Introduction to the HITSP

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Quality

• October 2, 2008 200 330 pm (Eastern)
• Presenters HITSP Population Perspective
  Technical Committee
• Floyd Eisenberg, MD, MPH, Senior Key Expert,
  Siemens Healthcare and co-chair of the Population
  Perspective TC
• Lori Fourquet, e-HealthSign, LLC

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Learning Objectives
a webinar series on U.S. healthcare
interoperability

• During this 90-minute webinar, participants will
  explore the population perspective of health
  information sharing for quality, gaining a basic
  knowledge of
• quality measure specification data element types
  and value sets
• defining and selecting a sub-population of
  patients (measure denominator)
• defining and identifying expected interventions
  (measure numerator)
• terminology issues in identifying inclusion and
  exclusion criteria

(continued)
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Learning Objectives (continued)
a webinar series on U.S. healthcare
interoperability

• expectations for information transfer from EHRs
  to quality reporting organizations
• HITSP specifications for quality information
  sharing
• the relationship of the quality use case and
  interoperability specification to other efforts
  for public health and for data repurposing

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Agenda
a webinar series on U.S. healthcare
interoperability

• Quality
• Quality Measure Specification
• Clinical Data for Analysis
• Inclusion Criteria
• Exclusion Criteria
• Quality Reporting
• Security and privacy requirements for Quality

• HITSP Interoperability Specification for Quality
  (HITSP IS 06)
• Units of Exchange
• Health Information Summary Documents
• Health Information Messages
• Conformance Subsets
• Questions and Answers

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Introduction Steves Story . . . part six

• Patient is a 26-year-old male coping with the
  long-term effects of a brain tumor that was
  removed during his childhood
• Patient is assisting with home care for his
  grandfather, a recent widower and diabetic who
  has become despondent and non-compliant with
  self-care requirements
• The family is becoming concerned about the
  quality of care Steves grandfather is receiving
• A search for new providers and a successful
  diabetes program is being conducted by the family
• Fact-based information is needed, more than
  practice locations, hours of operation, frequency
  of procedures and anecdotes based on reputation,
  e.g.,
• Critical care information such as comparative
  outcomes of care for diabetic patients and those
  with depression
• General preventive care success factors

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Overview

• HITSP is a volunteer-driven, consensus-based
  organization that is funded through a contract
  from the Department of Health and Human
  Services.
• The Panel brings together public and
  private-sector experts from across the healthcare
  community to harmonize and recommend the
  technical standards that are necessary to assure
  the interoperability of electronic health records.

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Deliverables and Mode of Operation

• The HITSP Standards Harmonization Framework
• Identify a pool of standards for an AHIC
  (American Health Information Community) Use Case
• Identify gaps and overlaps in the standards for
  this specific Use Case
• Make recommendations for resolution of gaps and
  overlaps
• Select standards using HITSP-approved Readiness
  Criteria
• Develop Interoperability Specifications (IS) that
  use the selected standard(s) for the specific
  context
• Test the IS

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Deliverables and Mode of Operation

• Each HITSP Interoperability Specification defines
  a set of constructs that
• specify how to integrate and constrain selected
  standards to meet the business needs of a Use
  Case and
• define a Roadmap to use emerging standards and to
  harmonize overlapping standards when resolved.
• In essence, a HITSP IS represents a suite of
  documents that integrate and constrain existing
  standards to satisfy a Use Case

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Deliverables and Mode of Operation

• HITSP construct types, in decreasing breadth of
  scope, include
• Interoperability SpecificationsIntegration of
  all constructs used to meet the business needs of
  a Use Case
• Transaction PackagesLogical grouping of
  transactions
• TransactionsLogical grouping of actions that use
  components and/or composite standards to realize
  the actions
• ComponentsLogical grouping of base standards
  that work together, such as messaging and
  terminology

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Deliverables and Mode of Operation

• IS Status State in the acceptance process
• Released Panel approved for submission to HHS
• Accepted Secretary of HHS has accepted for a
  period of testing
• Recognized Secretary of HHS has recognized the
  IS for immediate implementation
• Revisions and updates may mean that multiple
  versions of some Interoperability Specifications
  exist with differing status levels

