Quality Measure Execution – Early Hearing Proposal for 2014/15 presented to the Quality, Research...
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Transcript of Quality Measure Execution – Early Hearing Proposal for 2014/15 presented to the Quality, Research...
Quality Measure Execution – Early Hearing Proposal for 2014/15
presented to theQuality, Research & Public Health (QRPH)
Planning Committee
Lisa R. Nelson, Lantana Consulting Group (LCG)Public Health Informatics Institute (PHII)
Centers for Disease Control and PreventionOffice of Noncommunicable Diseases, Injury and Evironmental Health
National Center on Birth Defects and Developmental Disabilities (NCBDDD)(CDC/ONDIEH/NCBDDD)
Revised Diagrams for Public Comment 8/5/2015
WORLD
The Market
World
www.ecology.com
http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_02.pdf
US National Vital Statistics Report
The ProblemAssure hearing screening for all newborns
Innovation is needed to improve the process: more efficient, more effective, achieve better outcomes through continuous process improvement
Quality Measure standards are evolving
Innovation is needed to protect prior investment, harness current/relevant technical standards-based capabilities
Burden of surveillance/quality measurement is escalating
Innovation is needed to reduce the burden
The burden of data collection is not aligned withthe benefit incenting collection of the needed data
Innovation is needed to shift/align the data collection model
Process
Value PropositionThe update of the QME-EH profile will:
establish a method for efficiently and effectively implementing electronic clinical quality measures (eCQM) for early hearing screening (EHDI-1a, NQF1354) which will shift the implementation model to reduce the burden of quality measure data collection and can be applied to benefit all eCQM implementations.
Faster adoption of electronic CQMs, reduced cycle time for innovation, faster payoff.
More data, less burden.
Better alignment between bearing the burden and reaping the benefit.
Process Improvement
Market Readiness
Legislated Use Cases
• EHDI-1a is one of 29 Clinical Quality Measures for Eligible Hospitals
Shifting focus to electronic CQM submission
• Meaningful Use Stage 3 will push electronic submission, eCQMs
• International interest in developing eCQM capability
Emerging “suppliers” positioned strategically to meet the demand for eCQM support with new “combined capabilities”
• Benefits from investment in “data element” capabilities
• Additional promotional efforts
• EHDI community and vendors
• eCQM in general
• Emerging international implementations Assessments Conferences
On-lineEducation
Existing IHE Profiles and RisksRisk of this proposal not being undertaken this cycle?
IHE OPPORTUNITY COSTS
Lost opportunity to establish SDO “positioning and differentiation”- IHE establishes standard methods for the application of standards- HL7 builds and maintains standards
Missed chance to show “catalytic conversion competency” within IHE- IHE meets emerging standards application needs- “JIT Applied Innovation”
Failure to capitalize on prior investment, leverage current assets- IHE Technical Framework creates economies of scale for standards
development- More meaningful uses for existing standards
Use Case
Current Use Case
Creation of the QRDA R1.0
- Category I document
Data collection/file creation burden on EMR System
Proposed Use Case
Creation of the QRDA R2.0 (with C-CDA R1.1 errata)
- Category I and Category III documents
Data collection burden eased, Utilize SDC (innovative application)
Shifted to a PHIS “self-serve” model
Suggest a role for Redaction Services Profile (out of scope)
