April 29 - QRPH Planning Discussion

Agenda

• Presence
• Summary of the previous activities
  • The wiki pages have been moved to reflect the new domain name.
  • Two new co-chairs were elected on March 14, 2008
    • Ana Estelrich (GIP-DMP, French Government) for the Planning Committee Quality Domain
    • Jason Colquitt (Greenway Medical)for the Technical Committee Quality Domain

Persons Present April 29, 2008:

• Ana ESTELRICH (GIP-DMP)
• Floyd EISENBERG (SIEMENS MEDICAL)
• Anna ORLOVA (PUBLIC HEALTH DATA STANDARDS CONSORTIUM)
• Jason COLQUITT (GREENWAY MEDICAL)
• Vassil PEYTCHEV (EPICS)
• Keith BOONE (GE MEDICAL)
• Harry SOLOMON (GE MEDICAL)
• Didi DAVIS (HIMSS)
• Chris CARR (RSNA)
• Penelope SOLIS (AMERICAN HEART ASSOCIATION)
• Thomas KUHN (AMERICAN COLLEGE OF PHYSICIANS)

Work in progress

1. Performance Measurement Data Element Structured for EHR Extraction
   1. Issues:
      1. Dependencies on the
      2. ITI Sharing Value Sets Profile
      3. Collaborative for Performance Measure Integration with EHR Systems XML Schema Reference Guide
   2. The technical details are listed under the technical frameworks. Certains things that must be considered:
      1. The white paper Performance Measurement Data Element Structured for EHR Extraction should remain as such since there are some gaps between the Collaborative's current schema and what the EHR vendors might require. The Collaborative plans to continue work on the schema to enhance it over the next several months, adding some additional measures for testing. IHE QRPH can use the draft schema within the white paper to enable additional comments and testing. The EHR Vendor Association is planning to join the Collaborative and naturally bring changes to the existing schema are to be expected. Nevertheless, this is a hot topic interesting Europe, USA, and Asia. The white paper can have an implementable part (written like a profile) which includes using SVS to get the Value Sets, and a transform it to get a performance measure from XML to a template format (the modified schema that Vassil proposed to Floyd and Jason). Some additional work can occur as part of the white paper effort to coordinate the schema with CDA (HL7 v3.0) requirements.
   3. Another point that was brought up in the April 22 call is the additional set of stored queries for XDS metadata (not patient-centric). Perhaps a revision of priorities is needed. The deadline for a Change Proposal for the ITI Committee is May 2nd. The original request arose from a HITSP Use Case evaluation for Biosurveillance in 2006 which expects a query across existing records for all patients to establish a cohort of patients for further analysis by public health. Similar queries would enable quality and research initiatives. The urgency of such requirements requires some discussion. Floyd with follow up with Lori Fourquet with regard to that need. Options include:
      1. An HIE can create a database of relevant data as new documents are registered in an XDS domain - queries for Public Health, Research, etc, can work with the database to identify the cohort, then get additional data based on known patients (pseudonymized or not).
      2. In absence of an HIE, send a query request which would look very much like a quality measure, including the relevant value set(s): how to identify a denominator to determine a cohort, how to identify actions or results or procedures related to patients in the cohort (in effect, a numerator) and how to identify exception for patients in which the query is not interested. With this information, the receiving organization can set up its own queries into its local databases and return an appropriate list.
2. Status on Clinical Research, Public Health and Quality use of EHR Data.
   1. C-DASH stable enough?
   2. Mapping between CCD and C-DASH? How realistically feasible is that?
   3. No visibility for before the 3 weeks left for face to face.....
3. Status on Drug Safety Content.
   1. Is FDA expecting result in ICSR Ballot or SDTM? How does BRIG fit in? It seems that the answer is in [ICSR Overview + Technical information] and input is required regarding the availability of technical resources to assist in the effort quickly. Additional discussion are planned with FDA over the next week to determine the availability of such resources. These discussions will occur at the HL7 meeting in conjunction with the Patient Safety Workgroup there. If sufficient technical resources are not available, it may be prudent to scope this project for post-market surveillance of adverse drug events until next year's efforts.

Comments with follow-ups from the group

1. How important is the query for Multiple Patients in terms of ITI-18. HITSP might need that to enhance the Biosurveillance Use Case work from 2006 but prioritization will be reviewed in the next week. What is there right now?
2. C-DASH has been out for two weeks, the deadline for final comments is May 14, 2008. Is this suitable for Clinical Research Profile? Discussion for the Clinical Research Profile will occur within PCC Technical Committee.
3. For the Drug Safety Profile to capture data from EHRs for post-market surveillance, ICSR needs to be present in the work, mapped to CDA. Some discussion regarding feasibility and technical resources planned during HL7 Phoenix meeting next week. Also will determine the stability of ICSR and where it is implemented.
4. SVS-based Quality Paper work will continue. Calls are scheduled tomorrow and Thursday to continue the work effort. There are some outstanding issues but there is good promise of a workable solution for an implementable prototype from the white paper which can lead to two defined profiles for 2009.

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