Quality Measure Execution – Early Hearing Proposal for 2014/15 presented to the Quality, Research & Public Health (QRPH) Planning Committee Lisa R. Nelson, Lantana Consulting Group (LCG) Public Health Informatics Institute (PHII) Centers for Disease Control and Prevention Office 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 US National Vital Statistics Report

The Problem Assure 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 with the benefit incenting collection of the needed data Innovation is needed to shift/align the data collection model

Process Value Proposition The 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-line Education

Existing IHE Profiles and Risks Risk 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 CCD Middleman 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 = CR Report Assembler = RA Content Consumer = CS Larger Context 2/25/2015 Permutations of 3 actors and 3 content modules Share CR RA CS CR RA CS Aggregate-Level Quality Report = ALQR Patient-Level Quality Report = PLQR Summary of Care Document = SoCD Electronic Clinical Quality Measure Definition for EHDI Measure = EHDI eCQM EHDI eCQM Measure Definition EHDI eCQM Measure Definition ALQR PLQR SoCD

Con Actor Key: CR = Content Creator RA = Report Assembler CS = Content Consumer Use Case #1 Share CR CS ALQR ALQR Option Key: ALQR = Aggregate-Level Quality Report PLQR = Patient-Level Quality Report SoCD = Summary of Care Document

Con Actor Key: CR = Content Creator RA = Report Assembler CS = Content Consumer Use Case #2 Share CR CS PLQR PLQR Option Key: ALQR = Aggregate-Level Quality Report PLQR = Patient-Level Quality Report SoCD = Summary of Care Document

Con Use Case #3 Share CR Share CR RA CS Measure Definition SoCD to PLQR PLQR CS SoCD PLQR SoCD Actor Key: CR = Content Creator RA = Report Assembler CS = Content Consumer Option Key: ALQR = Aggregate-Level Quality Report PLQR = Patient-Level Quality Report SoCD = Summary of Care Document

Con Use Case #4 Share CR Share CR RA CS Measure Definition SoCD to PLQR PLQR ALQR PLQR CS SoCD PLQR PLQR to ALQR ALQR SoCD Actor Key: CR = Content Creator RA = Report Assembler CS = Content Consumer Option Key: ALQR = Aggregate-Level Quality Report PLQR = Patient-Level Quality Report SoCD = Summary of Care Document SoCD to PLQR = Assemble PLQR from SoCD PLQR to ALQR = Assemble ALQR from PLQR

Con Use Case #5 Share CR Share CR RA CS Measure Definition PLQR ALQR PLQR CS SoCD PLQR ALQR SoCD Share CS ALQR Not in scope for this Use Case A system that implements a Content Creator with SoCD option also implements a Content Consumer with ALQR option. Actor Key: CR = Content Creator RA = Report Assembler CS = Content Consumer Option Key: ALQR = Aggregate-Level Quality Report PLQR = Patient-Level Quality Report SoCD = Summary of Care Document SoCD to PLQR = Assemble PLQR from SoCD PLQR to ALQR = Assemble ALQR from PLQR SoCD to PLQR PLQR to ALQR

Con Content Creator ALQR opt Content Consumer ALQR opt Share Aggregate-Level QR Use Case #1 Actor Key: CR = Content Creator RA = Report Assembler CS = Content Consumer Option Key: ALQR = Aggregate-Level Quality Report PLQR = Patient-Level Quality Report SoCD = Summary of Care Document

Con Content Creator PLQR opt Content Consumer PLQR opt Loop Share Patient-Level QR Use Case #2 Actor Key: CR = Content Creator RA = Report Assembler CS = Content Consumer Option Key: ALQR = Aggregate-Level Quality Report PLQR = Patient-Level Quality Report SoCD = Summary of Care Document

Con Content Creator SoCD opt Report Assembler SoCD to PLQR opt Content Consumer PLQR opt Share Patient- Level QR Summary of Care Document Loop Use Case #3 Create Exception Report Actor Key: CR = Content Creator RA = Report Assembler CS = Content Consumer Option Key: ALQR = Aggregate-Level Quality Report PLQR = Patient-Level Quality Report SoCD = Summary of Care Document

Con Content Creator SoCD opt Report Assembler SoCD to PLQR opt PLQR to ALQR opt Content Consumer ALQR opt Share Patient- Level QR Loop Share Aggregate-Level QR Use Case #4 Create Exception Report Summary of Care Document Actor Key: CR = Content Creator RA = Report Assembler CS = Content Consumer Option Key: ALQR = Aggregate-Level Quality Report PLQR = Patient-Level Quality Report SoCD = Summary of Care Document