Proposed Standards & Identified Systems
HL7• CDA R2, C-CDA R1.1 CCD, • QRDA R2 with errata for C-CDA R1.1,
Category I and Category III • QDM-based HQMF R1.1
IHE• Quality Measure Execution for Early
Hearing (QME-EH)• Structured Data Capture (SDC)
Vocabulary Standards• SNOMED CT• LOINC
Electronic Medical Record (EMR) System• Produce C-CDA R1.1 CCDMiddleman System• Consume CCD• Produce QRDA Cat I and Cat III Public Health Information System (PHIS) • Consume QRDA Cat I and Cat III
Con
Content Creator = CRReport Assembler = RAContent Consumer = CS
Larger Context 2/25/2015Permutations of 3 actors and 3 content modules
ShareCRRA CS CRRACS
Aggregate-Level Quality Report = ALQRPatient-Level Quality Report = PLQRSummary of Care Document = SoCD
Electronic Clinical Quality Measure Definition for EHDI Measure = EHDI eCQM
EHDI eCQM
MeasureDefinition
EHDI eCQM
MeasureDefinition
ALQRPLQR
SoCD
Con
Actor Key:CR = Content CreatorRA = Report AssemblerCS = Content Consumer
Use Case #1
ShareCR CS
ALQR
ALQR
Option Key:ALQR = Aggregate-Level Quality ReportPLQR = Patient-Level Quality ReportSoCD = Summary of Care Document
Con
Actor Key:CR = Content CreatorRA = Report AssemblerCS = Content Consumer
Use Case #2
ShareCR CS
PLQR
PLQR
Option Key:ALQR = Aggregate-Level Quality ReportPLQR = Patient-Level Quality ReportSoCD = Summary of Care Document
Con
Use Case #3
ShareCR ShareCRRA
CS
MeasureDefinition
SoCD to PLQR
PLQRPLQR
CSSoCD
PLQRSoCD
Actor Key:CR = Content CreatorRA = Report AssemblerCS = Content Consumer
Option Key:ALQR = Aggregate-Level Quality ReportPLQR = Patient-Level Quality ReportSoCD = Summary of Care Document
Con
Use Case #4
ShareCR ShareCRRA
CS
MeasureDefinition
SoCD to PLQR
PLQR
ALQR
PLQRCSSoCD
PLQR PLQR to ALQR
ALQRSoCD
Actor Key:CR = Content CreatorRA = Report AssemblerCS = Content Consumer
Option Key:ALQR = Aggregate-Level Quality ReportPLQR = Patient-Level Quality ReportSoCD = Summary of Care DocumentSoCD to PLQR = Assemble PLQR from SoCDPLQR to ALQR = Assemble ALQR from PLQR
Con
Use Case #5
ShareCR ShareCRRA
CS
MeasureDefinition
PLQR
ALQR
PLQRCSSoCD
PLQR
ALQRSoCD
Share
CS ALQR
Not in scope for this Use Case
A system that implementsa Content Creator with SoCD optionalso implements a Content Consumer with ALQR option.
Actor Key:CR = Content CreatorRA = Report AssemblerCS = Content Consumer
Option Key:ALQR = Aggregate-Level Quality ReportPLQR = Patient-Level Quality ReportSoCD = Summary of Care DocumentSoCD to PLQR = Assemble PLQR from SoCDPLQR to ALQR = Assemble ALQR from PLQR
SoCD to PLQRPLQR to ALQR
Con
Content CreatorALQR opt
Content ConsumerALQR opt
ShareAggregate-Level QR
Use Case #1
Actor Key:CR = Content CreatorRA = Report AssemblerCS = Content Consumer
Option Key:ALQR = Aggregate-Level Quality ReportPLQR = Patient-Level Quality ReportSoCD = Summary of Care Document
Con
Content CreatorPLQR opt
Content ConsumerPLQR opt
Loop
SharePatient-Level QR
Use Case #2
Actor Key:CR = Content CreatorRA = Report AssemblerCS = Content Consumer
Option Key:ALQR = Aggregate-Level Quality ReportPLQR = Patient-Level Quality ReportSoCD = Summary of Care Document
Con
Content CreatorSoCD opt
Report AssemblerSoCD to PLQR opt
Content ConsumerPLQR opt
Share
Share
Patient-Level QR
Summary of Care Document
Loop
Loop
Use Case #3
Create Exception Report
Actor Key:CR = Content CreatorRA = Report AssemblerCS = Content Consumer
Option Key:ALQR = Aggregate-Level Quality ReportPLQR = Patient-Level Quality ReportSoCD = Summary of Care Document
Con
Content CreatorSoCD opt
Report AssemblerSoCD to PLQR optPLQR to ALQR opt
Content ConsumerALQR opt
Share
Patient-Level QR
Loop
Loop
Share
Aggregate-Level QR
Use Case #4
