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 GroupLisa.Nelson@LantanaGroup.com

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