QRPH Session: White Paper: Performance Measurement Data Element Structured for EHR Extraction IHE North America Webinar Series 2008 Floyd Eisenberg, MD

QRPH Session:

White Paper:Performance Measurement Data Element Structured for EHR Extraction

IHE North America Webinar Series 2008IHE North America Webinar Series 2008

Floyd Eisenberg, MD MPH FACPFloyd Eisenberg, MD MPH FACP Siemens HealthcareSiemens Healthcare

Jason ColquittJason ColquittGreenway Medical SystemsGreenway Medical Systems

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

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Figure 1. Evidence-Based Guideline & Measurement Process

Performance Measurement Data Element Structured for EHR ExtractionGuideline & Measurement Flow

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Analyzer / Aggregator

Form Manager

Form Receiver

Form Archiver

Form Filler

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 DataPatient Level Export of Quality Data(PEQD)(PEQD)

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PEQD - 2007

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PEQD – 2007 Retrieve Form for Data Capture

Receipt of Measures, Transmission of Results

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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

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Measurement Specification


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

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Measure Description


<xs:element name="Measure"><xs:complexType>

<xs:sequence><xs:element name="TopicType" type="xs:string" /><xs:element name="MeasureDeveloper" type="xs:string" /><xs:element name="MeasureDeveloperID" type="xs:string" />

<xs:element minOccurs="0" name="DateSent" type="xs:date" /><xs:element minOccurs="0" name="ApprovedBy" type="xs:string" /><xs:element minOccurs="0" name="DateApproved" type="xs:date" /><xs:element minOccurs="0" name="EndorsedBy" type="xs:string" /><xs:element minOccurs="0" name="EndorsedDate" type="xs:date" /><xs:element minOccurs="0" name="Rationale" type="xs:string" /><xs:element minOccurs="0" name="ImprovementNotation" type="xs:string" /><xs:element name="MeasureStatement" type="xs:string" /><xs:element name="MeasurementUnit" type="xs:string" /><xs:element minOccurs="0 "name="MeasurementLength" type="xs:unsignedByte"/><xs:element name="Copyright" type="xs:string" /><xs:element minOccurs="0" name="Disclaimer" type="xs:string"/><xs:element minOccurs="0" name="NoticeOfUse" type="xs:string"/>

</xs:sequence><xs:attribute name="ID" type="xs:string" use="required" /><xs:attribute name="Name" type="xs:string" use="required" /><xs:attribute name="Version" type="xs:decimal" use="required" /><xs:attribute name="VersionDate" type="xs:date" use="required" />

</xs:complexType></xs:element>In the XML Schema optional elements have a minOccurs="

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Measure Element (Age)


<xs:element maxOccurs="unbounded" name="Information"><xs:complexType>

<xs:sequence><xs:element minOccurs="0" name="Statement" type="xs:string" /><xs:element minOccurs="0" name="MinAge" type="xs:unsignedByte" /><xs:element minOccurs="0" name="MaxAge" type="xs:unsignedByte" /><xs:element minOccurs="0" name="AgeUnit" type="xs:string" /><xs:element minOccurs="0" name="CalculationDescription" type="xs:string" /><xs:element minOccurs="0" name="MeasureCalculationDate" type="xs:string"/><xs:element name="NumberOfLogicalExpressions" type="xs:int" /><xs:element maxOccurs="unbounded" name="LogicalExpression">

</xs:element></xs:sequence>

<xs:attribute name="Type" type="xs:string" use="required" /></xs:complexType>

</xs:element>

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Guideline & Measurement Flow: EHRS

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The Joint Commission. Specifications Manual for National Hospital Inpatient Quality Measures [Version 2.5, Discharges 10-01-08 (4Q08) through 03-31-09 (1Q09)]

Note: To calculate age must use the month and day portion of admission date and birthdate to yield the most accurate age.

Patient is in the HF Initial Patient Population

>= 18 years

Patient not in the HF Initial Patient

Population

Patient is not eligible to be sampled for the

HF measure setPatient is eligible to be

sampled* for the HF measure set

Variable Key:Patient Age

Initial Patient Population Reject Case FlagLength of Stay

Set Initial Patient Population Reject Case Flag = “No”

Set Initial Patient Population Reject Case Flag = “Yes”

Return to Data Processing Flow

(Data Transmission section)

ICDEnd

Length of Stay (in days) = Discharge Date minus

Admission Date

Length of Stay

<= 120 days

> 120 days

ICD-9-CMPrincipal Diagnosis

Code

ICD-9-CM Principal or

Other Procedure Codes

OnTable 2.1

At least one on Table 2.2

All Missing orNone on Table 2.2

Note: To calculate age must use the month and day portion of admission date and birthdate to yield the most accurate age.

