1. Query Health QRDA Requirements

2. QRDA Requirements Discussion
QRDA Category II and III Common Requirements
Link QRDA to the HQMF query (document)
Capture the data source providing the response
Capture the time the result was created
Capture the reporting period that was used to create the result
Capture results uniquely for each Population Criteria section in the HQMF
HQMF will have at least one Population Criteria section
Each Population Criteria section will have at most one IPP, One Denominator, One Numerator, One Exclusions, One Exceptions section.
There can be multiple Stratifiers within the Population Criteria section
Support Specific Stratification criteria
For e.g Count of patients with diabetes stratified by the following age groups
Age between 14 and 21
Age between 21 and 30 etc.
Support generic Stratification criteria
For e.g Count of patients with diabetes stratified by Zip Codes (The Query does not enumerate all the Zip codes)

3. QRDA Requirements Discussion Cont’d
QRDA Category II and III Common Requirements Cont’d
Capture what is being counted (e.g patients, encounters, procedures)
Category III Specific requirements
Supports only Aggregate information and no patient level information.
Category II Specific requirements
Support Patient level information
Only an Identifier for the patient for follow up
Unlike Category I, the patient information in Category II must not contain any of the detailed information present in the medical record.
So the CCDA Templates and the QDM Data Type Patterns are not applicable for Category II or III
Must include all patients who qualify for IPP

4. QRDA II and III Representation
Background:
QRDA is based on the CDA document.
Schemas used are the baseline CDA schemas (CDA.xsd)
QRDA Category I currently in ballot
QRDA II and III
Header
Reporting Parameters
Measure Section
For Query Health, the results for all the Population Criteria sections would be present within one Measure Section.

5. QRDA II and III Representation – Header
Header Elements: (Common to both Category II and III)
realmCode
typeId
templateId - Changes based on Category II or III Id
Code
Title
EffectiveTime – Time when the report is generated
Confidentiality Code – Could change if the Data Source chooses to
Language Code
RecordTarget
External Document Id Reference (New in Category I)
Author
Informant
Custodian
LegalAuthenticator
Proposing these to be the same for each data source

6. QRDA II and III Representation – Header Cont’d
Header Elements XML: (Common to both Category II and III)
<realmCode code="US"/> <typeId root=" " extension="POCD_HD000040"/> <!-- QRDA Category III template ID. --> <templateId root=" "/> <id root="88414c01-715a-45bb-83bb-db7ac860fe9d"/> <!-- QRDA document type code (yet to be created). --> <code code=" " codeSystem=" " codeSystemName="LOINC" displayName="Quality Measure Report"/> <title>QRDA Calculated Summary Report</title> <effectiveTime value=" "/> <confidentialityCode codeSystem=" " code="N"/> <languageCode code="en-US"/>
<reference typeCode="REFR">
<externalDocument classCode="DOC" moodCode="EVN">
<!-- This is the NQF Number, root is an NQF OID for eMeasure
Number and extension is the eMeasure's NQF number -->
<id root=" " extension="0301"/>
</externalDocument>
</reference> <!-- This is an aggregate summary report. Therefore CDA's required patient identifier is nulled. --> <recordTarget> <patientRole> <id nullFlavor="NA"/> </patientRole> </recordTarget>

7. QRDA II and III Representation – Header Cont’d
Header Elements XML Cont’d: (Common to both Category II and III)
<!-- The author of the CDA document in this example is an IS06 "Processing Entity".--> <author> <time value=" "/> <assignedAuthor> <id nullFlavor="NA"/> <representedOrganization> <id root=" "/> <name>Good Health Clinic </name> </representedOrganization> </assignedAuthor> </author> <!-- The reporting healthcare facility is represented using the CCD "Source of Information" construct, via the Informant participant. --> <informant> <assignedEntity> <id nullFlavor="NA"/> <representedOrganization> <id root=" "/> <name>Good Health Clinic</name> </representedOrganization> </assignedEntity> </informant> <!-- The custodian of the CDA document is the same as the legal authenticator in this example. --> <custodian> <assignedCustodian> <representedCustodianOrganization> <id root=" "/> <name>Good Health Clinic</name> </representedCustodianOrganization> </assignedCustodian> </custodian> <!-- The legal authenticator of the CDA document is the same as the custodian in this example. --> <legalAuthenticator> <time value=" "/> <signatureCode code="S"/> <assignedEntity> <id nullFlavor="NA"/> <representedOrganization> <id root=" "/> <name>Good Health Clinic</name> </representedOrganization> </assignedEntity> </legalAuthenticator>

