1. QRPH Session: White Paper: Performance Measurement Data Element Structured for EHR Extraction IHE North America Webinar Series 2008 Floyd Eisenberg, MD MPH FACP Siemens Healthcare Jason Colquitt Greenway Medical Systems

2. Learning Objectives Your Product: How does QRPH work relate to you? Performance Measurement Data Element Structured for EHR Extraction –Aligning the EHR / HIE with quality reporting standardization initiatives Clinical Research Data Capture –Aligning the EHR / HIE with clinical research and clinical trials management

3. IHE QRPH Figure 1. Evidence-Based Guideline & Measurement Process Performance Measurement Data Element Structured for EHR Extraction Guideline & Measurement Flow

4. IHE QRPH Analyzer / Aggregator Form Manager Form Receiver Form Archiver Form Filler Patient Encounter Source Patient Encounter Consumer Data Repository Clinical Data Consumer Information Source Display Document Registry Document Consumer Document Repository Document Source Enterprise Report Repository Report Creator Care Delivery Information System Actors` Actors Grouped for Options Document Source Document Recipient Monitoring Agent / Destination Agency  Submit Report [Reserved]  Provide and Register Document Set [ITI-14]  Retrieve Document [ITI-17]  Query Registry [ITI-16]  Retrieve Document for Display [ITI-12]  Retrieve Specific Info for Display [ITI-11]  Patient Encounter Management [ITI-31]  Query Data [PCC 1 - 6]  Retrieve Form [ITI-34]  Submit Form [ITI-35]  Archive Form [ITI-36]  Submit Aggregate Data [reserved]  Provide and Register Document Set [ITI-14] Provide Notification of New Measure Definition [reserved] Patient Admin Management (PAM) Query for Existing Data (QED) Retrieve Into for Display (RID) Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Reliable Interchange (XDR) Retrieve Form for Data Capture (RFD) Key Actors from Other Profiles Patient Level Export of Quality Data (PEQD)

5. IHE QRPH PEQD - 2007

6. IHE QRPH PEQD – 2007 Retrieve Form for Data Capture Receipt of Measures, Transmission of Results

7. IHE QRPH Measurement Specification http://www.ama-assn.org/ama1/pub/upload/mm/472/referenceguide.pdf Collaborative for Performance Measure Integration with EHRS Create a standard way to express and communicate measures Establish standards that permit structured, encoded performance measure information to be incorporated into EHRS, preserving the clinical intent of the performance measure Improve the process of performance measurement update and maintenance for EHR Vendors

8. IHE QRPH Measurement Specification http://www.ama-assn.org/ama1/pub/upload/mm/472/referenceguide.pdf Collaborative for Performance Measure Integration with EHRS Performance Measure Description Performance Measure in Template Patient Population Denominator Numerator Exclusions Logical Expressions Performance Measure in XML

9. IHE QRPH Measure Description http://www.ama-assn.org/ama1/pub/upload/mm/472/referenceguide.pdf In the XML Schema optional elements have a minOccurs="

10. IHE QRPH Measure Element (Age) http://www.ama-assn.org/ama1/pub/upload/mm/472/referenceguide.pdf

11. IHE QRPH Guideline & Measurement Flow: EHRS

12. IHE QRPH Guideline & Measurement Flow: EHRS The Joint Commission. Specifications Manual for National Hospital Inpatient Quality Measures [Version 2.5, Discharges 10-01-08 (4Q08) through 03-31-09 (1Q09)]

13. IHE QRPH Guideline & Measurement Flow: EHRS The Joint Commission. Specifications Manual for National Hospital Inpatient Quality Measures [Version 2.5, Discharges 10-01-08 (4Q08) through 03-31-09 (1Q09)]

14. IHE QRPH Guideline & Measurement Flow: EHRS The Joint Commission. Specifications Manual for National Hospital Inpatient Quality Measures [Version 2.5, Discharges 10-01-08 (4Q08) through 03-31-09 (1Q09)]