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Current Interoperability Specifications (IS)
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IS 06 Quality

• This Interoperability Specification defines
  specific standards that capture the integration
  of data to support quality measurement feedback
  and reporting into electronic health records
  (EHRs), use of quality measures to support
  clinical decision making, and public reporting of
  healthcare quality through the exchange of data
  between healthcare organizations and providers
  and public health via an electronic network.
• Version 1.0 Recognized
• Version 1.0.1 Panel Review

Healthcare Provider
Quality Reporting Organizations
IS 06 VIA AN ELECTRONIC NETWORK
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IS 06 QualityOverall Objectives

• Hospital-based quality measures
• Automate data capture and reporting of Hospital
  Quality Alliance (HQA) measures through EHRs in
  support of provider workflows
• Communicate HQA measure data to external agencies
  
• Clinician-level data
• Automate data capture and reporting of Ambulatory
  Quality Alliance (AQA) measures through EHRs in
  support of provider workflows
• Communicate AQA quality measure data to external
  entities for aggregation and reporting

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IS 06 QualityOverall Objectives (continued)

• Feedback to Clinicians
• enable real-time or near-real-time feedback
  regarding specific quality indicators which are
  relevant for a particular patient
• enable provision of tailored performance
  information to clinicians on quality measures for
  specific patient groups
• (continued)

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IS 06 QualityOverall Objectives (continued)

• Public Reporting
• Aggregate data across multiple sources (claims
  data, medication data, laboratory data, etc.)
• Support quality measurement, promote
  accountability among providers, and aid consumers
  in making informed choices
• Communicate quality measurement data quickly and
  clearly in a manner that makes it useful to a
  wide variety of decision makers (patients,
  healthcare providers, payers, health plans, and
  regulators who are involved with this process)

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IS 06 QualityStakeholders

• Ancillary Entities
• Clinicians
• Consumers
• Government Healthcare Agencies
• Healthcare Delivery Organizations
• Health Information Exchange
• Health Information Management Personnel

• Health Information Technology System Developers
• Healthcare Payers
• Healthcare Purchasers
• Health Researchers
• Processing Entities
• Public Health Agencies
• Quality Organizations

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IS 06 QualityRequirements

• Quality Measure Specification
• Structured and codified
• Denominator and Numerator Inclusions Value Sets
• Denominator and Numerator Exclusions Value Sets
• Data Capture / Aggregation
• Data Reporting to External Agencies

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IS 06 QualityRequirements (continued)
Integrating the Healthcare Enterprise (IHE)
Quality, Research Public Health Domain,
Performance Measurement Value Set White Paper,
August 2008
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IS 06 QualityPerspectives

• Hospital-based care

Clinician / Ambulatory-based care
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IS 06 Quality Data Elements / Types

• Healthcare Information Technology Expert Panel
  (HITEP)
• Convened by the National Quality Forum (NQF)
• Identified 84 Institute of Medicine (IOM) High
  Priority Measures
• Common data types
• Reduce logic to common data types
• Analyze frequency
• 88 Data Elements (9 additional subtypes added by
  HITEP)
• Facility / clinician demographics
• Patient demographics
• Clinical data

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IS 06 QualityData Elements / Types / Examples

• Base Facility Data Elements
• Identifier
• Name
• Location
• Patient Data Elements
• Pseudonymized Data Linker
• Encounter Date/Time
• History
• Birth
• Gender
• Visit Data
• Location
• Discharge
• Death

• Clinical Data Elements
• Problem Data
• Diagnosis Data
• Allergy / Adverse Reaction
• Vital Signs
• Procedures and Diagnostic Tests
• Medication Data
• Study Findings/Test Results Laboratory
• Study Findings/Test Results Radiology and Other
  Studies
• Other (e.g. clinician-clinician communications,
  provider-patient communications, care
  classification-comfort measure only, clinical
  trial)

