QRPH Technical Performance Quality Report TC Minutes 5 Dec 2008

Attendees:

• Chad Bennett (Iowa Foundation for Medical Care)
• Patty Craig (The Joint Commission)
• Floyd Eisenberg (National Quality Forum)
• Jaime Lucove (Allscripts)
• Jan Orton (Intermountain Healthcare)
• Jacob Reider (Allscripts)

Project Scope

Three inpatient measure sets (Specification links above):

• Active Version of Stroke measures 1, 2, 3, 5, 8, and 10 as of 21 Nov 2008 ("Missing” numbers have not been approved to be included in the measure set)
  • STK-1 --- STK-1 Algorithm
  • STK-2 --- STK-2 Algorithm
  • STK-3 --- STK-3 Algorithm
  • STK-5 --- STK-5 Algorithm
  • STK-8 --- STK-8 Algorithm
  • STK-10 --- STK-10 Algorithm

• Active versions of Venous Thromboembolism (VTE) Measures:
  • VTE-1 --- VTE-1 Algorithm
  • VTE-2 --- VTE-2 Algorithm
  • VTE-3 --- VTE-3 Algorithm
  • VTE-4 --- VTE-4 Algorithm
  • VTE-5 --- VTE-5 Algorithm
  • VTE-6 --- VTE-6 Algorithm
  • VTE Specifications & Exclusions

• Active Versions of Emergency Department (ED) Measures
  • ED-1
  • ED-2
  • Data Element Codes ED Measure
  • Data Elements
    

Project Facts and Proposals per December 5, 2008 Discussion

1. The current measures are endorsed by the National Quality Forum (NQF). The Joint Commission updates their measures every six months and the next update is due for publication in March (or at least submission for publication). Therefore, work on the ‘current’ measures will be outdated somewhat by publication. We should use the most updated version.
2. Many of the data elements in the measures will require judgment calls with respect to whether EHR-available data are useful and sufficient to express the intent of the element and the context intended by the measure developer. For the output of the effort to have a specified measure that has the same meaning as the manual version, measure developers must participate. Patty Craig represents The Joint Commission and is seeking an additional resource from the measure development area. The Oklahoma Foundation for Medical Care (OFMC) is a partner in the measure development and a request for their participation is in progress.
3. Some of the data elements in the measures will not have clear EHR or electronic codified data concepts. To accommodate such items, we propose that the measure specification be included as content within a Retrieve Form for Data Capture (RFD – an ITI Profile) as output of a Form Manager. The EHRs, as Form Receivers, will auto fill what is possible and enable human filling of information not in codified standard form. The completed form can be returned then as a constrained structured document (i.e., QRDA with Schematron testing). This last (return) step requires further analysis with respect to scope.
4. The project will encode a measure within an existing structure. Inclusion of the implementation in an EHR which and subsequent production of a patient-level aggregate patient report using HL7 Quality Reporting Document Architecture (QRDA) is part of the roadmap but potentially out of scope for this Performance Quality Report Profile in 2009. Since QRDA is a draft standard for trial use (DSTU) in HL7, a profile may not be necessary for testing and such testing can occur in the US domain through the Healthcare Information Technology Standards Panel <HITSP>. HITSP expects to use a patient-level QRDA report (Category I). To be determined is the extent to which an aggregate report (Categories II and III) will be used. Note that QRDA includes schematron rules so that in such testing the completeness, terminology and structure of the QRDA can be validated before submission to an external performance monitoring organization.
5. Successful final output is a fully specified measure set (3 of them) in electronic format that can be used by an EHR, an HIE, or some coordinator of clinical and administrative data. A statistical analysis step would help to validate that the calculated aggregate results are the same or better than the data currently submitted using manual processes.
   

Next Steps

• IHE QRPH Planning / Technical Committee Call Dec 22, 2008 to determine final status for profiles and white papers.
  

Agenda QRPH Joint Planning/Technical TCon 22 Dec 2009
Date and Time: Dec 22 12:00 - 2:00 PM CST
WebEx Link


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