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> ...
- <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
- April/May ballot requires project launch in February
- Timing critical to meet HITSP, IHE timelines
- Continue to coordinate with other efforts
- Address full set of 84 HITEP priority measures
- Rule set and metadata useful for Collaborative import definition file?
- Pilot: criteria under consideration
- number of systems? sites? measures? requestors/recipients of data?
- live data or canned? sole submissions or duplicates?
- number of patients? of records? length of pilot?
- Communication plan to support adoption