Quality Reporting HIT Standards Project July 2007

1. Quality Reporting HIT Standards Project July 2007

2. Goal • Participants • Rationale • Project Overview • How to Participate

3. QRDA: Project Goal Quality Reporting Document Architecture Develop a standard for healthcare information systems to communicate quality measurement data across disparate systems in a standardized fashion.

4. Participants: A Private Collaborative Founders Project Management HL7 Sponsor Primary Benefactor For Phase One

5. Using Data for Quality Performance Measurement *Problem • Time-consuming and problematic operations for data acquisition from electronic systems • Multiple and disparate systems within health care organizations complicate data mining and coordination of efforts • Resource-intensive data mapping efforts to link systems and performance measurement data requirements • Conflicts or differences between administrative data sets • Physicians and providers struggle to meet increasing demands for performance data *Source: Agency for Healthcare Research & Quality Opportunity • Support efficient collection, aggregation and reporting of quality measurement information • Among providers within a healthcare system • Among providers from different healthcare systems • Among providers and requestors of quality data (e.g. QIOs, payers, accrediting orgs, etc.) • More… • Support adoption of quality measurement • Among developers of health information technology systems • Among providers and payers

6. Example: Traditional Quality Measure Reporting Requestors of Quality Data (e.g. quality improvement organization) IT Assistance, Manual Data Entry Manual Abstraction Administrative Data Ad Hoc Forms Ad Hoc Databases IT Assistance, Manual Data Entry Medical Record (Paper, EMR) Requestors of Quality Data (e.g. payer) IT Assistance, Manual Data Entry scrubbing Requestors of Quality Data (e.g. accrediting org) Provider periodic reporting documentation Provider sends one set of measure information to multiple requestors of quality data

7. Example: QRDA Simplifies Quality Measure Reporting Requestors of Quality Data (e.g. quality improvement Organization) HL7 v3 message, QRDA Manual Abstraction Administrative Data Ad Hoc Forms Ad Hoc Databases Medical Record (Paper, EMR) Requestors of Quality Data (e.g. payer) Requestors of Quality Data (e.g. accrediting org) Provider periodic reporting documentation Provider sends one set of measure information to multiple requestors of quality data

8. HL7 v3 Standard Specification ADT PIS Hospital or Ambulatory Information System RIS/PACS Requestors of Quality Data QRDA LIS EDIS

9. Goal: Shared Approach to Document Architecture quality measure Data Elements in Common Format Measure Name Measure Set Submitting Entity Receiving Entity Procedure Code Diagnosis Code Lab Results Criteria Patient/Provider data etc. Quality Reporting Document Architecture Measure Name Measure Set Submitting Entity Receiving Entity Procedure Code Diagnosis Code Lab Results Criteria Patient/Provider data Etc… quality measure quality measure

10. QRDA Project Overview Phase Two: • Ballot and publish QRDA Draft Standard for Trial Use through HL7 • Training material and support for vendors adopting the QRDA for pilot measures; Guidelines on prioritized reporting measures • Conduct proof of concept demonstrations Phase One: • Define project opportunity • Select standards development expert for support • Secure endorsement and funding • Recruit volunteers • Develop prototype QRDA-compliant reports • Make recommendations for moving forward • Secure endorsement and funding for Phase Two 3 months TBD

11. Major Phase One Deliverables • Data elements for pilot measures • Using NQF-endorsed quality measures; 2 adult outpatient; 2 pediatric inpatient • Minimum of two clinical document architecture samples of quality reporting document • Training and education for project team and interested stakeholders • Description of relationship of this project with other, similar efforts • Coordination with related efforts • Description of options for moving forward • Definition of benefit from IT perspective • Webcast on findings

12. Leverage and Harmonize With Others Certification Commission for Health Information Technology - For possible vendor certification of the QRDA standard Collaborative for Performance Measure Integration with EHR Systems - Addressing performance measure functionality and integration with EHRs - Facilitating integration, calculation and reporting of measures within vendor products for reporting - Includes American Medical Association, National Committee on Quality Assurance and Centers for Medicare & Medicaid Services Health Information Technology Standards Panel American Health Information Community - Promoting automation of quality data reporting - Developing quality use cases Health Level Seven - Vehicle for publishing the QRDA standard - Working with Clinical Interoperability Council, Electronic Health Record Technical Committee, Government SIG, Pediatric Data Standards SIG, Structured Documents Technical Committee, and more Integrating the Healthcare Enterprise - Driving vendor adoption of standards

13. Phase One: Volunteer Opportunities

14. Volunteer List – How to Participate • Contact joy.kuhl@chca.com if you are interested in: • serving on the phase one project team in one of the volunteer roles • joining an email list to stay up-to-date on major project activities

15. Primary Project Contacts Chad Bennett Iowa Foundation for Medical Care The Collaborative for Performance Measure Integration with EHR Systems cbennett@ifmc.org Crystal Kallem American Health Information Management Association (AHIMA) HL7 Structured Documents Technical Committee crystal.kallem@ahima.org Joy Kuhl, Project Facilitator Alliance for Pediatric Quality HL7 Pediatric Data Standards Special Interest Group joy.kuhl@chca.com Feliciano Yu, MD HL7 Pediatric Data Standards Special Interest Group The Children’s Hospital of Alabama fyu@peds.uab.edu

17. HospitalCommunity PhysicianCommunity Alliance for Pediatric Quality Four national pediatric organizations aligned to improve the qualityof health care for America’s children. • 200+ children’s hospitals and 60,000 pediatricians using the same play book to improve care • Alignment of physicians and hospitals is essential to improvement progress • Combined expertise and spheres of influence will accelerate improved quality for children

18. AllianceGoals & Strategies • Promote meaningful pediatric improvement and measures • Promote initiatives using measures for improvement • Spread use of measures for improvement and public reporting • Develop a comprehensive catalogue of pediatric improvement priorities and measures • Ensure health information technology works for children • Seek industry-wide adoption of data standards for pediatrics • Promote integration of child health EHR-S standards into vendor systems • Endorse pediatric data standards that make comparability possible • Explore opportunities for collecting and sharing data Our Strategies • Work for consensus – speak with one voice for improvement in quality for children; advance pediatric improvement initiatives, measures and data/health information technology • Endorse and promote projects that advance pediatric quality and health information technology • Convene stakeholders • Advocate in media and legislature

19. Project Fit With Alliance Mission Alliance for Pediatric Quality • Lead, shape and accelerate recognition and adoption of quality improvement • Promotes improvement priorities • Provides specific data elements for pediatric quality measures • Maps data elements to HL7 RIM • Develops HL7 v3 Implementation Guideline for measure/s using QRDA standard HL7 PeDSSIG With other HL7 committees, organizations and vendors within the HL7 enterprise • Adopts HL7 implementation plan through system updates • Develops internal logic/algorithms to capture data elements for specific measure/s • Validates and tests accuracy of data output for specific measure Vendor EMR systems and other systems • Possible vendor certification of compliance CCHIT Reporting Facility Practice/Healthcare Institution • Purchases vendor that complies with HL7 standards • Receives functionality through vendor system • Participates in reporting to Improvement Organization (s) Requestors of Quality Data Or other central quality assurance bodies such as CHCA, NACHRI, etc. • Accepts QRDA data-submissions for benchmarking