Performance Measurement Data Element Structured for EHR Extraction

Current work

White paper: Performance Measurement Data Element Structured for EHR Extraction
White Paper - Performance Measurement Data Element Structured for EHR Extraction - Using value sets for identifying quality measure components (22 April Update)

Related materials

• ITI Sharing Value Sets Profile activity
• Collaborative for Performance Measure Integration with EHR Systems XML Schema Reference Guide

Comments from Vassil Peytchev The goal of the Collaborative is to create a standardized way to communicate performance measures using structured, encoded performance measure information, which can be also used within EHR applications.

There are three levels of performance measures representation: - Performance measure description - Performance measure template - Performance measure machine processable information

This holds a resemblance to the levels of a CDA document: Level 1 - Unstructured text level 2 - Structured text Level 3 - Discrete data

The CDA is patient-centric, so it is not directly applicable here.

However, HL7 just published a draft for the SDA (structured document architecture) which is not patient-centric, and can be directly applicable for this use.

The Structured Document committee of HL7 is also working on a Quality Reporting Document Architecture (QRDA).

These intersecting activities strongly suggest that collaboration is the best way forward. Given the emphasis on HL7 CDA and CCD-based (and therefore HL7 V3 based) specifications throughout the US (HISTP, CCHIT), and internationally (IHE).

The Collaborative can consider the following notes about the Performance Measure Integration specification:

• use of HL7 V3 data types when applicable. This will make the XML

representation (of codes in particular), uniform across a variety of data exchange requirements.

• make use of the IHE process. The IHE SVS profile, for example, will use a very similar structure to the CodeGroup and Code structure to represent contents of general value sets (using HL7 v3 datatypes).
• consider the use of the HL7 SDA as a basis for a performance measure description. This will allow for a future expandability of the format.
• reconsider the use of XML in the template for logical expressions.

A transformation of the XML content to a more readable form is preferred, and technically straight forward to do.

• Measure specific information for two exemplars:
  • Acute Myocardial Infarcton Measure - ACEI / ARB Prescribed at Discharge - Joint Commission
    • Heart Failure Measure - ACEI / ARB Prescribed at Discharge - Joint Commission
    • Data Elements Required for AMI-3 ACEI / ARB Prescribed at Discharge for Acute Myocardial Infarction Patients
    • Selected items comparing existing specifications to expected EHR content for AMI 3 Measure