Quality Planning Committee Minutes 2007-11-05 06

Quality Domain Planning Committee Agenda

Nov 5-6, 2007, RSNA Building, Oakbrook IL

Quality, Research and Public Health Planning Committee

Activity	Discussion Summary
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: Structured Quality Measure Validation and Aggregation Structured Quality Measure Definition and Import Receive & Forward Proxy Actor Proposed Work Item: Imaging Structured Reporting - Creation and Transmission Electronic Exchange of Patient Care Coordination Data Using the Omaha System; a Terminology That Supports Clinical Practice
PC Selects "Short List" of Profiles, Effort & Feasibility Analysis	PC evaluation grid available at the following link from the ftp site: [3]
Structured Quality Measure Validation and Aggregation	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.
Structured Quality Measure Definition and Import	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: We would have a mechanism to test the work of the Collaborative, and The schema would look like other structured documents with which vendors are comfortable, presumably making it easier for them to use. The timeline: Submit proposal to HL7 in January 2008 (San Antonio). The project would be to take the existing schema, put it in an HL7 structured document per the RIM specifications. The quality structured document would be on agenda for HL7 mtg in May, so the work of developing a prototype of the structured document with a few measures applied to it would occur in Q1 and Q2 of 2008. The IHE profile could be completed in June using the HL7 structured document standard. The HL7 submission is a parallel track. The IHE profile would use an existing HL7 standard that would be constrained for use. Since it is an existing standard it can be used by IHE. By carefully creating the constraint in keeping with HL7 v3 RIMM, there would be minimal rework in establishing the same constraint as a new HL7 standard for quality measures (QMD). However, since the HL7 timeline is not likely to provide an approved standard in time for IHE (or HITSP) in 2008, the constrained IHE profile would allow nearer term practice. The profile is actually and implementation guide that would be finalized in July and go for comment in August. Committee ballot and desktop testing would follow. In September at the IHE educational sessions, the QMD would be presented to get interest from the vendors to test. Consider EHR as well as Data Warehouse vendors as potential participants. At the January 2009 Connectathon the profile, and therefore the HL7 standard - and therefore the import content, would be tested by the vendors.
Receive & Forward Proxy Actor	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.
Proposed Work Item: Imaging Structured Reporting - Creation and Transmission	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.
Electronic Exchange of Patient Care Coordination Data Using the Omaha System; a Terminology That Supports Clinical Practice	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.