QRDA Status

Quality Reporting Document Architecture

Purpose: Develop an electronic data standard for healthcare information systems to use in communicating patient level quality measurement data across disparate systems.

Sponsors: HL7 Pediatric SIG, Alliance for Pediatric Quality, AHIMA, Iowa Foundation for Medical Care

Primary Benefactor for Phase I: Alliance for Pediatric Quality

HL7 Sponsor: HL7 Pediatrics SIG

Project Management: Alschuler Associates

Mission: Lead, shape and accelerate recognition and adoption of quality improvement

Goal: Promote pediatric improvement and measures
- Spread use of measures for improvement and public reporting

Goal: Ensure HIT works for children
- Seek industry-wide adoption of data standards for pediatrics
- Endorse pediatric data standards that make comparability possible

Problem: lack of clinical data standard for quality reporting*

Data collection is time consuming, burden for physicians and providers
Data mapping is resource-intensive
Lack of standard data complicates or inhibits data mining
Administrative data sets inconsistent with clinical findings

Source: Agency for Healthcare Research & Quality

Opportunity: clinical data standard for reporting

Extracted directly from the EMR
- reduces collection burden
- eliminates data mapping
- supports data mining across applications
- higher quality data
Supports adoption of quality measurement
- Burden on physicians and providers reduced
- Vendors have single model for findings for reporting and exchange

Leverage and Harmonize with Others:

American Health Information Community (AHIC), Health Information Technology Standards Panel (HITSP), and Certifcation Commission for Health Information Technology (CCHIT) - Promoting automation of quality measurement data collection, aggregation and reporting - Developing quality use case and interoperability specifications - Certifying vendor products for interoperability

NQF Health Information Technology Expert Panel (HITEP) - Identify high-value data from EHRs for quality measurement

Collaborative for Performance Measure Integration with EHR Systems (The Collaborative)Sponsored by American Medical Association (AMA) and National Committee on Quality Assurance (NCQA) - Addressing performance measure functionality and integration with EHRs - Facilitating integration, calculation and reporting of quality measures within vendor products

Integrating the Healthcare Enterprise (IHE) - Building Technical Framework for coordination of quality data submission, aggregation and feedback - Driving vendor adoption of standards

Health Level Seven (HL7) - Developing, balloting and 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

Coordination Points:
- QRDA leverages The Collaborative’s export construct
- QRDA maps to the HITEP data elements for quality
- QRDA is the payload in the IHE PEQD multi-party profile
- Combined efforts of The Collaborative, IHE, QRDA and SDOs support the AHIC and HITSP use cases
Coordination Priorities:
- QRDA coordination with eMeasure definitions (“import” construct) will drive validation and improve data quality
- Integrating data from the national exchange framework will enrich quality measurement and promote longitudinal assessment

Strawman samples:

JCAHO asthma measure --- Pediatric, inpatient
- CAC-1
- CAC-2
DOQ-IT CAD-1-7 --- Adult, ambulatory
- Single or multiple visits
- With evidence that test ordered; with test result

QRDA Validation: Rules validate assertions

if templateId =
- <templateId root=“2.16.840.1.113883.3.117.1.2.4.3 " displayable="Use of relivers for Inpatient Asthma (CAC-1)"/>
and diagnosis =
- <value xsi:type="CD" code="493.01" codeSystem="2.16.840.113883.6.103" codeSystemName="ICD-9" displayName="Extrinsic Asthma, with Status Asthmaticus"/>
then QRDA SHALL contain
- <substanceAdministration> ...

<?xml version="1.0" encoding="UTF-8" standalone="yes"?>
<schema xmlns="http://www.ascc.net/xml/schematron" xmlns:cda="urn:hl7-org:v3">

  <title>Schematron schema for validating conformance to JACHO CAC1</title>
  <ns prefix="cda" uri="urn:hl7-org:v3" />
  <phase id='errors'> <active pattern='example'/>  </phase>
    <pattern id='example' see='#example'>
      <title>Example</title>
      <rule context='*[cda:templateId/@root="2.16.840.1.113883.3.117.1.2.4.3"] 
      [cda:value/@code="493.01"
       [cda:value/@codeSystem="2.16.840.113883.6.103"]]'>
      <assert test="//cda:substanceAdministration/cda:code[@code='93.94'] [@codeSystem='2.16.840.113883.6.103']">If Extrinsic Asthma, with Status Asthmaticus 
      is observed, respiratory medication must be administered by nebulizer</assert>
      </rule>
  </pattern>

</schema>
Next Steps

Address open issues
Refine scope statement (patient-level data for measure population)
Synchronize/support “model of meaning”:
review receiver requirements
explore question/answer format &/or clinical findings
Explore relationship between Import/Export requirements
Ballot within HL7 as Draft Standard for Trial Use - Planned for September 2008
April/May ballot requires project launch in February
Pilot: criteria under consideration: Current Measures - Based on Current QRDA Development Effort (Open for expansion)
Central Venous Catheter Associate Bloodstream Infections (Inpatient)
BMI Screening Rate per 100 patient days (Inpatient)
Retinopathye screening for Pediatric Health (Inpatient)

QRDA Status

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