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IS 06 Quality Main Business Actors
Processing Entity / HIE
Document-Based Transmission
Hospital Clinician/Ambulatory Provider
Quality Measurement Organization
Message-Based Transmission
Measurement Consumer
Other Communities
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IS 06 Quality Implementation Option 1 EHR does
the work
Acronym Legend MDO Measure Development
Organization NQF National Quality Forum
measure endorsement, maintenance, syndication,
and live broadcast
EHR
Quality Measure imported
Quality Measure
Quality report detail exported
Quality Report
EHR creates patient data summary internally, uses
imported measure to calculate quality scores and
export quality report
Patient Data
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IS 06 Quality Implementation Option 2Quality
Improvement Organization (QIO) / HIE
Acronym Legend HIE Health Information
Exchange MDO Measure Development
Organization NQF National Quality Forum
measure endorsement, maintenance, syndication,
and live broadcast
Quality Measure imported
QIO
Message
EHR
Quality Measure
Data transmit
Quality report detail exported
Patient Data
Clinical Data imported
Quality Report
Document
QIO uses imported Quality measures and clinical
details to calculate quality scores and export
Quality report
Quality data assembled internally
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IS06 QualityTraditional HL7 Messaging
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IS06 QualityDocument Sharing
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IS06 QualityAssembly of Patient-Level Quality
Data
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IS 06 Quality New Constructs for IS06
Query for Existing Data (NEW)
TP 21
Supports dynamic queries for clinical data to
gather patient-level quality data elements
Patient Level Quality Data Message (NEW)
Patient Level Quality Data Document (NEW)
C 34
C 38
Support the process of sending patient-level
quality data to an aggregator for analysis and
aggregation of quality measures
Patient Demographics Query (NEW)
T 23
Provide a list of patients and their demographics
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IS 06 Quality Privacy and Security
Collect Communicate Security Audit Trail
Secured Communication Channel
T 17
T 15
Ensure the authenticity, integrity, and
confidentiality of transactions, and the mutual
trust between communicating parties
Record audit event in repository
Access Control
Consistent Time
T 16
TP 20
Provides a mechanism to ensure that all the
entity systems communicating within the network
have synchronized system clocks
Ensure that an entity is the person or
application that claims the identity provided
Nonrepudiation of Origin
C 26
Describes the mechanisms to define and identify
security relevant events and the data to be
collected and communicated as determined by
policy, regulation or risk analysis. It also
provides the mechanism to determine the record
format to support analytical reports that are
needed.
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IS 06 Quality Privacy and Security
Entity Identity Assertion
Anonymize
C 19
C 25
Ensure that an entity is the person or
application that claims the identity provided
Provides specific instruction for anonymizing
data that is ready for repurposing. Anonymization
According to the International Organization for
Standardization (ISO), is the process that
removes the association between the identifying
data set and the data subject.
Manage Consent Directives
Pseudonymize
TP 30
T 24
Defined to support pseudonymization of protected
health information. Pseudonymization The
process of supplying an alternative identifier
that permits a patient to be referred to by a key
that suppresses his/her actual identification
information
Deals with the capture and communication of
patient consent directives and non-patient
originated authorizations for disclosure of
health information
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IS 06 Quality Infrastructure
Patient ID Cross-Referencing
Manage Sharing of Documents
TP 22
T 13
Deals with identifying and cross-referencing
different patient attributes for the same
patient.
Facilitates the registration, distribution and
access of patient electronic health records
across health enterprises
Notification of Document Availability
Retrieve Form for Data Capture
T 29
TP 50
Notifies its recipient that a document is
available and provides the information needed to
retrieve the document
Supports public health authority reportable
conditions monitoring and management. Enables
capture of supplemental data variables not
typically maintained in an electronic health
record or laboratory information system
Transfer of Documents on Media (NEW)
Document Reliable Interchange (NEW)
T 33
T 31
Supports media interchange of metadata and
documents
Supports a point-to-point interchange of metadata
and documents
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IS 06 Quality Future Direction
Measurement Criteria Document
Measurement Criteria Message
TBD
TBD
Current Activities Collaborative for
Performance Measure Integration with EHR
Systems National Committee for Quality Assurance
(NCQA) American Medical Association
(AMA) Electronic Health Records Association
(EHRA, formerly EHRVA) http//www.ama-assn.org/a
ma/pub/category/18352.html
New Constructs Required
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IS 06 Quality Future Direction (continued)
Quality Measurement Message
Quality Measurement Document
TBD
TBD
Current Activities Quality Reporting Document
Architecture (QRDA) September 2008 Ballot HL7,
Vancouver, BC
New Constructs Required
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IS 06 Quality Future Direction (continued)
Validation, Data Quality Checking
Derived Information
TBD
TBD
Quality check of the output for a quality report
Describe how to derive information from existing
data element, e.g., duration of medication from
frequency and dispensed.
Case Review Message
Case Review Document
TBD
TBD
Feedback mechanism to the provider to assure
patients represented in the quality report are
valid review step
New Constructs Required
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Units of Information Exchange HITSP IS
Constructs - Re-Use and Re-Purpose
Type 1 Base or Composite Standards

