Performance Quality Report QRPH Review Call 17 June 2009

Attendees:

• Liora Alschuler (Alschuler Associates)
• Chad Bennett (Iowa Foundation for Medical Care)
• Lynn Hennings Castle (BCBSA)
• Patty Craig (The Joint Commission)
• Jason Colquitt (Greenway Medical Systems)
• Kathleen Connor (Microsoft)
• Aaron Cutshall (Regenstrief Institute)
• Bob Dolin (Semantically Yours)
• John Donnelly (HIMSS)
• Gay Giannone (Alschuler Associates)
• Annette Smith Durrette (Shared Health)
• Floyd Eisenberg (National Quality Forum)
• Kendra Hanley (American Medical Association)
• Delane Heldt (American Medical Association)
• Lori Fourquet (eHealth Sign)
• Crystal Kallem (FORE)
• Robert Kaye (HIMSS)
• Tom Murray (National Quality Forum)
• Jan Orton (Intermountain Healthcare)
• Jacob Reider (Allscripts)
• Phil Renner (National Committee for Quality Assurance)
• Shawn Dunaway-Shanks (Siemens Healthcare)
• Noah Stromer (DC Group, for USHIK)
• David Stumpf (United Health Group)
• Gary Walker (Quintiles)

Electronic Measure Discussion

The meeting was a joint session with IHE QRPH Technical Committee, the HITSP Quality Tiger Team, and subject matter experts and technical writers.

1. Overview of Performance Quailty Report Profile and status
2. Presentation of content (volume 3) by Bob Dolin based on work performed for Alschuler Associates
   1. eMeasure Presentation
3. Overall plan for the content management is no draw on the HL7 Reference Information Model (RIM) which underlies most of the HITSP specifications in the US realm, and also is used internationally. Clinical concepts from measures defined as RIM graphs bound to vocabularies will allow consistency of data modeling and use.
4. Discussion regarding definitions for numerator, denominator, patient populations - Followup per Delane Heldt from Collaborative for Performance Measure Integration with EHRS where definitions are provided.
5. A question arose regarding the header information for the measure - whether to include educational source for information provided to the patient, Plan of Care information source and cost. For consideration:
   1. The guideline from which the measure is developed is a valid reference for the header information
   2. The Plan of Care is derived from the guideline and may also have a reference
   3. Consider that educational sources are specific to the educational materials used for the clinician or for the patient. If the measure requires that an intervention occurs that intervention is defined as a data element. That element may be represented by various values, each representing materials determined by the measure developer to be acceptable. Each of those materials may be represented by an oid and the header of that oid should contain the reference for the educational material.
   4. It is not yet clear how cost is a component of a measure header in contrast to a data element for capture as part of the measure or as metadata collected along with the measure information.
6. The measure, in addition to numerator, denominator, and exclusion data elements, and logic, may contain additional data element to be captured for the purpose of risk adjustment and evaluation purposes for future measure modifications.
7. To be determined is how logic will be represented within a measure specification - within the measure format or external to it.
8. Clarify Dates/Expectations for IHE F2F in July - Next call Wednesday June 24 1-2 Central Time
9. Confirm measures to be included in the Volume 3 section as exemplars. The two measures selected by HITSP and one ambulatory measure will be specified for this purpose:
   1. Stroke 3 (STK-3) from the CMS set: Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge. Link to STK-3
   2. Stroke 8 (STK-8) from the CMS set: Ischemic or hemorrhagic stroke patients or their caregivers who were given education and/or educational materials during the hospital stay addressing all of the following: activation of emergency medical system, need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke. Link to STK-8
   3. Comprehensive Diabetes Care: Link to Comprehensive Diabetes Care. Note that for the purpose of the profile, only the HbA1c control (<8.0%) will be incorporated into the specification.

Next Steps

24 June 2009 Conference Call to review profile modifications based on today's call.

1. Time: 1-2 PM Central Daylight Time
2. Location: The call will be hosted by the National Quality Forum: https://www1.gotomeeting.com/join/552821192
3. Audio Dial-in: 800-444-9007; ID: 3624570287#
4. Meeting ID: 552-821-192

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