Quality Standards Success

1. Quality Standards Success • Quality improvement, measurement and reporting should use standards that are consistent and harmonized with each other. Else, we face a proliferation of misaligned efforts and inefficient resource use. • These measures and their standards should support incremental and iterative development. Else, each iteration starts from scratch. • Systems to support quality should be modular and maintained over time as requirements (and the nature of quality) evolve. Else, systems are not agile and do not support quality initiatives. … in the context of MU3

2. Quality Standards Topics Standards which support flexible platforms for measuring and reporting quality (QueryHealth, QRDA/HQMF) Standards for clinical decision support, both knowledge representation and application programming interfaces (APIs) for query/response to knowledge resources Standards for application programming interfaces supporting modular application integration Standards which support defect reporting to PSOs Standards needed for registry support including structured data capture and transmission to third party repositories

3. Standards which support flexible platforms for measuring and reporting quality • GAPS • HQMF R1: limited logical expressions (e.g. 40 pages of XML to represent apparently simple “if/then”) • QDM: limited concept expressions (e.g. can’t express target site for procedure, thus need to vastly expand value sets with hundreds of codes “right front molar”) • QRDA: may diverge from CCDA (e.g. standard development may recommend modifications not possible with CCDA)

4. Standards which support flexible platforms for measuring and reporting quality • GAP: HQMF R1: limited logical expressions (e.g. 40 pages of XML to represent apparently simple “if/then”) • QUESTION: Which version of HQMF is “sufficient” for MU3? If none, define successful outcome for acceptable version. • CONSIDERATIONS:“Sufficient,” at a minimum, addresses: • more standard way of representing logic • advanced logical functions • ADE – calculates AOC for time in therapeutic range • risk adjustment • OPTIONS: R1 (current), R2 (already balloted), modular R2.x, 2.5. • RECOMMENDATIONS: • FUTURE: In a perfect world, if you could do more to the standard – what else would you change? What is your “wishlist” of HQMF features you would like for MU3?

5. Standards which support flexible platforms for measuring and reporting quality GAP: HQMF R1: limited logical expressions (e.g. 40 pages of XML to represent apparently simple “if/then”)

6. Standards which support flexible platforms for measuring and reporting quality GAP: HQMF R1: limited logical expressions (e.g. 40 pages of XML to represent apparently simple “if/then”) QUESTION: Which version of HQMF is “sufficient” for MU3? If none, define successful outcome for acceptable version.

7. Standards which support flexible platforms for measuring and reporting quality • GAP: HQMF R1: limited logical expressions (e.g. 40 pages of XML to represent apparently simple “if/then”) • QUESTION: Which version of HQMF is “sufficient” for MU3? If none, define successful outcome for acceptable version. • CONSIDERATIONS:“Sufficient,” at a minimum, addresses: • more standard way of representing logic • advanced logical functions • ADE – calculates AOC for time in therapeutic range • risk adjustment

8. Standards which support flexible platforms for measuring and reporting quality • GAP: HQMF R1: limited logical expressions (e.g. 40 pages of XML to represent apparently simple “if/then”) • QUESTION: Which version of HQMF is “sufficient” for MU3? If none, define successful outcome for acceptable version. • CONSIDERATIONS:“Sufficient,” at a minimum, addresses: • more standard way of representing logic • advanced logical functions • ADE – calculates AOC for time in therapeutic range • risk adjustment • OPTIONS: R1 (current), R2 (already balloted), modular R2.x, 2.5.

9. Standards which support flexible platforms for measuring and reporting quality • GAP: HQMF R1: limited logical expressions (e.g. 40 pages of XML to represent apparently simple “if/then”) • QUESTION: Which version of HQMF is “sufficient” for MU3? If none, define successful outcome for acceptable version. • CONSIDERATIONS:“Sufficient,” at a minimum, addresses: • more standard way of representing logic • advanced logical functions • ADE – calculates AOC for time in therapeutic range • risk adjustment • OPTIONS: R1 (current), R2 (already balloted), modular R2.x, 2.5. • RECOMMENDATIONS:

10. Standards which support flexible platforms for measuring and reporting quality • GAP: HQMF R1: limited logical expressions (e.g. 40 pages of XML to represent apparently simple “if/then”) • QUESTION: Which version of HQMF is “sufficient” for MU3? If none, define successful outcome for acceptable version. • CONSIDERATIONS:“Sufficient,” at a minimum, addresses: • more standard way of representing logic • advanced logical functions • ADE – calculates AOC for time in therapeutic range • risk adjustment • OPTIONS: R1 (current), R2 (already balloted), modular R2.x, 2.5. • RECOMMENDATIONS: • FUTURE: In a perfect world, if you could do more to the standard – what else would you change? What is your “wishlist” of HQMF features you would like for MU3?