Unified Quality Measurement Execution Engine (UQME)

A Unified Quality Measure Execution Engine (UQME) for the Philips HSDP

Pelagia SykoudiPDEng Thesis PresentationSeptember 18, 2015SAI TU/e Software Technology Program

ContextIntro to Quality Measure StandardsProblem StatementRequirementsArchitectureImplementationDemoConclusions

Agenda

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31. Context

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Quality of healthcare servicesHealthcare ServicesPatients

4Patients need to be provided appropriate healthcare services.

In order to ensure this, we need to measure quality of delivering healthcare services.

It is not just a matter of what is provided but also how they are provided and what is the experience of patients.

What is Quality?

Healthcare delivery must be safeHealthcare delivery must be effectiveHealthcare delivery must be patient-centeredHealthcare delivery must be timelyHealthcare delivery must be efficientHealthcare delivery must be equitable

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Health data

Insurance

Devices

Electronic Medical Records (EMRs)

Imaging

Clinic

Billing

LabsHealthcare delivery includes a huge volume of health data.These data sources can be used for measuring quality.6

How can we measure the quality of healthcare delivery?

7In order to measure quality we need to first unambiguously define Quality Measure.Quality Measures are tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, organizational structure.

What is a Quality Measure or Indicator?

Example: the number of re-admittances for heart failure patients who were administered aspirin in Emergency Department (ED) over the ones not administered aspirin in ED.

8How are Quality Measures defined?Clinical Practice GuidelinesQuality Measures

What did happenWhat should happenHow are they executed or used in a uniform fashion against the healthcare data sources e.g. EMRs?Healthcare StandardsUniformity of health dataInteroperability

Example Quality Measure: Ratio of adult obese non-smoker patients, who follow physical activities.

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Initial PopulationDenominatorDenominator ExclusionNumerator

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Example Quality Measure: Ratio of adult obese non-smoker patients, who follow physical activities.

112. Intro to Quality Measure Standards

What is HL7 International?12HL7 International is an ANSI non-profit organization focusing on healthcare standards development.

Providing specifications or protocols oriented to healthcare domains such as:

Pharmacy

Claims Processing

Devices

13To improve healthcare delivery in terms of its workflowTo transfer knowledge between different providersTo establish the best and most widely used standards in healthcare

HL7 objective?HL7 publishes: Health Quality Measure Format (HQMF)Quality Report Document Architecture(QRDA)Defines a quality measureReports the results of a quality measure

HQMF

It represents internationally the clinical quality measure metadata, data elements and logic.

HQMF defines quality measure as:14Ratio/Proportion CohortContinuous Variable

HQMF15HQMFCriteria:DiagnosisDemographic characteristicsProceduresMedicationsdefinesPopulations:Initial PopulationDenominatorNumeratorsExclusionsStratifiers setscombined criteriaHQMF R1, R2-R2.1

HQMF

HQMF BodyHQMF HeaderHQMF Document StructureTable of ContentsData Criteria SectionPopulation Criteria SectionTitle: Adult obese non-smoker patients, who follow physical activities. Measure Period: 01/01/2014 31/12/2014Measure id: 0012Measure Type: ProcessMeasure Scoring: Proportion

Data Criteria SectionObese patients (diagnosis)Patients older than 18 years old (patients characteristic)Patients who smoke (patients characteristic) Patients who follow physical activities (participation activities)Patients race (patients characteristic)Patient gender (patients characteristic)

HQMF Body

Population Criteria SectionInitial Patient Population All True At least one true Obese patientsDenominator All True At least one true Patients older than 18 years old

Denominator Exclusion All True At least one true Patients who smokes

Numerator All True At least one true Patients who follow physical activitiesNumerator Exclusion None

1216Patients weighted more than 80 kg

17QRDA

It is a template healthcare standard document used to report the results of indicators computed by HQMF documents. QRDAreports resultsPopulations:Initial PopulationDenominatorNumeratorsExclusions Stratifiers

18QRDA

QRDA Document StructureTable of ContentsReporting ParametersMeasure SectionDocument id: 0012 Document created: May 2015eMeasure Title: Adult obese non-smoker patients, who follow physical activities. eMeasure Version Number: 1

Performance Rate: 80%Initial Population: 100Male: 60Female: 40Black: 30White: 50Asian: 20Denominator: 80Male: 50Female:30Black: 20White: 40Asian: 20Denominator Exclusion: 30Male: 25Female: 5Black: 10White: 15Asian: 5Numerator: 40Male:25Female: 15Black: 10White: 20Asian:10Numerator Exclusion: None12

193. Problem Statement

Research20

HSDPHTSH2HTASYEMR

UQMEE

Quality MeasuresResults

The design and development of a standard-based unified quality measure execution engine, using HL7 standards, providing scalable quality measurements in interoperable health data, integrated with the Philips HSDP.21Why do we need a uniform standard-based solution?

