November 16, 2010 CBCC Conference Call

Community-Based Collaborative Care Working Group Meeting

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Attendees

• Jon Farmer
• Suzanne Gonzales-Webb CBCC Co-chair
• Mary Ann Juurlink Scribe
• John Moehrke Security Co-chair
• Ioana Singureanu
• Richard Thoreson CBCC Co-chair
• Serafina Versaggi
• Tony Weida
• Craig Winter

Agenda

1. (05 min) Roll call, approve minutes November 9th, call for additional agenda items & accept agenda
2. (55 min) Draft Semantic Health Information Performance and Privacy Standard Project Scope Statement

Review of HL7 Project Scope Statement Data Segmentation Pre-Requisites Preview of scope statement

The EHRS functional model working group is trying to match functions to content standards. The impetus of this scope statement is to improve data quality measures as well as to define missing functionality. This is required to support segmentation and privacy e.g. define automation for consent directive. Generally the first sections describes the art of HL7 balloting. We are expecting to;

• make changes to the EHR functional model e.g. some of the behavioural functional profiles that exist
• refine the DAM describing the health information for performance and privacy for data segmentation in particular
• refine vocabulary domain and value sets where they exists

2. Project Intent

The project intent is to revise and supplement current standards

2.a. Ballot Type

Draft for comment informative ballot or DSTU ballot

3. Sponsoring Group

We don’t have a complete list of project participants; however we expect groups to identify themselves as they hear about the scope of the project. We will seek more involvement from other groups e.g.

• Public Health reporting
• The National Quality Forum may be interested in the performance and quality data that we are looking to record

We are expecting to make changes to the EHR functional model or functional profiles; we would like to enlist Jim Krentz from SAMSA to help submit these for consideration as enhancements to the EHR-S FM.. We expect the National Quality Forum (NQF) might also interested be as a co-sponsor, and we will reach out to Floyd Eisenberg (NQF) and the Structured Documents Work Group (Bob Dolin) to see if there is interest in collaboration.

4. Project Definition

Section 4: is about background – the fact that data segmentation has emerged as a requirement

4.a. Project Scope

There is a need to identify the Meta data required for data quality and for data segmentation. We are looking to define the level or quality the data collected by electronic system will have to meet in order for data segmentation to be automated. Clearly you can read a paper document and determine whether something is to be embargoed or not but if you can automate the process using electronic data this is the future. These issues and data perquisites are needed to support privacy and policies. In terms of quality we are looking at advance capability of different quality measures and quality data that is intended to evaluate performance of health care delivery organization. But even there we are struggling to identify precisely what of the multitude of data that is already being collected would be relevant to measure overall performance. Furthermore sometimes it will be information that is not collected today e.g. evaluating the access to health care information - is the information capture? This information could be captured in a disparate system, e.g. not integrated with information that is linked to other data related to a performance measure.

4.b. Project Need

Issues to be covered in the project analysis

• Relationship of data context to performance measure
• Not just talking about one provider EHR system, in the new interoperable world care is coming from multiple providers
• Information needs to be semantically interoperable

Different approach depending on quality of the data in the underlying systems, how to handle the data if:

• Structured data / unstructured data
• Standard encoded / not encoded

Richard - The state is the single public payor for the safety net population and the question is do they have the information they need to assess the quality of health for their entire population. How is the information shared? Quality is sometimes focused on the provider level and aggregated in a particular provider system. A larger question is to look the whole pattern of care for the entire population as that provides information about the needs, services and about the outcomes. If you don’t have that information you can’t make policy in an informed way. If information is important for someone’s health it may also be a factor for public health. Eventually we need a scale so people can equate the performance of an information system based on scope of information and the quality/detail of the information that is available for people to make policy into an administered program.

Ioana - Quality of information also depends on the completeness of the information. We want to make sure that we understand what is considered to be a complete set for segmentation for quality evaluation? That is quality evaluation across the population and giving decision makers the possibilities to look for patterns. Types of completeness

• Coding value sets
• How well the data is being collected

What are the criteria to evaluate the data e.g. access patterns

Richard - There are new privacy and security requirements brought forth by Subtitle D of the Health Information Technology for Economic and Clinical Health Act (HITECH). New concerns that need to be addressed also the ongoing concern - pay for performance, giving decision makers a way to evaluate programs and population health.

Richard – For the policy agenda we need to know what does the information tell you or doesn’t tell you

Ioana – These are brand new concerns, also pay for performance

Additional background link http://gforge.hl7.org/gf/download/docmanfileversion/5950/7714/11-1_SHIPS.doc

John – Concerned about scope creep e.g. talking about quality of any particular record – then quality from an operational environment provides quality treatment vs not quality treatment. There seems to be overlap with the Public Health and Emergency Response Working Group.

Ioana - We need to insure if there is overlap we are reusing

John - What is the relationship between the segmentation part and the quality part e.g. segmentation is needed whether you have good data or not good data

Ioana – Is quality of data sufficient for data segmentation? Quality of data collected during the health care delivery process e.g. the quality of data that is produced by the EHR system.

• Is this data sufficient so it can be used automatically for data segmentation and computing measures?
  • Subset of meta data that goes along for segmentation
  • Subset for quality measures
• How the data is used to measure specific quality measures, and this information becomes available to inform policy makers

Both uses of the data require specific data quality. We will identify what that quality of the information is and represent it for everyone to understand. If we are segmenting data what data should we have in our hands before segmenting it.

• What sort of data we need so we can apply policies to it– that is what segmentation is all about (smaller work item)
• What quality of measures do we need to address today to understand range of concerns we have in deriving those measures (extensive work item)

Add sentence to scope: Data quality in real time performance evaluation (initially for high priority Behavioural Health topics)

Richard – Segmentation for privacy in terms of

• Quality of a service
• Outcome of service

All interrelated EHR certification could be based on functionality (stage 1)