• Re-UseApplying an existing construct to more
  than one IS
• Re-PurposeUpdating a construct to meet the
  needs of a new Use Case
• Can extend or constrain when reusing or
  re-purposing
• Specifications contain a common superset
• Superset can be extended as new requirements are
  encountered
• Superset can be constrained with use-specific
  constraints

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IS 06 Quality Strengths

• Effective interoperability
• Quality Measurement is based on existing EHR
  available data
• Reporting is processed in a standard, machine
  readable format
• Current activities that increase data entry for
  quality measurement are reduced
• Implementation is flexible for local architecture
• Data are secure and private
• Near real-time feedback is available for
  clinicians
• Information is available for consumers to make
  healthcare choices

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Steves story . . . the future

• Patients can make informed decisions about the
  ongoing care of themselves and their family
  members
• consumers have access to quality and safety
  reports about individual providers and care
  facilities
• Data is collected automatically during routine
  care and reused for performance measurement
• Outcome data is available for determining best
  care protocols, enables standards-based and
  evidence-based care
• Reports are standard and comparable enabling true
  benchmarking and continuous improvement
• Transparency is the rule
• Decision support is part of the workflow, with
  useful safety alerts 

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Healthcare in an interoperable world . . . The
Future is Now

• HIT data exchange is becoming transparent so that
  the quality of care delivered by providers and
  hospitals can be known no matter where the
  patient is located
• Consumers are empowered to
• get the right information at the right time
• find appropriate, quality and safe care for
  themselves and their families
• assume that repeatable information will be safe
  and secure while also being accessible by those
  who need it before, during and after a visit to
  a care provider
• Care providers are empowered to
• provide safe, effective and evidence-based care
  with information integrated within a clinical
  care workflow

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How YOU can become involved

• Use or specify HITSP Interoperability
  Specifications in your HIT efforts and in your
  Requests for Proposals (RFPs)
• Ask for CCHIT certification
• Leverage Health Information Exchanges to promote
  HITSP specifications to make connections easier
  in the future
• Ask . . . Is there a HITSP standard we could be
  using?
• Get involved in HITSP . . . Help shape the
  standards

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How YOU can become involved
Learn more about specific HITSP activities in
these webinars available for replay
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Webinar Series II Coming soon Stay Tuned same
time Thursdays 200-330 pm EDT Send your
Webinar ideas to hitsp_at_ansi.org
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Join HITSP in developing a safe and secure
health information network forthe United States.

Visit www.hitsp.org or contact . . .
Michelle Deane, ANSI mmaasdeane_at_ansi.org Re
HITSP, its Board and Coordinating Committees
Jessica Kant, HIMSS Theresa Wisdom,
HIMSS jkant_at_himss.org twisdom_at_himss.org Re
HITSP Technical Committees
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A Successful Collaboration

• Interweaving many different standards to address
  business needs
• A successful collaboration between HITSP and
  several HITSP member organizations developing
  base standards and implementation guides/profiles

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www.HITSP.org
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Quality
Questions and Answers