8. QRDA II and III Representation – Reporting Parameters
<entry> <act classCode="ACT" moodCode="EVN"> <id root="55a43e eb-81c3-9a3a1ad41225"/> <code code=" " codeSystem=" " displayName="Observation Parameters"/> <effectiveTime> <low value=" "/> <!-- The first day of the period reported. --> <high value=" "/> <!-- The last day of the period reported. --> </effectiveTime> <!--This example includes an enumeration of the "aggregation-level" data elements here in the Reporting Parameters section.--> <entryRelationship typeCode="COMP"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="ageBetween17and21"/> <code nullFlavor="NA"></code> </observation> </entryRelationship> <entryRelationship typeCode="COMP"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="genderMale"/> <code nullFlavor="NA"></code> </observation> </entryRelationship> <entryRelationship typeCode="COMP"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="NUMERATOR"/> <code nullFlavor=“NA"></code> <value xsi:type="CD" code=" " codeSystem=" " displayName="NUMERATOR"/> </observation> </entryRelationship> <entryRelationship typeCode="COMP"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="DENOMINATOR"/>
<code nullFlavor=“NA"></code> <value xsi:type="CD" code=" " codeSystem=" " displayName="DENOMINATOR"/> </observation> </entryRelationship> </act> </entry>
List of Stratifiers from HQMF Query represented as Observations (Ids can be used to link them across QRDA / HQMF if required), Should they be ACT’s ?
Present for all Queries
(Numerator, Denominator, Exceptions, Exclusions, IPP)

9. QRDA III Representation – Measure Section
<entry typeCode="DRIV"> <act classCode="ACT" moodCode="EVN"> ---- For a Particular Population Criteria Section
<id/> <code nullFlavor=“NA"/> <text>The percentage of patients years of age with diabetes (type 1 or type 2) who had HbA1c > 9.0%.</text> <statusCode code="completed"/> <entryRelationship typeCode="SPRT"> <act classCode="ACT" moodCode="EVN"> <id root="0" extension="ageBetween17and21"/> <code></code> <entryRelationship typeCode="SPRT"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="NUMERATOR"/> <code></code> <value xsi:type="INT" value="1"></value> </observation> </entryRelationship> <entryRelationship typeCode="SPRT"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="DENOMINATOR"/> <code></code> <value xsi:type="INT" value="2"></value> </observation> </entryRelationship> </act> </entryRelationship> <entryRelationship typeCode=“SPRT"> <act classCode="ACT" moodCode="EVN"> <id root="0" extension="genderMale"/> <code></code> <entryRelationship typeCode="REFR"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="NUMERATOR"/>
……. </entryRelationship> </act>
<act> </act> For the Next Population Criteria Section </entry>
Stratifier designated as an ACT and
Referencing by id element
Aggregate Data Elements represented as Observations supporting the ACT

10. QRDA II Representation – Measure Section
<entry typeCode="DRIV"> <act classCode="ACT" moodCode="EVN"> <id/>
<text>The percentage of patients years of age with diabetes (type 1 or type 2) who had HbA1c > 9.0%.</text> <statusCode code="completed"/> <entryRelationship typeCode="SPRT"> <act classCode="ACT" moodCode="EVN"> <code nullFlavor="NA"></code> <participant typeCode="RCT"> <participantRole classCode="PAT"> <id extension=" " root=" "/> </participantRole> </participant> <entryRelationship typeCode="SPRT"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="ageBetween17and21"/> <code></code> <value xsi:type="INT" value="0"></value> </observation> </entryRelationship> <entryRelationship typeCode="SPRT"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="genderMale"/> <code></code> <value xsi:type="INT" value="1"></value> </observation> </entryRelationship> <entryRelationship typeCode="SPRT"> <observation classCode="OBS" moodCode="EVN"> <id root="0" extension="NUMERATOR"/> <code></code> <value xsi:type="INT" value="0"></value> </observation> </entryRelationship>
Patient Information
Stratifier’s designated as observations
Common Aggregate Data Elements (Numerator, Denominator …)