Create Exception Report
Summary of Care Document
Actor Key:CR = Content CreatorRA = Report AssemblerCS = Content Consumer
Option Key:ALQR = Aggregate-Level Quality ReportPLQR = Patient-Level Quality ReportSoCD = Summary of Care Document
Con
Content CreatorSoCD optContent ConsumerALQR opt
Report AssemblerSoCD to PLQR optPLQR to ALQR opt
Content ConsumerALQR opt
Share
Patient-Level QR
Loop
Loop
Share
Aggregate-Level QR
Use Case #5
Create Exception Report
Summary of Care Document
Share
Aggregate-Level QR
Not in scope for this Use Case
Actor Key:CR = Content CreatorRA = Report AssemblerCS = Content Consumer
Option Key:ALQR = Aggregate-Level Quality ReportPLQR = Patient-Level Quality ReportSoCD = Summary of Care Document
Strategy for Vol3/4 Work
• Define data elements in Appendix D, Vol. 1– D.1 for PLQR– D.2 for ALQR
• In Volume 4 – Define 2 Document-level templates– PLQR for EHDI Measure in US Realm– ALQR for EHDI Measure in US Realm
• In Volume 3 – Define 2 Document-level templates– Replicate then generalize the US-Realm templates to a non-
realm specific level– Re-alignment…look at WHO guidelines or some other
International guideline-or gap analysis approach
Old/archived work
Con
Content Creator = CRReport Assembler = RAContent Consumer = CS
Use Case #1 (Not used after Public Comment)
ShareCRRA CS
MeasureDefinition
Assemble ALQR
ALQR
ALQR
Con
Content Creator = CRReport Assembler = RAContent Consumer = CS
Use Case #2 (Not used after Public Comment)
ShareCRRA
MeasureDefinition
Assemble PLQR
PLQR
CS PLQR
Con
Use Case Not Covered
Share
Content Creator = CRReport Assembler = RAContent Consumer = CS
ShareCR ShareCRRA
MeasureDefinition
Assemble PLQR
PLQRPLQR
CSSoCD
SoCD
CRRA
MeasureDefinition
ALQRPLQR
CS
PLQR Assemble ALQR
CSALQR
System that implementsa Content Creator with SoCD optionalso implements a Content Consumer with ALQR option.
Con
Content Creator
Quality Report Assembler
Content Consumer
Post Condition
Create Exception Report
QA ReportType I Errors
QA ReportType II Errors
Con
Content Creator
Quality Report Assembler
Content Consumer
ShareAggregate-level QR
Use Case #1
Con
Content Creator
Quality Report Assembler
Content Consumer
Loop
SharePatient-level QR
Use Case #2
Con
Content Creator
Quality Report Assembler
Content Consumer
Share
Share
Patient-level QR
Care SummaryLoop
Loop
Use Case #3
Create Exception Report
Con
Content Creator
Quality Report Assembler
Content Consumer
Share
Patient-level QR
Care SummaryLoop
Loop
Share
Aggregate-level QR
Use Case #4
Create Exception Report
Con
Content Creator
Quality Report Assembler
Content Consumer
Share
Care SummaryLoop
Loop
Aggregate-level QR
Use Case #5
Share
Patient-level QR
Create Exception Report
Con
Content Creator
Quality Report Assembler
Content Consumer
Create Exception Report
Create Exception Report
Con
ContentCreator
Care Summary Patient QRAggregate QR
ContentConsumer
Larger Context 2/24/2015
Share
Patient QR
Quality Report Assembler
Share
Share
Patient QRAggregate QR
Con
Content Creator = CRReport Assembler = RAContent Consumer = CS
Larger Context 2/25/2015
Share Share
Share
CRRA CRRACSCRRACS
Con
Content Creator = CRReport Assembler = RAContent Consumer = CS
Larger Context 2/25/2015 – View #1
Share Share
ShareCRRA
CRRACS
CS
CR CS CRRA
Con
Content Creator = CRReport Assembler = RAContent Consumer = CS
Larger Context 2/25/2015 – View #2
Share Share
ShareCRRA
CRRACS
CS
CR
CRRA
Con
Content Creator = CRReport Assembler = RAContent Consumer = CS
Larger Context 3/2/2015
Share Share
ShareCRRA
CS
CR CRRACS
MeasureDefinition
MeasureDefinition
Con
Content Creator = CRReport Assembler = RAContent Consumer = CS
Larger Context 2/25/2015 – View #2 – alt.
