Quality Measurement – Clinical Decision Support Harmonization Proposal

1. Quality Measurement – Clinical Decision Support Harmonization Proposal

2. Leverage existing relevant work to establish modularized and harmonized standards that meet Quality-related business needs Includes quality measurement and CDS Initial target timeframe: January 2014 ballot cycle Work with TSC to extend ballot deadlines Continue work past ballot submission Goal

3. Proposed Approach Quality Measurement Standards HQMF R2.X CDS Standards CDS Knowledge Artifact IG, DSS IG Quality Measurement-Specific Components TBD, as needed CDS-Specific Components E.g., CDS usage context, such as CDS target = Spanish-speaking patient Foundational Components Clinical data model Expression/logic Document structure Vocabularies Templates and meta-data

4. Proposed Approach – Details

5. vMR Logical Model update vMR XML IG update vMR Templates IG update Expression Logic DAM and IG for Quality Measurement & CDS HQMF R2.X update CDS Knowledge Artifact IG update Decision Support Service IG update Others updates as needed if QDM updated – QRDA Cat. I/III, C-CDA PSSs and Specifications (Jan. 2014)

6. Expression Logic

7. The Foundation • Clinical Quality is a data-centric problem • Quality measurement seeks to measure clinical indicators • Clinical decision support seeks to identify established patterns and offer relevant guidance • Both these activities at their core involve set-based data processing • As such, they are most naturally and easily expressed in a data-language • set-focused – deals with computation of sets of information (e.g. encounters, medications, lab results, etc.) • expressive – express as naturally as possible the computation of those sets (e.g. composable, reusable, flexible) • complete – provide mechanisms so that the computation can be arbitrarily complex (e.g. computational, interval, set operations)

8. Operations • Set Operations • Retrieve, Filter, Union, Intersect, Extend, Project, Join • Computational • Comparison, Logical, String Manipulation, Arithmetic, etc. • Interval • During, Between, Overlaps, Meets, etc. • Aggregate • Count, Min, Max, First, Last, N

9. HQMF Operations • Data Criteria • Retrieve • Filter w/ specific operations and attributes • Temporally Related Information • Semi-join w/ temporal conditions • Excerpt • Aggregate Computation • Outbound Relationship • Semi-join w/out temporal conditions • Grouper • Union and Intersection • Population Criteria • Logical Operations (AND/OR/NAND/NOR/XOR) • Measure Observations • Computation

10. An Approach to Harmonization • Define the logical set of operations • Described above • Define each of the HQMF constructs in terms of those operations • such that an existing HQMF document becomes a syntactic short-hand for an equivalent underlying expression in terms of the foundational elements • Note that the foundational elements are independent of any particular data model, but the syntactic short-hands need not be...

11. Data Criteria - Retrieval

12. Data Criteria – Value Filter

13. Data Criteria – Value Filter (cont)

14. Temporally Related Information

15. Excerpt

16. Outbound Relationship • Same as temporally related information, but uses relationship definition as conditions instead of temporal operators

17. Grouper

18. Population Criteria

19. Measure Observation