Data Exchange for Quality Measures DEQM Viet Nguyen

Data Exchange for Quality Measures (DEQM) Viet Nguyen, MD Linda Michaelsen Bryn Rhodes Erica Haas, DVM January 16, 2018

The “layers” of a measure • Measure Authorities – NCQA (HEDIS), CMS • Written Measure guidelines/requirements • Clinical process to generate clinical data • Administrative process to gather/compile/report the data • Measure Reporting process • EHR UX to support above • What payer/provider/vendor systems requirements • FHIR resources/operations to support process – DEQM, CQF, CQL • Terminology • Claims based (often proprietary) code systems • Clinically based code systems (SNOMED-CT, LOINC, Rx. NORM) • Need to translate, aggregate and support multiple versions

Relationship of DEQM IG and Other IGs • DEQM IG provides framework for quality measure exchange in the US Realm • MRP use case is an example of using the framework • HEDIS IG • http: //build. fhir. org/ig/cqframework/he dis-ig/ • QI-Core IG • http: //build. fhir. org/ig/cqframework/qicore/index. html • Since QI-Core is dependent on USCore, QI-Core will need to wait until R 4 US-Core is available (plan is mid 2019) • measure-mrp used in the $submitdata operation Disclaimer 3

Selection of Measures • Considerations ‒ Advance the use of DEQM framework by defining how additional measures would work ‒ Create a patterns (e. g. screening measure, process measure, outcome measure) ‒ Leverage existing CQL work ‒ Elaborate DEQM IG guidance • Relation to QRDA 1 and 3 • Relation to e. CQMs and other measures • Hospital measure (e. g. Stroke measures) vs professional measures Disclaimer 4

Colon Cancer Screening (COL) • A HEDIS measure also included in STARS program • http: //build. fhir. org/ig/cqframework/hedis-ig/index. html ‒ See links for COL • Establish the FHIR “Pattern” for screening measures ‒ Exercise new resources not previously used • Add this measure to DEQM IG as additional example Disclaimer 5

DEQM Project Working Calls • Define FHIR Screening Measure “Pattern” • Understand the COL measure data and reporting requirements • Define clinical, EHR and administrative workflow for ‒ Data collection ‒ Reporting • FHIR gap analysis ‒ Resources & profiles (US Core, Qi. Core, etc. ) • Define technical workflow to support above ‒ Identify FHIR DEQM operations to support reporting • Write COL measure example to be added to DEQM IG as “addendum” Disclaimer 6

What measure should be evaluated next?

Selection of Measures • Considerations ‒ Advance the use of DEQM framework by defining how additional measures would work ‒ Create a patterns (e. g. screening measure, process measure, outcome measure) ‒ Leverage existing CQL work ‒ Elaborate DEQM IG guidance • Relation to QRDA 1 and 3 • Relation to e. CQMs and other measures • Hospital measure (e. g. Stroke measures) vs professional measures Disclaimer 8

Other considerations? • Test out the screening measure pattern with another screening measure – Breast Cancer Screening? • Develop a new measure pattern? • Hypertension measure – payers need BPs • Short measure reporting period – e. g. readmissions • Lifetime Exclusions • Behavioral health measures • Complex measure – Diabetes Disclaimer 9

Da Vinci Program Manager: Jocelyn Keegan, Point of Care Partners jocelyn. keegan@pocp. com Da Vinci Technical Lead: Dr. Viet Nguyen, Stratametrics LLC vietnguyen@stratametrics. com Disclaimer 10