Share Share
ShareRA
CS
CR RA
MeasureDefinition
MeasureDefinition
Con
Content Creator = CRReport Assembler = RAContent Consumer = CS
Larger Context 2/25/2015 – View #3 -disagree
Share Share
ShareCRRA
CRRACS
CS CRRA
Con
Content Creator = CRReport Assembler = RAContent Consumer = CS
Larger Context 2/25/2015 – View #3 - alt
Share Share
ShareCRRA
CRRACS
CS
CR
CRRA
Con
Content Creator = CRReport Assembler = RAContent Consumer = CS
Larger Context 2/25/2015 – View#4
ShareCRRA CS CRRA
Con
Content Creator = CRReport Assembler = RAContent Consumer = CS
Larger Context 2/25/2015 – View#4
ShareCRRA CS CRRACS
Con
Content Creator = CRReport Assembler = RAContent Consumer = CS
Larger Context 3/2/2015
Share Share
ShareCRRA
CS
CR CRRACS
MeasureDefinition
MeasureDefinition
Thinking on the use of RFD
Discussion
What level of effort do you foresee in developing this profile?- Moderate Effort
- Content Profile – - Primarily an update of standards- QRDA Document vs. CDA Document content modules- US and International solution simultaneously addressed (?)
- New Use Case work- New Actor-Transaction Diagram
- No new actors, no new transactions- Grouping of existing IHE Actors
- (Content Creator, Content Consumer grouped with other IHE Actors)
- New Sequence Diagram
Profile Editor:Lisa Nelson, Lantana Consulting [email protected]
Evolution of RFD
Con
ContentCreator Share
ContentConsumer
Burden on the EHR
Care Summary
P-level QR
Aggregate QR
Con
ContentCreator Care Summary
P-level QR
Aggregate QRContentConsumer
Create a mechanism to benefit senders or receivers, shift the collection burden for secondary uses
New capability that senders can make or buy.
New capability that receivers can make or buy.
New middleware opportunity.
EHDI Quality ReportCreator
Share
Con
P-levelCCreator
Care Summary ShareP-level QR
Aggregate QR
FFFM
FR
P-levelCConsumerAggregateCCreator
P-leveI QR
ITI-34
ITI-35
New Actor: Quality Report Creator
Care Summary
P-level QR
Aggregate QR
UniversalDocument Types
Care SummCConsumer
FA
ITI-36
Con
ContentCreator
Care Summary Patient QRAggregate QR
ContentConsumer
Larger Context
Quality Report Creator
Share
Care SummaryPatient QR
Patient QRAggregate QR
Patient QRAggregate QR
Con
ContentCreator
Care Summary
P-level QR
Aggregate QRContentConsumer
Larger Context
Quality Report Creator
Data Privacy& ConsentAuthority
Metadata RepositoryAuthority
Value SetAuthority
Code SystemAuthority
Data Quality Report
Derivation Rule Issue Report
Hearing Plan of Care
In Scope
Share
Con
P&C Agent Information Sender
Quality Report Creator
Information Receiver
Metadata Repository
Value Sets Authority
Load Standard Metadata & VSs
Precondition
Define SDC Form
Get and use eCQM Definition
Redact Patient Summary(ies) for intended quality measure
eCQM Def
eCQM Def
Get and use eCQM Definition
QRPH-44
ITI-48
Share
Share
QRPH-43
Loop
Loop
Loop
Loop
Con
Content Creator(CCD)
Quality Report Creator
Content Consumer(QRDA I and 3)
Create Quality Reports
Share
Create P-level Quality Reports
Share
Patient Level QR
Clinical Summary
Loop
Alt
Share
Survey
Loop[for each clinical summary]
[data processing successful]
[data processing exception]
Share
Aggregate QR
Loop
[Optional creation of Agg. Report]
[Process P-level QRs]
Option
Patient Level QR
Create Aggregate Quality Report
Con
Content Creator
Quality Report Creator
Content Consumer
Create Patient-level Quality Reports (internals)
Share
Create Patient level QR
Share
Plevel QRITI-35
ITI-34
Pt.SummCConsumer
Form Filler
Share
Plevel QRITI-35
ITI-34
Pt.SummCConsumer
Form Filler
Form Processor
PlevelQR Content Creator
Submits automatically if complete
Alt
Loop[for each redacted patient summary intended for the survey]
[data processing successful]
[data processing exception]
Form Processor
PlevelQR Content Creator
ITI-36
ITI-36