Patient Age (in years) = Admission Date minus Birthdate

PatientAge

< 18years

HF Initial Patient Population Algorithm

Process all cases that have successfully reached the point in the Data Processing Flow which calls this Initial Patient Population Algorithm. Do not process cases that have been rejected before this point in the Data Processing Flow.

Start HF Initial Patient Populationlogic sub-routine

ICDStart

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Guideline & Measurement Flow: EHRSHF-3: ACEI or ARB for LVSD Numerator: Heart failure patients who are prescribed an ACEI or ARB at hospital discharge.Denominator: Heart failure patients with LVSD and without both ACEI and ARB contraindications.

START

HF-3H

Clinical Trial = YMissing

HF-3X

= N

Comfort Measures

Only =1,2,3Missing

HF-3X

= 4

Run cases that are included in the HF Initial Patient Population and pass the edits defined in the Data Processing Flow through this measure.

Discharge Status

= 01, 03, 04, 05, 06, 61, 62, 63, 64, 65, 70

=02, 07, 20, 43, 50, 51, 66

HF-3B

HF-3B

HF-3B


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BNot in

Measure Population

LVSD

= Y

Contraindication to Both ACEI and ARB at Discharge

=N

=YMissing

HF-3

HF-3

HF-3

Stop

= YMissing

HF-3

ARB Prescribed at Discharge

XCase Will

Be RejectedD

In Measure Population

EIn Numerator Population

ACEI Prescribed at Discharge

=N

=YMissing

=N

Missing = N

HF-3B

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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

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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 System RxNorm (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



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


308138


308139


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



Measurement Value Sets:

IHE QRPH

Measurement Value Sets:ACEI Value Set XML<?xml version="1.0" encoding="utf-8"?><CodeGroup ID="CG1" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:ihe="urn:ihe:iti:svs:2008" xsi:noNamespaceSchemaLocation="../schema/Collaborative/Measure.xsd"> <ihe:ValueSet id="1.2.6.1.4.1.21367.2008.3.1.2008.1" displayName="ACEIs - NHIQM - Appendix C, Table 1.2" version="2.5" /> <ihe:SourceCodeSystem id="2.16.840.1.113883.6.88"/> <ihe:ConceptList> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="349442" displayName="Amlodipine 10 MG / benazepril 20 MG Oral Capsule" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="629569" displayName="Amlodipine 10 MG / benazepril 40 MG Oral Capsule" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="308137" displayName="Amlodipine 2.5 MG / benazepril 10 MG Oral Capsule" />` <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="308138" displayName="Amlodipine 5 MG / benazepril 10 MG Oral Capsule" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="308139" displayName="Amlodipine 5 MG / benazepril 20 MG Oral Capsule" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="629570" displayName="Amlodipine 5 MG / benazepril 40 MG Oral Capsule" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="308608" displayName="benazepril 10 MG / Hydrochlorothiazide 12.5 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="308607" displayName="benazepril 10 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="308610" displayName="benazepril 20 MG / Hydrochlorothiazide 12.5 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="308611" displayName="benazepril 20 MG / Hydrochlorothiazide 25 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="308609" displayName="benazepril 20 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="308612" displayName="benazepril 40 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="313866" displayName="benazepril 5 MG / Hydrochlorothiazide 6.25 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="308613" displayName="benazepril 5 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="310796" displayName="Hydrochlorothiazide 12.5 MG / quinapril 10 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="310797" displayName="Hydrochlorothiazide 12.5 MG / quinapril 20 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="310809" displayName="Hydrochlorothiazide 25 MG / quinapril 20 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="312311" displayName="Perindopril 2 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="312312" displayName="Perindopril 4 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="312313" displayName="Perindopril 8 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="312748" displayName="quinapril 10 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="312749" displayName="quinapril 20 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="314203" displayName="quinapril 40 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="312750" displayName="quinapril 5 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="346568" displayName="Ramipril 1.25 MG Extended Release Capsule" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="401965" displayName="Ramipril 1.25 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="348000" displayName="Ramipril 10 MG Extended Release Capsule" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="261962" displayName="Ramipril 10 MG Oral Capsule" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="401968" displayName="Ramipril 10 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="198188" displayName="Ramipril 2.5 MG Oral Capsule" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="251856" displayName="Ramipril 2.5 MG Oral Tablet" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="198189" displayName="Ramipril 5 MG Oral Capsule" /> <ihe:Concept codeSystem="2.16.840.1.113883.6.88" code="251857" displayName="Ramipril 5 MG Oral Tablet" /> </ihe:ConceptList></CodeGroup

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

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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

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• 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

Documents

QRPH Session: White Paper: Performance Measurement Data Element Structured for EHR Extraction IHE North America Webinar Series 2008 Floyd Eisenberg, MD