Con Content Creator SoCD opt Content Consumer ALQR opt Report Assembler SoCD to PLQR opt PLQR to ALQR opt Content Consumer ALQR opt Share Patient- Level QR 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 Creator RA = Report Assembler CS = Content Consumer Option Key: ALQR = Aggregate-Level Quality Report PLQR = Patient-Level Quality Report SoCD = 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 = CR Report Assembler = RA Content Consumer = CS Use Case #1 (Not used after Public Comment) Share CR RA CS Measure Definition Assemble ALQR ALQR ALQR

Con Content Creator = CR Report Assembler = RA Content Consumer = CS Use Case #2 (Not used after Public Comment) Share CR RA Measure Definition Assemble PLQR PLQR CS PLQR

Con Use Case Not Covered Share Content Creator = CR Report Assembler = RA Content Consumer = CS Share CR Share CR RA Measure Definition Assemble PLQR PLQR CS SoCD CR RA Measure Definition ALQR PLQR CS PLQR Assemble ALQR CS ALQR System that implements a Content Creator with SoCD option also implements a Content Consumer with ALQR option.

Con Content Creator Quality Report Assembler Content Consumer Post Condition Create Exception Report QA Report Type I Errors QA Report Type II Errors

Con Content Creator Quality Report Assembler Content Consumer Share Aggregate-level QR Use Case #1

Con Content Creator Quality Report Assembler Content Consumer Loop Share Patient-level QR Use Case #2

Con Content Creator Quality Report Assembler Content Consumer Share Patient- level QR Care Summary Loop Use Case #3 Create Exception Report

Con Content Creator Quality Report Assembler Content Consumer Share Patient- level QR Care Summary Loop Share Aggregate-level QR Use Case #4 Create Exception Report

Con Content Creator Quality Report Assembler Content Consumer Share Care Summary 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

Con Content Creator Care Summary Patient QR Aggregate QR Content Consumer Larger Context 2/24/2015 Share Patient QR Quality Report Assembler Share Patient QR Aggregate QR

Con Content Creator = CR Report Assembler = RA Content Consumer = CS Larger Context 2/25/2015 Share CR RA CR RACS CR RACS

Con Content Creator = CR Report Assembler = RA Content Consumer = CS Larger Context 2/25/2015 – View #1 Share CR RA CR RACS CR CS CR RA

Con Content Creator = CR Report Assembler = RA Content Consumer = CS Larger Context 2/25/2015 – View #2 Share CR RA CR RACS CR RA

Con Content Creator = CR Report Assembler = RA Content Consumer = CS Larger Context 3/2/2015 Share CR RA CS CR RACS Measure Definition Measure Definition

Con Content Creator = CR Report Assembler = RA Content Consumer = CS Larger Context 2/25/2015 – View #2 – alt. Share RA CS CR RA Measure Definition Measure Definition

Con Content Creator = CR Report Assembler = RA Content Consumer = CS Larger Context 2/25/2015 – View #3 -disagree Share CR RA CR RACS CR RA

Con Content Creator = CR Report Assembler = RA Content Consumer = CS Larger Context 2/25/2015 – View #3 - alt Share CR RA CR RACS CR RA

Con Content Creator = CR Report Assembler = RA Content Consumer = CS Larger Context 2/25/2015 – View#4 Share CR RA CS CR RA

Con Content Creator = CR Report Assembler = RA Content Consumer = CS Larger Context 2/25/2015 – View#4 Share CR RA CS CR RA CS

Con Content Creator = CR Report Assembler = RA Content Consumer = CS Larger Context 3/2/2015 Share CR RA CS CR RACS Measure Definition Measure Definition

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 Group

Evolution of RFD

Con Content Creator Share Content Consumer Burden on the EHR Care Summary P-level QR Aggregate QR

Con Content Creator Care Summary P-level QR Aggregate QR Content Consumer 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 Report Creator Share

Con P-level CCreator Care Summary Share P-level QR Aggregate QR FF FM FR P-level CConsumer Aggregate CCreator P-leveI QR ITI-34 ITI-35 New Actor: Quality Report Creator Care Summary P-level QR Aggregate QR Universal Document Types Care Summ CConsumer FA ITI-36

Con Content Creator Care Summary Patient QR Aggregate QR Content Consumer Larger Context Quality Report Creator Share Care Summary Patient QR Aggregate QR Patient QR Aggregate QR

Con Content Creator Care Summary P-level QR Aggregate QR Content Consumer Larger Context Quality Report Creator Data Privacy & Consent Authority Metadata Repository Authority Value Set Authority Code System Authority 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 Get and use eCQM Definition QRPH-44 ITI-48 Share QRPH-43 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 QR ITI-35 ITI-34 Pt.Summ CConsumer Form Filler Share Plevel QR ITI-35 ITI-34 Pt.Summ CConsumer Form Filler Form Processor Plevel QR 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 Plevel QR Content Creator ITI-36