15. IHE QRPH Measurement Description Requirements Content for Sharing Value Sets Profile – 2008 (ITI) Value Set for Each Data Element Context for Each Value Set http://static.ihe.net/Technical_Framework/upload/IHE_ITI_TF_Supplement_Sharing_Value _Sets_PC_2008-06-06.pdf

16. IHE QRPH Measure AMI-3, HF-3 Measure Version Number 2.5 Measure Table Number 1.2 Table Name ACEIs Last Measure Version Update 1.05 Code SystemRxNorm (OID: 2.16.840.1.113883.6.88) Test OID (For Illustrative Purposes ONLY)1.2.6.1.4.1.21367.2008.3.1.2008.1 Medication (as per measure description) RxNorm Semantic Clinical Drug (SCD)Associated RxNorm Code Accupril quinapril 5 MG Oral Tablet 312750 quinapril 10 MG Oral Tablet 312748 quinapril 20 MG Oral Tablet 312749 quinapril 40 MG Oral Tablet 314203 Accuretic Hydrochlorothiazide 12.5 MG / quinapril 10 MG Oral Tablet 310796 Hydrochlorothiazide 12.5 MG / quinapril 20 MG Oral Tablet 310797 Hydrochlorothiazide 25 MG / quinapril 20 MG Oral Tablet 310809 Aceon Perindopril 2 MG Oral Tablet 312311 Perindopril 4 MG Oral Tablet 312312 Perindopril 8 MG Oral Tablet 312313 Altace Ramipril 1.25 MG Extended Release Capsule 346568 Ramipril 1.25 MG Oral Tablet 401965 Ramipril 10 MG Extended Release Capsule 348000 Ramipril 10 MG Oral Capsule 261962 Ramipril 10 MG Oral Tablet 401968 Ramipril 2.5 MG Oral Capsule 198188 Ramipril 2.5 MG Oral Tablet 251856 Ramipril 5 MG Oral Capsule 198189 Ramipril 5 MG Oral Tablet 251857 Benazepril Amlodipine 10 MG / benazepril 20 MG Oral Capsule 349442 Amlodipine 10 MG / benazepril 40 MG Oral Capsule 629569 Amlodipine 2.5 MG / benazepril 10 MG Oral Capsule 308137 Amlodipine 5 MG / benazepril 10 MG Oral Capsule 308138 Amlodipine 5 MG / benazepril 20 MG Oral Capsule 308139 Amlodipine 5 MG / benazepril 40 MG Oral Capsule 629570 benazepril 10 MG / Hydrochlorothiazide 12.5 MG Oral Tablet 308608 benazepril 10 MG Oral Tablet 308607 benazepril 20 MG / Hydrochlorothiazide 12.5 MG Oral Tablet 308610 benazepril 20 MG / Hydrochlorothiazide 25 MG Oral Tablet 308611 benazepril 20 MG Oral Tablet 308609 benazepril 40 MG Oral Tablet 308612 Measurement Value Sets:

17. IHE QRPH Measurement Value Sets: ACEI Value Set XML ` </CodeGroup

18. IHE QRPH XDS-MS Section ACEI Ordered at Discharge: clinicaldocument / component / structuredbody / component / section [code=LOINC 10183-2 (hospital discharge medications)] / entry / substanceadministration / consumable / manufacturedproduct / labeleddrug / code=[Valueset=ACEIlist] Value Set Data Context

19. IHE QRPH Measurement Reporting Quality Reporting Document Architecture - QRDA HL7 Ballot – September 2008 Individual Patient-Level Reporting Aggregation of Individual Patient-Level Information Schematron Rules Levels of Aggregate Reporting in Consideration http://www.alschulerassociates.com/library/documents/QRDA_ Phase_I_Public_Report.pdf

20. IHE QRPH Expectations –Participation of Quality Measure Developers Incorporate Content in SVS Demonstrations for Quality Measures Test Measure Constructs (e.g., Collaborative Efforts) Enable more Facile Management of Quality Measurement Data Element Extraction for Analysis