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Query Health Technical WG 8/2/2012

Query Health Technical WG 8/2/2012. Agenda. Announcements. HQMF R2 DSTU open for ballot Recommend community members to provide comments. Specification Updates. HQMF Under HL7 ballot QRDA Started requirements discussion of Category III reports on Tuesdays

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Query Health Technical WG 8/2/2012

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  1. Query HealthTechnical WG8/2/2012

  2. Agenda

  3. Announcements • HQMF R2 DSTU open for ballot • Recommend community members to provide comments

  4. Specification Updates • HQMF • Under HL7 ballot • QRDA • Started requirements discussion of Category III reports on Tuesdays • HL7 Wiki: http://wiki.hl7.org/index.php?title=Quality_Reporting_Document_Architecture_Category_3 • S&I Framework Wiki: http://wiki.siframework.org/Query+Health+SDWG+Joint+Workgroup

  5. RI Update • PopMedNet • I2b2 – POPMedNet Integration Complete. • PopMedNet HQMF Translator work started • Started generating HQMF from PMN Query Builderand integrating HQMF to Intermediate Translator. • i2B2 • Working on completing the CEDD ontology to align with CCDA • Working on HQMF Generator and Translator using the CEDD. • hQuery • Address complex code generating issues associated with complex HQMF criteria elements

  6. Pilot Updates • MDPHNet • Latest PMN code installed for pilot. • Most of the Query Envelope in use currently. • CEDD implementation started. • NYDOH • Portal for Pilot up and running • VM that contains the PMN Data Mart Client + i2b2 stack for the data source created • Integration with the test site to be started next week • FDA • Portal for Pilot up and running • Waiting on approval from IRB for the data source integration • Waiting on approvals to integrate data mart client with PMN Portal. • CQM Pilot (AllScripts) • Pilot profile being updated. • Technical discussions to start next week.

  7. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema • Existing Query Health Schema: • http://code.google.com/p/query-health/source/browse/#hg%2FStandards%2Fhqmf%2Fschemas • HQMF R2 Ballot Schema: • Download from HL7 • Changes are driven by: • Existing Query Health schema was based on HL7 Data Types R1.1 • HQMF R2 Ballot Schema based on HL7 Data Types R2 • Support for Continuous, Ratio Measures and computation • Elimination of some query health defaults

  8. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d • 1. Data Type ST inheritance hierarchy has changed. • Used for “Title” , “LocalVariableName” etc • Old XML: • <title>Sample Quality Measure Document</title> • <localVariableName>ageBetween17and21</localVariableName> • New XML: • <title value="Sample Quality Document“/> • <localVariableName value="ageBetween17and21"/> • 2. Author/Custodian Changes: • Author/Custodian now represented using author.responsibleParty and custodian.responsibleParty • Old XML: • <author typeCode="AUT" contextControlCode="OP"><assignedPersonclassCode="ASSIGNED"/></author> • New XML: • <author typeCode="AUT" contextControlCode="OP"> <responsiblePartyclassCode="ASSIGNED"/> </author> • 3. Code Element • Display Name is now an element instead of an attribute • Old • <code code="424144002" codeSystem="2.16.840.1.113883.6.96" displayName="Age"/> • New • <code code="424144002" codeSystem="2.16.840.1.113883.6.96"> <displayName value="Age"/> • </code>

  9. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d • 4. Data Criteria’s “Id” element • Used to uniquely identify data criteria entries. The “data criteria id element” data type has changed from II to DSET_II • Note: There are other places where the id has been retained like it was before. For e.g References, Definitions etc. • Old XML: • <observationCriteria> <id root="0" extension="ageBetween17and74"/> • New XML: • <ObservationCriteria> • <id> <item root="0" extension="ageBetween17and74"/></id> • 5. Data Criteria: TemporallyRelatedInformation Pause Quanitity • Pause Quantity changed from PQ to IVL_PQ • Old XML: • <temporallyRelatedInformationtypeCode="SAS"> <pauseQuantity value="-1" unit="a"/> • New XML: • <temporallyRelatedInformationtypeCode="SAS"> <pauseQuantity > <any xsi:type="PQ" value="-1" unit="a"/> </pauseQuantity>

