Query Health Operations Workgroup HQMF & QRDA Query Format - Results Format

1. Query Health Operations WorkgroupHQMF & QRDAQuery Format - Results Format February 9, 2012 11:00am – 12:00am ET

2. Agenda • Discuss Query Health Specifications & Standards • HQMF and QRDA at a high level • QRDA • Quality Measures • HQMF- Query Format • QRDA- Results Format • Distinction between HQMF & QRDA • OWG Focus

3. Query Health Specifications & Standards-

4. Quality Measures • Under HHS direction, NQF was tasked with retooling 113 endorsed quality measures from a paper-based format to an eMeasure format. • A quality measure is a quantitative tool that provides an indication of an individual or organization’s performance in relation to a specified process or outcome via the measurement of an action, process or outcome of clinical care. • Derived from clinical guidelines • Designed to determine whether the appropriate care has been provided • Performance Measures/ Quality Indicators • Quality measures are used for three general purposes: • Quality Improvement • Accountability • Research

5. Health Quality Measures Format HQMF- Query Format

6. HQMF Background • HQMF is a standard for representing health quality measures as an electronic document that is machine readable. • A health quality measure encoded in the HQMF format is referred to as an “eMeasure”. • eMeasures is a critical component of the workflow to support MU • eMeasures may be understood by providers to guide optimal care, and to guide collection of Electronic Health Record (EHR) and other data, which is then assembled into quality reports • In July 2010, 44 of the 113 measures were published in the CMS’s EHR Incentive Program Final Rule. • HQMF targets the following groups: • Healthcare Providers • EHR Vendors • Physicians and Clinicians • Quality Improvement Reporting Agencies • If HQMF is not supported, the Reference Implementation will provide native format options to express the queries.

7. Benefits of HQMF • Expresses a large majority of queries related to MU, ACO Related Queries, Comparative Effectiveness, Population Measures, and basic research related queries. • Expresses queries in a declarative format independent of the implementation language. • Ex. The number of people diagnosed with high blood pressure in NYC • Standardizes measure’s structure, metadata, definitions, and logic, the HQMF provides for quality measure consistency and unambiguous interpretation. • Bridges an important gap in automated performance measurement. • Streamlines implementation of measures and reduces the burden of manual data collection and reporting. • Makes it easier for physicians and other clinicians to monitor and evaluate the care they are providing patients based on data routinely captured during care processes. • Fosters the success of quality improvement efforts for physicians and other clinicians • Enhances the use of nationally-recognized performance measures at the point of care to enable greater transparency for providers and consumers. • Better enables EHR queries.

8. HQMF Enhancements • HQMF is being enhanced in various ways to support the needs of the healthcare industry for a standardized query format: • Make HQMF schema more executable • Provide example snippets of XML in the HQMF implementation guide to support implementers • Create “green” XML schema to enhance readability • Develop general tooling improvements and enhancements to support schema generation and validation

9. Reuse of Native Query Clients and Builders • The Query Health solution relies on native query builders and clients, including web-based portals, to construct queries and review results. • A native query builder is a piece of software that is “native” or local to the organization allowing a user to type in a query in layman’s terms, such as “Number of patients suffering from diabetes” vs. code • Web-based portals are interfaces that allow users to log in and exchange data; the portal is hosted on the web (in the cloud) vs. a physical portal

10. HQMF - Initial Questions and Implications • How does the HQMF format support auditing requirements (high-level and detailed)? • Is the requirement to audit against the instance of a query (Query X was made by Entity Y) or is the requirement to audit against what content is be queried (Query X asked for specific information on a procedure or encounter) • In general, are effective audit records being produced and appropriately managed; and do those records capture personal data? • How does the query format integrate with current security controls? • How would an organization manage the use of HQMF by its systems for both quality reporting and distributed queries? What types of policies would be needed? • Will the query clients support different levels of authentication to access the system?

11. Quality Results Document Architecture QRDA- Results Format

12. QRDA- Quality Reporting Document Architecture • Quality Reporting Document Architecture (QRDA) is a document format that will provide a standard structure with which to report quality measures. • Conforms to the requirements of the Health Level Seven (HL7) Clinical Document Architecture Release 2.0 (CDA). • Emerging Standard but not widely implemented • If a result cannot be expressed in QRDA, the Reference Implementation will provide other options based on MIME Types • MIME: Multi-purpose Internet Mail Extensions- a specification for sending messages over the internet

13. Categories of Quality Measure Reports • Category 1: Single Patient Reports • Individual patient-level quality reports with the full clinical data defined in the measure; Category One reports may contain one or more single measures and/or one or more sets of measures; Data points that meet exclusion criteria may be included and identified. • Category 2: Summary Reports • Reports containing aggregate data across a defined population; The report may or may not identify individual patient’s data within the summary; The defined population may represent the final measure numerator or denominator or both. • Category 3: Calculate Reports • Report of calculated result(s) for a given population and period of time, identifying exclusions; The report conveys the separate values for numerator and denominator and the calculated result(s).

14. Benefits of QRDA • Category III allows for returning aggregate or summary level results that will be useful to report results for Meaningful Use, ACO, Comparative Effectiveness Research, and many basic research results related to populations. • Allows for results to be represented in a declarative fashion, independent of the implementation language • Ex. 50 people in the ‘X’ district have Huntington’s disease

15. QRDA Enhancements • To support a query that would return aggregated data on Type II diabetes, QRDA Categories II and III must be fully specified and balloted to become a standard for real-world implementation. • The QRDA implementation guide must also be improved to be more prescriptive and provide real-world examples. • Inconsistencies in data representation in some QRDA and corresponding eMeasures must also be reconciled. • Eventual support for a template library for QRDA data elements will be needed.

16. QRDA- Initial Questions and Implications • Would there be a need to document the retention period for data that is returned as a query result? • How does the recipient of the information (the information requestor) ensure that the query results being received are valid? • How are controls related to secondary use of data enforced on the results received?

17. Additional OWG Focus Areas • Query Format • Feedback on the type of quality measures currently reported by your organization • For those currently doing distributed queries with other organizations, what oversight exists over the types of queries submitted as well as determined usage of query results • Results Format • Policy and Security implications focused on de-identification of results- Governance/Enforcement

18. Appendix: Query Health Solution – How it Works Together OWG Focus