Quality Planning Committee Minutes 2007-11-05 06
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Quality Domain Planning Committee Agenda
Nov 5-6, 2007, RSNA Building, Oakbrook IL
Quality, Research and Public Health Planning CommitteeActivity | Discussion Summary |
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Introduction and Review of New IHE Governance | New IHE governance review provided by Chris Carr. New information will be posted to this wiki site with respect to the Quality Domain as it becomes available. Current information regarding governance can be found at the International Board wiki site.[1] |
Recap - Overview of ONC Quality Use Case, 2007 PEQD Effort | For context, the workflow diagrams of the ONC Quality Use Case ([2]) were reviewed with the Planning Committee. The gaps with respect to the PEQD framework were reviewed. Primary gaps exist in (a) the measure definition from measure developers, (b) the analyzer and aggregator function and (c) in the patient-level data submission. |
Quality Reporting Document Architecture (QRDA) - Liora Alschuler, Pele Yu | The QRDA is in the process of review by HL7 Structured Documents with expectation of a ballot in May 2008. Briefly, QRDA is a constraint on CDA specific to quality reporting. It is likely that QRDA may be approved as a standard within the Quality Domain profile timeline for 2008, but approval in that timeline is not guaranteed. |
Review Brief Profile Proposals by Planning Committee | Individual Profile Summaries:
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PC Selects "Short List" of Profiles, Effort & Feasibility Analysis | PC evaluation grid available at the following link from the ftp site: [3] |
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Disposition: The validation component is a requirement of the Framework. It is a subsequent step to submission of the patient-level quality information, aggregation and analysis of that information, and re-send of the analyzed/aggregated information to the care provider (individual or organizational) for confirmation and/or correction of components of the report. The validation step is therefore deferred until 2009 work effort. The aggregation component is manageable with constraint on Medical Summary (as defined by HITSP in constructs to be published by December 2007 (C38), having completed comment resolution). The component is also managed with QRDA, but there is no definite assurance of formal approval by HL7 in May 2008. One option for the PC include creation of a constrained Medical Summary identical to the HITSP component and structure of QRDA such that the profile completion is independent of HL7 approval timelines. To be considered is identification of the time and editor required for creation of the profile. The PC identified this portion of the proposal as second in priority to Structured Quality Measure Definition and Import. |
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Disposition: The definition and import of a quality measure was identified as a high priority activity. There is existing work defining the "model" of a quality measure in the Collaborative for Performance Indicator Integration with EHRs, sponsored by the American Medical Association (AMA) and the National Committee for Quality Assurance (NCQA). The efforts of the Collaborative are available at: [4]. The Quality PC agreed to a series of Quality TC calls in the next several weeks to determine appropriate editors and feasibility of creating a profile to constrain HL7 Structured Document architecture and for use for Quality Measure Document <QMD> import based on the model identified by the Collaborative. The outcome would allow the structured document to be tested at the Connectathon in January 2009. The structure would include the mathematical logic expressed simply as identified by the Collaborative, and specifically not using any Clinical Decision Support <CDS> structure such as Arden, GELLO, etc. The expectation is that, at the Connectathon January 2009, 3 or 4 measures defined by measure developers in the new QMD format would be taken by participating vendors (EHR and/or data warehouse vendors) for incorporation into product. The plan would encourage further analysis and real-time use of developing and existing CDS structures. This process would offer 2 benefits:
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Disposition: The Quality PC identified the proposal as a benefit for the management of documents for the analyzer / aggregator. It is also required to manage the needs of biosurveillance as requested by HITSP as "Publish and Subscribe" to the ITI Planning Committee in 2006. The ITI Planning Committee has in 2007 referred a combination of two Publish and Subscribe propsals to the ITI Technical Committee. The Quality PC therefore, referred the "Receive & Forward Proxy Actor" to the ITI Technical Committee for incorporation into the Publish and Subscribe proposal process. Subsequent to the closure of the Quality PC meeting, the Publish and Subscribe proposal was presented to the ITI Technical Committee and will be included in a white paper regarding Publish and Subscribe. The Quality Technical Committee will review and make a decision dependent on the outcome of the ITI Technical Committee decision. |
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Disposition: The Quality PC identified that a structured imaging report could clearly provide structured data elements required for quality measures, and also for future clinical decision support management concurrently and retrospectively. The proposal indicated a set of 180 identified data elements to include within the structure. The request is best managed as a constraint of Medical Summary which is best managed by coordination with the Cardiology, Radiology and PCC Domains specific to individual provider communication about an individual patient. The output will clearly benefit quality measurement; however, the constrained Medical Summary is best managed by the other Domains. |
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Disposition: The proposal has also been submitted to the PCC Planning Committee. The Quality PC suggested the proposal addressed a broader requirement for continuity of care based on terminology, in this case the request is specific to the Omaha system. The PC referred the proposal to the PCC Nursing Terminology Subcommittee for management. |