  10. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d • 6. ClassCode, MoodCode, TypeCodeDefaults removed • Defaults for Criteria Elements, Definition Elements, Reference Element, Excerpts, PopulationCriteriaElements, Preconditions Old XML <encounterDefinition> <entry> <encounterCriteria> <encounterReferencemoodCode="DEF"> <excerpt> …. <patientPopulationCriteria> <precondition> • New XML • <encounterDefinitionclassCode=“ENC" moodCode="DEF"> • <entry typeCode="COMP"> • <encounterCriteriaclassCode="ENC" moodCode="DEF"> • <encounterReferenceclassCode="ENC" moodCode="EVN"> • <excerpt typeCode="XCRPT"> • …. • <patientPopulationCriteriaclassCode="OBS" moodCode="EVN"> • <precondition typeCode="PRCN">* • This is not consistent for all preconditions, • top level preconditions with population criteria don’t require it , • but inner preconditions require it

  11. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d New XML <entry typeCode="COMP"> <localVariableName value="AmbulatoryEncounter"/> <encounterCriteriaclassCode="ENC" moodCode="DEF"> <id> <item root="0" extension="AmbulatoryEncounter"/> </id> <!-- AmbulatoryEncounterValueSet --> <code valueSet="2.16.840.1.113883.3.464.1.1142"/> <definition> <encounterReferenceclassCode="ENC" moodCode="EVN"> <id root="0" extension="Encounters"/> </encounterReference> </definition> <temporallyRelatedInformationtypeCode="EAS"> <pauseQuantity > <any xsi:type="PQ" value="-1" unit="a"/> </pauseQuantity> <observationReferenceclassCode="OBS" moodCode="EVN"> <id root="0" extension="MeasurePeriod"/> </observationReference> </temporallyRelatedInformation> <excerpt typeCode="XCRPT"> <subsetCode code="PREVSUM"/> <encounterCriteriaclassCode="ENC" moodCode="DEF"> <repeatNumberlowClosed="true"> <low value="2"/> </repeatNumber> </encounterCriteria> </excerpt> </encounterCriteria> </entry> • 7. Temporal Relationship vs Excerpt Ordering • Reversed from earlier, repeat number changed Old XML <entry> <localVariableName>AmbulatoryEncounter</localVariableName> <encounterCriteria> <id root="0" extension="AmbulatoryEncounter"/> <!-- AmbulatoryEncounterValueSet --> <code valueSet="2.16.840.1.113883.3.464.1.1142"/> <definition> <encounterReferencemoodCode="DEF"> <id root="0" extension="Encounters"/> </encounterReference> </definition> <excerpt> <subsetCode code="PREVSUM"/> <encounterCriteria> <repeatNumber> <low value="2" inclusive="true"/> </repeatNumber> </encounterCriteria> </excerpt> <temporallyRelatedInformationtypeCode="EAS"> <pauseQuantity value="-1" unit="a"/> <observationReference> <id root="0" extension="MeasurePeriod"/> </observationReference> </temporallyRelatedInformation> </encounterCriteria> </entry>

  12. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d • 8. Population Criteria Element Changes • Common changes to numerator, denominator etc. Old XML <entry> <denominatorCriteria> <id root="c75181d0-73eb-11de-8a39-0800200c9a66" extension="DENOM"/> <precondition> <atLeastOneTrue> <precondition> <allTrue> <precondition> <observationReference> <id root="0" extension="HasDiabetes"/> </observationReference> </precondition> New XML <component typeCode="COMP"> <denominatorCriteriaclassCode="OBS" moodCode="EVN"> <id root="c75181d0-73eb-11de-8a39-0800200c9a66" extension="DENOM"/> <code></code> <isCriterionInd value="false"/> <precondition> <atLeastOneTrue> <id/> <precondition typeCode="PRCN"> <allTrue> <id/> <precondition typeCode="PRCN"> <observationReferenceclassCode="OBS" moodCode="EVN"> <id root="0" extension="HasDiabetes"/> </observationReference> </precondition> Entry  Changed to Component Code and isCriterionInd Elements are now required. Each of the logical operators now have an id element Inner Preconditions typecode not defaulted, but outer ones defaulted

  13. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d • 9. Measure Period • IVL_TS change from R1.1 to R2 Old XML <controlVariable> <localVariableName>MeasurePeriod</localVariableName> <measurePeriod> <id root="0" extension="MeasurePeriod"/> <value> <width unit="a" value="1"/> </value> </measurePeriod> </controlVariable> New XML <controlVariable> <localVariableName value="MeasurePeriod"/> <measurePeriod> <typeId root="0" extension="MeasurePeriod"/> <code code="MSRTP" codeSystem="2.16.840.1.113883.5.4"/> <value> <low ></low> <high></high> </value> </measurePeriod> </controlVariable> Was not able to add width….This needs to be rectified.

