1. Setting the Stage
Health information exchanges (HIEs) are participating in quality measurement through the Qualified Clinical Data Registry (QCDR) program
Both providers and payers are interested in quality calculations from an HIE for formal program reporting (QRDA1 & QRDA3 documents) and outside of formal quality reporting (“informal” channels)
This discussion is about potential “informal” means to supply quality information about patients. Proposal shows if an individual patient is compliant to a measure or not. This is not a view you get from a QRDA I or QRDA III.

2. “Informal” Channel
In dialogues with clients, this informal channel for quality measurement information would:
Use existing information pipes with EHRs / HIEs
Ideally leverage existing standards rather than create something new
Show a quality outcome calculation for a patient along with other relevant data for care transition/management (i.e. “one-stop-shop”)

3. Why Not QRDA 1 Document?
QRDA 1 documents not required to have all the data relevant for a care transition (just “smoking gun” or minimal necessary clinical detail for measures)
QRDA 1 documents do not require measure calculation section (i.e. unlike QRDA3)
While used in quality program submission, QRDA1 documents not routinely exchange by HIE/QCDR. Not all vendors are ready to receive/display.

4. Proposed Approach
C-CDA documents are the most common document format of patient-specific information (e.g. via XDS.b or XCA connections)
Take the measure calculation from QRDA and insert as section in C-CDA (documents are open-template)
Share Clinical Data
Health Information Exchange +
Qualified Clinical Data Registry
Share Clinical Data + Quality Calculation
Single document that has care transition info + quality calculations

5. Proposed Approach in C-CDA
Typical sections of C-CDA documents
QRDA 3 Measure Section
Above measures (and table format) are illustrative only
The measures included would be defined by use case (i.e. like quality programs)

6. Feedback Links to example XML
Section Only: CDAR2.1/QUALITY_Measures_in_CCDA/QUALITY_Measures_in_CCDA.xml
Full Example: CDAR2.1/QUALITY_in_ONC_CCD.xml
Could this be an example of how to use the versatility of open-templates + existing standards to “informally” share calculation? This obviously does not replace the formal needs of QRDA 1 & QRDA 3
Are there concerns with this that can be addressed while maintaining the desired “informal” channel?
Any feedback is welcome on the example proposed