Performance Measurement Data Element Structured for EHR Extraction

Current work

White paper: Performance Measurement Data Element Structured for EHR Extraction
April 26, 2008 --- version in progress

Previous work (versions)

• April 23, 2008
• April 22, 2008
• April 3, 2008

Related materials

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

Comments from Vassil Peytchev on Collaborative for Performance Measure Integration with EHR Systems

• 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 specifications:

• The 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 processes. 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 would be preferred.

• 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

Discussion on various sections and comments, tasks

• 23 Apr 2008 Discussion: Potential Coordination with work of the Collaborative for Performance Measure Integration with EHRS