  14. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d • 10. Value Sets to use IHE SVS or CTS2 • Value Sets in previous version within data criteria section, now moved to Document Level Old XML <dataCriteriaSection> …. <definition> <valueSet> <id root='1.2.840.10008.6.1.308'/> <text> <reference value='https://example.com/RetrieveValueSet?id=1.2.840.10008.6.1.308'/> <RetrieveValueSetResponsexmlns="urn:ihe:iti:svs:2008"> <ValueSet id="1.2.840.10008.6.1.308" displayName="Common Anatomic Regions Context ID 4031" version="20061023"> <ConceptListxml:lang="en-US"> <Concept code="T-D4000" displayName="Abdomen" codeSystem="2.16.840.1.113883.6.5"/> <Concept code="R-FAB57" displayName="Abdomen and Pelvis" codeSystem="2.16.840.1.113883.6.5"/> </ConceptList> </ValueSet> </RetrieveValueSetResponse> </text> </valueSet> </definition> • New XML • <definition> <valueSetclassCode="OBS" moodCode="DEF"> <id root='1.2.840.10008.6.1.308'/> <text> <reference value='https://example.com/RetrieveValueSet?id=1.2.840.10008.6.1.308'/> <RetrieveValueSetResponsexmlns="urn:ihe:iti:svs:2008"> <ValueSet id="1.2.840.10008.6.1.308" displayName="Common Anatomic Regions Context ID 4031" version="20061023"> <ConceptListxml:lang="en-US"> <Concept code="T-D4000" displayName="Abdomen" codeSystem="2.16.840.1.113883.6.5"/> <Concept code="R-FAB57" displayName="Abdomen and Pelvis" codeSystem="2.16.840.1.113883.6.5"/> </ConceptList> </ValueSet> </RetrieveValueSetResponse> </text> </valueSet> </definition> • NEED to change ED Data type in R2 datatypes to accomplish this. • Add <xsd:any namespace="##other" processContents="skip" minOccurs="0" maxOccurs="unbounded"></xsd:any> to the definition

  15. Schema Comparison of existing Query Health Schema and HQMF R2 Ballot Schema Cont’d • 11. Validation Changes at the Document Level • Emeasure XSD validations did not include defintions, and MeasurePeriod. • Added these examples. • New NQF59 Sample is based at: • http://code.google.com/p/query-health/source/browse/Standards/hqmf/samples/NQF59New_WithBallotSchema.xml

  16. Intermediate Translator Model Updates Discussion • Quality MeasureDocument – Effective Time • New Attribute which specifies the time period over which the measure is valid. • Not used in computation, so not adding to the model. • Value Sets • Ballot Schema includes support for Hierarchichal value sets • A Value set contains other value sets. • The Translator can deal with this complexity as needed • Currently not supported by translator. • Intermediate model not affected by change. • Added QueryAttribute to reflect MeasureAttribute • Types of things being counted • MeasureScoring (Continuous / Ratio / Proportion)

  17. Intermediate Translator Model Updates Discussion • MeasurePopulation is required to support Continuous/Ratio Measures • Added this to the data types. • MeasureObservationDefinition • Required to create the derivation expression and perform the required functions. • Important Parameters: Method Code • Count, Sum, Average, StdDev, Variance etc. • Derivation Expression • List of Attributes, Criteria • String Value of the Derivation • (Need to determine the best way to model this concept in a b-tree like structure for evaluation or use JS like function)

  18. Intermediate Translator Model Updates Discussion • Data Criteria Attributes • Status Code • Activity Time • Encounter Criteria Attributes • Length of Stay • Admission Time – low of effective • Discharge Time – high of effective • Need to add facility • Type, Arrival, Departure Time • Typically designated using outbound relationship • Add the additional types of population criteria. • Numerator Exclusion Criteria • Denominator Exclusion Criteria • Measure Population Criteria

  19. Intermediate Translator Updates • Procedure • Method Code • Approach Site Code • Target Site Code • SBADM / Supply Attributes • Method Code, Approach Site, Target Site, route, doseQuantity • rateQuantity, doseCheckQuantity, maxDoseQuantity, administration unit code

  20. Next Steps • Change Intermediate XSD and XSL to conform to the new Ballot schema. • Specifications • Participate in the resolution of QRDA discussions • HL7 SDWG / QH TWG Joint WG

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