![Page 1: HL7 Quality Reporting Document Architecture DSTU](https://reader036.vdocuments.us/reader036/viewer/2022062316/56815931550346895dc667c5/html5/thumbnails/1.jpg)
HL7 Quality Reporting Document Architecture DSTU
CDA Release 2, US Realm
HL7 September 2008 WGM (Vancouver, BC, Canada)
Pele Yu, MD MS FAAP
![Page 2: HL7 Quality Reporting Document Architecture DSTU](https://reader036.vdocuments.us/reader036/viewer/2022062316/56815931550346895dc667c5/html5/thumbnails/2.jpg)
To develop an electronic data standard for exchange
of patient-level quality measurement data between healthcare information systems.
Quality Reporting Document Architecture
![Page 3: HL7 Quality Reporting Document Architecture DSTU](https://reader036.vdocuments.us/reader036/viewer/2022062316/56815931550346895dc667c5/html5/thumbnails/3.jpg)
www.kidsquality.org
Paper Medical Records
Electronic Health Records Proprietary data
formats
Status Quo in Quality Measure Reporting
Data Entry100% manual process:
data abstraction and data mining
Prepare data
for analysis
Requestors of Quality Data
QualityImprovementOrganizations
AccreditingOrganizations,
Medical Societies, The
Alliance
Payers
Key-boarding or manual entry
Feedback to clinicians
Complete?
QRDA
Point of Care clinicians
Future of Quality Measure Reporting
![Page 4: HL7 Quality Reporting Document Architecture DSTU](https://reader036.vdocuments.us/reader036/viewer/2022062316/56815931550346895dc667c5/html5/thumbnails/4.jpg)
www.kidsquality.org
Coordination with Related Efforts
Measure Development
eMeasure Specification
Aggregators, Requestors
ok?ok? ok?
The Collaborative eMeasure specification
NQF, NCQA, AMA, APQ.... Measure definition
HIMSS IHE: Multi-party choreography using HL7 messages, services
AH
IC,
HIT
SP
Use
Cas
es
QRDA QRDA QRDA
feedback
Data Elements for Quality
HITEP
![Page 5: HL7 Quality Reporting Document Architecture DSTU](https://reader036.vdocuments.us/reader036/viewer/2022062316/56815931550346895dc667c5/html5/thumbnails/5.jpg)
QRDA Project History
• Phase 1: September 07 – January 08– Proof of concept, use CDA for quality reporting
• HAI reports for CDC (SDTC)• SDTC interest in CDA based non-clinical reporting
documents – Structured Documents Architecture (SDA)– Domain Analysis– Requirements Analysis
• Phase 2: May 2008 to present– DSTU Ballot – QRDA Implementation Guideline for 2 Pediatric
Measures (CHCA)– QRDA Reporting Categories (MedAllies)
• NHIN Trial Implementation demonstration project in NY• Summary patient record exchange using CDA
![Page 6: HL7 Quality Reporting Document Architecture DSTU](https://reader036.vdocuments.us/reader036/viewer/2022062316/56815931550346895dc667c5/html5/thumbnails/6.jpg)
QRDA Draft Standard 2008
• Category 1 – Patient-Level Reports– For DSTU Ballot
• Category 2 – Summary Reports– Informational, for Comments
• Category 3 – Calculated Reports– Informational, for Comments
![Page 7: HL7 Quality Reporting Document Architecture DSTU](https://reader036.vdocuments.us/reader036/viewer/2022062316/56815931550346895dc667c5/html5/thumbnails/7.jpg)
QRDA Category 1 Specifications• Header
– Header• US Realm• Unique CDA template ID, LOINC code, and Title
– Participants• Target a single patient• Author one or more entities (person, organization, device)• Informant one reporting entity (person, organization)• Custodian one custodian (person, organization)• Legal Authenticator one legal authenticator (person, organization)
• Body– One body– One or more sections, subsections (Measure Set, Measure)
• Section– Measure Set Section (measure set name, version, OID, description)– Measure Section (measure name, version, OID, description)– Reporting Parameters Section (applicable reporting period)– Patient Data Section (Re-use of CCD and CDA, if applicable)
![Page 8: HL7 Quality Reporting Document Architecture DSTU](https://reader036.vdocuments.us/reader036/viewer/2022062316/56815931550346895dc667c5/html5/thumbnails/8.jpg)
QRDA Specifications – RIM Constructs
• Header– Header
• US Realm• Unique CDA template ID, LOINC code, and Title
– Participants• Target a single patient• Author one or more entities (person, organization, device)• Informant one reporting entity (person, organization)• Custodian one custodian (person, organization)• Legal Authenticator one legal authenticator (person, organization)
• Body– One body– One or more sections, subsections (Measure Set, Measure)
• Section– Measure Set Section (measure set name, version, OID, description)– Measure Section (measure name, version, OID, description)– Reporting Parameters Section (applicable reporting period)– Patient Data Section (Re-use of CCD and CDA, if applicable)
QRDA P
hase
1
![Page 9: HL7 Quality Reporting Document Architecture DSTU](https://reader036.vdocuments.us/reader036/viewer/2022062316/56815931550346895dc667c5/html5/thumbnails/9.jpg)
QRDA Deliverable
• Implementation Guides for QRDA Category 1 Pediatric Measures– VON Neonatal Admission Hypothermia Measure
• Outcome measure
– CHCA Body Mass Index (BMI)• Process measure
• Rationale– Few data points, well-defined– Pilot potential– Pediatric measures on NQF Roadmap– Relevant to project stakeholder (CHCA)
![Page 10: HL7 Quality Reporting Document Architecture DSTU](https://reader036.vdocuments.us/reader036/viewer/2022062316/56815931550346895dc667c5/html5/thumbnails/10.jpg)
![Page 11: HL7 Quality Reporting Document Architecture DSTU](https://reader036.vdocuments.us/reader036/viewer/2022062316/56815931550346895dc667c5/html5/thumbnails/11.jpg)
![Page 12: HL7 Quality Reporting Document Architecture DSTU](https://reader036.vdocuments.us/reader036/viewer/2022062316/56815931550346895dc667c5/html5/thumbnails/12.jpg)
Implication of DSTU• QRDA is feasible
– RIM adaptable– CDA adaptable– Strong HL7 support– Industry awareness achieved
• Ready for industry use– HITSP– IHE– Pilot efforts
• Barriers for adoption and progress– Lack of continuity in effort– Lack of formal project management structure
![Page 13: HL7 Quality Reporting Document Architecture DSTU](https://reader036.vdocuments.us/reader036/viewer/2022062316/56815931550346895dc667c5/html5/thumbnails/13.jpg)
Next Steps
• QRDA DSTU Ballot reconciliation next few months– Resolve issues without substantive change and publish DSTU, or– Resolve issues w/ substantive changes, then re-ballot– Implications
• QRDA Phase 3– Funding for future development to refine DSTU leading to
Normative Standard• Category 1 DSTU• Category 2 and 3 include in next ballot cycle/s, if enough work is
done (MedAllies, etc)
– Create solid links with industry• Harmonize efforts (IHE, Collaborative, JCAHO, HEDIS, etc)• Engage vendors and MDOs
– Pilot and demonstration projects• Vendors, hospitals, QIOs