Report Creator $ Retrieve Document [ITI-17] # Patient Encounter Management [ITI-31] $ Retrieve Specific Info for Display [ITI-11] $ Query For Existing Data [PCC-nn] $ Provide and Register Document Set [ITI-14] $ Submit Report [Reserved] $ Retrieve Document for Display [ITI-12] $Registry Stored Query [ITI-18] Care Delivery Information System Actors` Form Filler Patient Encounter Source Data Repository Information Source Document Registry Document Repository Enterprise Report Repository

12. Work accomplished by the domain • Clinical 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. Work accomplished by the domain • Drug 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. Work accomplished by the domain • Performance 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 <ACEI> or Angiotensin Receptor Blocker <ARB> on discharge for a patient with an episode of Acute Myocardial Infarction <AMI>, who exhibits Left Ventricular Systolic Dysfunction <LVSD>.

15. Work accomplished by the domain • Performance 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. Work considered for the new cycle • Chronic Disease Management Reporting (CDMR) • Cross-system protocol insertion (CSPI) • Maternal Child Health – coordination with PCC • Diabetes Care Management • New-born screening – passed onto Planning committee • Performance Quality Report • 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 • ITI • ITI Pseudonymization • Muliple Patient Queries

17. Infrastructure used in CRDC - RFD • RFD - 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 selection • completion of a series of forms • partial completion of forms • returning to forms partially filled out in earlier sessions. • supports archiving a copy of the completed form.

18. Infrastructure used in QRPH – Publish and Subscribe • Publish 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. Content Profiles used in QRPH • PCC • Pathology • Laboratory • Radiology • ALL…. • An umbrella or a means of coordination for: • Secondary use of data • Population safety • Repurposing of data

20. Questions? ana.estelrich@sante.gouv.fr