HL7 Quality Reporting Document Architecture DSTU

CDA Release 2, US Realm

HL7 September 2008 WGM (Vancouver, BC, Canada)

Pele Yu, MD MS FAAP

To develop an electronic data standard for exchange

of patient-level quality measurement data between healthcare information systems.

Quality Reporting Document Architecture

www.kidsquality.org

Paper Medical Records

Electronic Health Records Proprietary data

formats

Status Quo in Quality Measure Reporting

Data Entry100% manual process:

data abstraction and data mining

Prepare data

for analysis

Requestors of Quality Data

QualityImprovementOrganizations

AccreditingOrganizations,

Medical Societies, The

Alliance

Payers

Key-boarding or manual entry

Feedback to clinicians

Complete?

QRDA

Point of Care clinicians

Future of Quality Measure Reporting

www.kidsquality.org

Coordination with Related Efforts

Measure Development

eMeasure Specification

Aggregators, Requestors

ok?ok? ok?

The Collaborative eMeasure specification

NQF, NCQA, AMA, APQ.... Measure definition

HIMSS IHE: Multi-party choreography using HL7 messages, services

AH

IC,

HIT

SP

Use

Cas

es

QRDA QRDA QRDA

feedback

Data Elements for Quality

HITEP

QRDA Project History

• Phase 1: September 07 – January 08– Proof of concept, use CDA for quality reporting

• HAI reports for CDC (SDTC)• SDTC interest in CDA based non-clinical reporting

documents – Structured Documents Architecture (SDA)– Domain Analysis– Requirements Analysis

• Phase 2: May 2008 to present– DSTU Ballot – QRDA Implementation Guideline for 2 Pediatric

Measures (CHCA)– QRDA Reporting Categories (MedAllies)

• NHIN Trial Implementation demonstration project in NY• Summary patient record exchange using CDA

QRDA Draft Standard 2008

• Category 1 – Patient-Level Reports– For DSTU Ballot

• Category 2 – Summary Reports– Informational, for Comments

• Category 3 – Calculated Reports– Informational, for Comments

QRDA Category 1 Specifications• Header

– Header• US Realm• Unique CDA template ID, LOINC code, and Title

– Participants• Target a single patient• Author one or more entities (person, organization, device)• Informant one reporting entity (person, organization)• Custodian one custodian (person, organization)• Legal Authenticator one legal authenticator (person, organization)

• Body– One body– One or more sections, subsections (Measure Set, Measure)

• Section– Measure Set Section (measure set name, version, OID, description)– Measure Section (measure name, version, OID, description)– Reporting Parameters Section (applicable reporting period)– Patient Data Section (Re-use of CCD and CDA, if applicable)

QRDA Specifications – RIM Constructs

• Header– Header

• US Realm• Unique CDA template ID, LOINC code, and Title

– Participants• Target a single patient• Author one or more entities (person, organization, device)• Informant one reporting entity (person, organization)• Custodian one custodian (person, organization)• Legal Authenticator one legal authenticator (person, organization)

• Body– One body– One or more sections, subsections (Measure Set, Measure)

• Section– Measure Set Section (measure set name, version, OID, description)– Measure Section (measure name, version, OID, description)– Reporting Parameters Section (applicable reporting period)– Patient Data Section (Re-use of CCD and CDA, if applicable)

QRDA P

hase

1

QRDA Deliverable

• Implementation Guides for QRDA Category 1 Pediatric Measures– VON Neonatal Admission Hypothermia Measure

• Outcome measure

– CHCA Body Mass Index (BMI)• Process measure

• Rationale– Few data points, well-defined– Pilot potential– Pediatric measures on NQF Roadmap– Relevant to project stakeholder (CHCA)

Implication of DSTU• QRDA is feasible

– RIM adaptable– CDA adaptable– Strong HL7 support– Industry awareness achieved

• Ready for industry use– HITSP– IHE– Pilot efforts

• Barriers for adoption and progress– Lack of continuity in effort– Lack of formal project management structure

Next Steps

• QRDA DSTU Ballot reconciliation next few months– Resolve issues without substantive change and publish DSTU, or– Resolve issues w/ substantive changes, then re-ballot– Implications

• QRDA Phase 3– Funding for future development to refine DSTU leading to

Normative Standard• Category 1 DSTU• Category 2 and 3 include in next ballot cycle/s, if enough work is

done (MedAllies, etc)

– Create solid links with industry• Harmonize efforts (IHE, Collaborative, JCAHO, HEDIS, etc)• Engage vendors and MDOs

– Pilot and demonstration projects• Vendors, hospitals, QIOs