Multiple businesses inside Philips have need to provide quality measure dashboards to their customersHSDP need a scalable quality measure execution engine that could address needs of different business using HSDP

224. Requirements

231.A medical practitioner will be able to select a clinical or claims quality measures from a list for executing quality measures 2.A medical practitioner will be able to use a document quality measures in HQMF R1/R2 or R2.1 document 3.The system will be able to map HQMF elements to executable queries4.A medical practitioner will be able to view the results of quality measures through graphs

Requirements

245. Architecture

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Data Repository

ResultsIndicators

Quality Measure Engine

Quality Measure Interface

Quality Measure Interface(QMI)Quality Measure Engine(QME)USER

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Quality Measure InterfaceQuality Measure EngineUSER

The user selects an indicatorSend HQMF indicatorSend QRDA resultsPresenting results through dashboardsSend requestSend results

Soap Web services27123456

QRDA validatorQMControllerHQMF DispatcherQRDA parser

USERQuality Measure EngineUser selection1params2HQMF xml3Sending HQMF xml4Receiving QRDA xml56QRDA xmlQRDA xml7True/False8QRDA xml9results10Show results11

componenteventUI28Quality Measure Interface

Engine ControllerQRDA generatorQuality Measure InterfaceHQMF ValidatorHQMF parserQuery GeneratorModelDatabaseHQMF xml1HQMF xml2True/False3HQMF xml4HQMF objects5executes queries7QRDA xml10Sends results8Results 9QRDA xml11queries629Quality Measure Engine

componentevent

Engine ControllerQRDA generatorQuality Measure InterfaceHQMF ValidatorHQMF parserQuery GeneratorModelDatabaseHQMF xmlQRDA xmlHQMF xmlTrue/FalseHQMF xmlHQMF objectsqueriesexecutesqueriessends resultsResultsQRDA xml1234576108 911

componenteventEngine30Quality Measure Engine

HQMF elements to Query transformation31Data criterionPopulation criteriaConditionCombined ConditionWHERE statementCombined WHERE statements using Logical Operators

HQMF parserQuery GeneratorHQMF elementsHQMF R1/R2/R2.1

componenteventHQMF R2HQMF paramsModelMappings between HQMF elements to SQL queriesHQMF elements to Query transformation32DatabaseSQL queries12345

336. Implementation

34Health data standards

Cypress:

UQMEE is a web application software solution with the following technologies:

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Prototype Data model35

Activities

Patients

Diagnosis

Encounters

Costs

Measurements

Medications

Participations

Transfers

Programs

Procedures1..n0..n0..nn10..n1..n1n1110..n0..n0..n

EncounterProceduresMedicationsDiagnosisLab results has PatientsPatients measuresname, id, gender, race hasPatientsEncountershave0..nPrototype Data model360..n

376. Demo

Screenshots of demo/demo38

396. Conclusions

What was the problem?There was a need to design and implement a standard-based (HL7) quality measure execution engine for HSDP.

What we get?Gain knowledge in healthcare quality measure standardsProvide an architecture and implementation of a UQMEEUse HQMF R1, R2, R2.1 and QRDA (HL 7) QMI and QME decoupling

Conclusions40

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Lessons learnt The domain is vast, multiple concepts included, many extensible options existHealthcare standards contain a high level of complexity and require extensive studyRapid Prototyping for quick hypothesis validation vs long term product development

Integration with HSDP

Development of authoring measures environment

Further investigation in open source solutions

Enable security featuresRecommendations42

43Philips ResearchSteffen PauwsAsim MuhammadCharalampos Xanthopoulakis People from the officeOOTI programAd Aerts Harold WeffersAcknowledgements..

Cypress CommunityOpen source and internet community

44Questions?

Thank you