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)