Product eMeasures

Product Brief - eMeasures

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Product Name

HL7 Version 3 Standard: Representation of the Health Quality Measures Format (eMeasure), Release 1

Standard Category

• Health Information Knowledge Representation Standards, Modeling Standards???

Integration Paradigm

• Documents

Type

DSTU

Releases

Release 1, balloted September 2009

Summary

The Health Quality Measures Format (HQMF) formally defines a quality measure (data elements, logic, definitions, etc) to support consistent and unambiguous interpretation. Quality measures encoded in the HQMF format are referred to as "eMeasures". Examples of statements standardized by the HQMF: Denominator =

1. 2 or more face to face visits within measurement period; AND
2. 18 or older at start of measurement period; AND
3. confirmed diagnosis of coronary artery disease (based on diagnostic or procedure criteria).
   

Initial Patient Population =

1. Principal inpatient discharge diagnosis of stroke; AND
2. Patient 18+ at admission; AND
3. Length of Stay <= 120 days.

Quality measure developers can encode their measures in this format so that they can be consumed by provider organizations, who will then be able to use the formal definitions to, for instance, query their EHR data stores.

Description

The Health Quality Measures Format (HQMF) is a standard for representing a health quality measure as an electronic document. A quality measure is a quantitative tool that provides an indication of an individual or organization’s performance in relation to a specified process or outcome via the measurement of an action, process or outcome of clinical care. Quality measures are often derived from clinical guidelines and are designed to determine whether the appropriate care has been provided given a set of clinical criteria and an evidence base. Quality measures are also often referred to as performance measures or quality indicators.

Through standardization of a measure's structure, metadata, definitions, and logic, the HQMF provides for quality measure consistency and unambiguous interpretation. A health quality measure encoded in the HQMF format is referred to as an "eMeasure".

Standardization of document structure (e.g. sections), metadata (e.g. author, verifier), and definitions (e.g. "numerator", "initial patient population") enables a wide range of measures, currently existing in a variety of formats, to achieve at least a minimal level of consistency and readability, even if not fully machine processable.

From there, a formal representation of the clinical, financial and/or administrative concepts and logic within an eMeasure support unambiguous interpretation and consistent reporting. Examples of statements that can be formally represented by the HQMF include:

To be included in a measure's Denominator. a patient will have had at least two face to face visits; AND will have a confirmed diagnosis of coronary artery disease (based on diagnostic or procedure criteria); To be included in a measure's Initial Patient Population, a patient will have had a principal inpatient discharge diagnosis of stroke; AND a hospital length of stay less than or equal to 120 days.

This project was supported by volunteer efforts and through the National Quality Forum’s (NQF, www.qualityforum.org) contract with the U.S. Department of Health and Human Services to promote the effective use of Electronic Health Record (EHR) systems. The initiative aims to significantly improve the quality and efficiency of patient care by making possible the capture and reporting of quality measure information for physicians and other health care providers.

The NQF is a unique, multi-stakeholder, nonprofit organization dedicated to improving the quality of American healthcare by setting national priorities and goals for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance, and promoting the attainment of national goals through education and outreach programs.

NQF is also working with other organizations to assure that quality measure specifications can be uniformly incorporated into EHRs and reported to physicians and other clinicians for continuing quality improvement efforts at the point of care.

The Collaborative for Performance Measure Integration with EHR Systems ("Collaborative"), co-sponsored by the American Medical Association (AMA) and the National Committee for Quality Assurance (NCQA) and Electronic Heath Record Association (EHRA), is a group of stakeholders in the physician performance measurement and quality improvement arena who have a shared goal to provide the industry with workable recommendations for performance measure use. The Collaborative’s goals are:

1. To create a standardized way of communicating Performance Measures;
2. To establish standards that permit structured, encoded Performance Measure information to be incorporated into EHR applications while preserving the clinical intent of the Performance Measure; and
3. To improve the process of Performance Measure update and maintenance for EHR vendors

The Collaborative developed the HQMF reference guide, a prototype to address performance measure functionality and integration with EHR systems. The HQMF prototype defined a standardized way of expressing performance measures while preserving the clinical intent of the measure itself. In spring 2009, NQF sponsored efforts to take the prototype HQMF and align it with HL7 constructs. This draft HL7 standard was produced through volunteer efforts and the Health Quality Measure Format (HQMF) project sponsored by the NQF.

Business Case (Intended Use, Customers)

• Vendors, EHRs
• Providers: physicians and other clinicians
• Quality Improvement reporting agencies

Benefits

As physicians and other clinicians are asked to participate in more and more quality improvement and pay-for-performance programs, standardizing the implementation of NQF-endorsed performance measures will be critical in making quality improvement efforts useful and meaningful for physicians and other clinicians and for improving the health of patients.

Unambiguous expression of concepts and logic within an eMeasure is a necessary step towards the larger objective of automatically enabling a direct query against an EHR or other operational data store. While HQMF is not an EHR query language, through the provision of unambiguous and formal definitions, it is an EHR query enabler. Additionally, an unambiguous representation of the clinical concepts in an eMeasure allows EHR vendors and healthcare providers to be proactive in capturing such information at the point of care. If, for instance, a quality measure reports on the provision of educational material to stroke patients, the corresponding eMeasure will make it clear exactly what type of educational care provision would be considered appropriate care. The EHR could prompt the end user to provide precisely the care described. If the eMeasure calls for the collection of a certain data element not normally captured by the EHR, the EHR might now prompt the user in some way to provide this information, thereby enhancing not only the quality of data reporting, but also the quality of care.

Implementations/ Case Studies (Actual Users)

from DSTU:

• Child Health Corporation of America
• IHE

Resources

Work Groups

• Structured Documents
• Clinical Decision Support
• Patient Care

Relationship to/ Dependencies on, other standards

• CDA R2
• RIM
• The foundational work on the HQMF was initially a prototype of the Collaborative for Performance Measure Integration with EHR Systems (a collaborative of the American Medical Association, the National Committee for Quality Assurance, and the Electronic Health Records Association); and the RAND's work on a Performance Measure Reporting Language (PMRL) for representing performance measures in a computer-interpretable and sharable format.

Links to current projects in development

• Project Insight ID # 508, Electronic Quality Measure Specification, Release 1