Quality Roadmap

Scope and Current Work

There is ongoing work in several parts of the healthcare community today to incorporate quality guidelines into clinical workflow. To support and coordinate these efforts, the American College of Cardiology (ACC), the American Heart Association (AHA), the Healthcare Information and Management Systems Society (HIMSS), and the Radiological Society of North America (RSNA) have joined together to sponsor and launch the IHE Quality domain. Its mission is to address the infrastructure necessary to share information relevant to quality improvement in electronic patient care and health care records.

Profile Selection

These Brief Profile Proposals were submitted for the 2006-2007 Development Cycle:

• Structured Quality Measure Validation and Aggregation
• Structured Quality Measure Definition and Import
• Receive & Forward Proxy Actor
• Proposed Work Item: Imaging Structured Reporting – Creation and Transmission
• Electronic Exchange of Patient Care Coordination Data Using the Omaha System; A Terminology That Supports Clinical Practice

These Detailed Profile Proposals were short-listed and evaluated by the Technical Committee

These items were selected by the Planning Committee for this Cycle:

• TF Maintenance

Timeline : 2007-2008 Development Cycle

Timeframe	Activity	Scheduled	Location
2007
Nov.	Submit Brief Profile Proposals to Planning Committee (PC)	Nov 5 - Deadline	E-mail
Nov.	PC Selects "Short List" of Profiles	Nov 6 10am	Face-to-Face
Nov.	PC Selects Final Profiles	Dec 6 1400-1500	Tcon
2008
Jan.	Update Technical Framework from 2007	Jan 8-10	Face-to-Face
March.	Kick-off New Profile Development	March 10-13	Face-to-Face
May.	TC Prepares Supplements for Public Comments	May 19-23	Face-to-Face
June.	TC Publishes Technical Framework for Public Comment	June 9	Tcon
July.	TC Reviews Public Comment Feedback and Prepare Trial Implementation	July 21-25	Face-to-Face
2009
Jan.	Test implementations at Connectathon		Chicago

Priority: H : Essential Now, M : Essential Future, L : Nice to Have

Roadmap

Topic	Pri	Standards/Prerequesites	Coord	Strategy	Year
Peer Review Peer review and feedback		ACR RadPeer program AMA/ABMS program using performance measures for peer review of physician hospital groups
Decision support for ordering and procedure approvals		Massachusetts program based on ACR appropriateness criteria (consult with Dr. Keith Dreyer/MGH) Generate justification data when needed (through use of QED?) AQA principles for developing measures of appropriateness ACC/AHA Appropriateness Criteria, decision support tools
Retrospective review of outcomes based on utilization of evolving technologies		NOPR (PET registry) ACRIN/CMS/Brown Univ.
Radiation dose Appropriate aggregation of dose information Minimization of dose to target patient population
Real-time documentation of continuing education and certification (point-of-care CME)		ACCME standards for award of physician CME ABMS MOC requirements Medbiquitous/SCORM
Patient assessment to prevent adverse events
Adverse event reporting		Expected AHIC/ONC/HITSP Use Case on Adverse Events Joint commission requirements (per state) CDC has voluntary and mandatory reporting for some diseases Care coordination efforts across disciplines - NQF, CMS, Joint Commission Adverse Event Reporting Structural measures
Measure Reporting Institutional (process) Physician (performance) Core Measure Reporting (AHA?/JCAHO?)		AHIC/ONC/HITSP Use Case on Quality (including patient identity management) Measures developers (eg, AMA/PCPI, NCQA, ACC/AHA, JCAHO), endorsers, testers and implementers (eg, NQF, AQA) Measuring health delivery disparities across demographic segments (eg, race, gender, socioeconomic status) - AHA Health Research and Educational Trust, HRSA Care coordination efforts across disciplines - NQF, CMS Structural measures State/provincial/regional quality measures
Data registries Procedure-specific datasets (eg, ACC Carotid Artery Stent Registry) Intermediary point to aggregate date to share with CMS, other destination agencies Gathering quality data (peer review, patient safety, protocols in place and physician use of protocols) from various care settings		Disease management registries: STS, ACC NCDR, Tumor Registry, Trauma Registry, HDC Registry (HRSA) Immunization registries National Practitioner Database
Standardized reporting: develop standard formats for reports (eg, Echo, Cath Lab, Nuc Med) to ensure report has elements needed to collect quality data
Consumer aspects of quality reporting PHR as record of repeat procedures Consumer view of provider quality information Patient self management Home health monitoring Informed patient consent		NQF Consumer Council AARP OASIS Data for Home Care (CMS) CMS Hospital Compare and Nursing Home Compare
Harmonization with other initiatives NCVHS hearings in July