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Electronic Quality Measure Format specification June 16, 2009 Bob Dolin, MD

Electronic Quality Measure Format specification June 16, 2009 Bob Dolin, MD Gay Giannone , MSN, RN. Outline. Quality framework eMeasure timeline eMeasure formalism Clinical concepts HQMF logical operators Data elements (for eMeasure metadata) eMeasures and clinical guidelines

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Electronic Quality Measure Format specification June 16, 2009 Bob Dolin, MD

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  1. Electronic Quality Measure Format specification June 16, 2009 Bob Dolin, MD Gay Giannone, MSN, RN

  2. Outline • Quality framework • eMeasure timeline • eMeasure formalism • Clinical concepts • HQMF logical operators • Data elements (for eMeasure metadata) • eMeasures and clinical guidelines • Using an eMeasure to query an EHR • eMeasures and QRDA

  3. Quality Framework NCQA, AMA, APQ.... Measure definition ONC/HITSP Quality Use Case Measure Development NQF HITEP The Collaborative, RAND… eMeasure specification Quality Data Set eMeasure Specification HIMSS IHE: Multi-party choreography using HL7 messages, services feedback QRDA QRDA QRDA Aggregators, Requestors

  4. eMeasure Timeline • (May-Jun, 2009) Conceptual design • (July, 2009) IHE review • (Aug 10-Sept 14, 2009) HL7 ballot (DSTU) • (Dec, 2009) HL7 ballot (DSTU) (if necessary) • (Jan, 2010) IHE Connectathon • (Mar, 2010) HIMSS Interoperability Showcase • (~2011) DSTU feedback (on eMeasure and QRDA) [http://www.hl7.org/dstucomments/index.cfm]

  5. eMeasure Formalism • Clinical concepts are “operationalized” as RIM graphs + vocabulary; • Measure-specific criteria are derived; • Measure-specific parameters are assembled. • Example: Denominator = • [1] >= 2 F2F visit within period; AND • [2] 18+; AND • [3] Dx CAD (based on diagnosis or certain procedures)

  6. eMeasure Formalism – Clinical concepts are “operationalized” as RIM graphs • “F2F Encounter” • PatientEncounter • classCode is "ENC" • moodCode is "EVN" • code is drawn from ValueSetX • statusCode is "completed" • effectiveTime is present • subject participant is patient • “Presence of Coronary Artery Disease” ="Presence of Coronary Artery Disease by diagnostic criteria" OR "Presence of Coronary Artery Disease by procedure criteria" • "Presence of Coronary Artery Disease by diagnostic criteria" • Observation • classCode is "OBS" • moodCode is "EVN" • code is drawn from ValueSetY • statusCode is "completed" • subject participant is patient • "Presence of Coronary Artery Disease by procedure criteria" • Procedure • classCode is "PROC" • moodCode is "EVN" • code is drawn from ValueSetZ • statusCode is "completed" • subject participant is patient

  7. eMeasure Formalism – Measure-specific criteria are derived • >= 2 F2F visit within period: • derived from "QRDA Observation Parameters Act" • derived from "F2F Encounter" • derivationExpr • <observation classCode="OBS"moodCode="DEF"> • <!-- >= 2 F2F visit within period --> • <code /> • <derivationExpr> • Count of "F2F Encounter" within measurement period >=2 • </derivationExpr> • <value xsi:type="BL"/> • <actRelationshiptypeCode="DRIV"> • <act>QRDA Observation Parameters Act</act> • </actRelationship> • <actRelationshiptypeCode="DRIV"> • <encounter>F2F Encounter</encounter> • </actRelationship> • </observation>

  8. eMeasure Formalism – Measure-specific parameters are assembled • Denominator(boolean) =">= 2 F2F visit within period" AND "18 or older at start of measurement period" AND "Presence of Coronary Artery Disease". • <!-- Denominator • Inclusion --> • <observation moodCode="DEF"> • <code /> • <value xsi:type="BL"/> • <actRelationshiptypeCode="PRCN"conjunctionCode="AND"> • <observation>>= 2 F2F visit within period</observation> • </actRelationship> • <actRelationshiptypeCode="PRCN"conjunctionCode="AND"> • <observation>18 or older at start of measurement period</observation> • </actRelationship> • <actRelationshiptypeCode="PRCN"conjunctionCode="AND"> • <observation>Presence of Coronary Artery Disease</observation> • </actRelationship> • </observation>

  9. Data Elements (for eMeasure metadata) • Define data elements applicable to all eMeasures. • Show how those data elements map into the eMeasure XML schema (similar to the way we map data elements into the CDA XML schema).

  10. eMeasures and Clinical Guidelines • Where an eMeasure is derived from a clinical guideline, the derivation relationships can be expressed in the eMeasure specification

  11. Querying an EHR • Assumes a RIM interface • eMeasure is expressed in terms of RIM structures + vocabulary • EHR is expected to be able to generate HITSP constructs (e.g. CCD) eMeasure Specification

  12. eMeasure and QRDA • Workflow described in QRDA pre-dated the eMeasure specification

  13. eMeasures and QRDA • To the extent possible, an eMeasure will automatically generate a corresponding measure-specific QRDA specification. • eMeasure will contain metadata used in QRDA (e.g. measure, measure set, reporting parameters) • QRDA will reuse the eMeasure templates.

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