Open Source Software Tools for Electronic Clinical Quality Measures
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1 Open Source Software Tools for Electronic Clinical Quality Measures Beth Halley, MBA, RN, FHIMSS Renee Rookwood, MS, RN Sharon Sebastian, MS, RN-BC, PMP, CPHIMS
2 Objectives Define electronic clinical quality measures (ecqms) Describe open source software and tools available for electronic specification, testing and certification of clinical quality measures The electronic clinical quality measure testing tool (Bonnie) The 2014 certification tool used for clinical quality measure software solutions (Cypress) The clinical quality measure software tool that empowers providers (pophealth) Provide ecqm Open Source Tools discussion opportunity 2
3 Clinical Quality Measures What are Clinical Quality Measures (CQM)? Tools that help us measure a segment of healthcare delivery Each CQM has a different goal: effective, safe, efficient, patientcentered, equitable, and/or timely care Clinical Quality Measures are key components of the Meaningful Use program as part of the HITECH Act 3
4 The Goal for Clinical Quality Reporting in Meaningful Use Accurate and Reliable Measures of Quality Reduce Burden on Providers and Vendors Expedite National Implementation of CMS Programs Increase Measurement within Healthcare Is the quality of care improving in this country?
5 Electronic CQMs (ecqms) What are ecqms? ecqms are based on information extraction from Electronic Health Records (EHRs) Being considered for use in various programs Can be exceedingly complex, difficult to implement, and testing requires alignment to several intricate interoperability standards ecqms are key components of the Meaningful Use program ecqm CMS Library Reference: Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html Approved for Public Release. Case No Distribution Unlimited.
6 The Changing Landscape Payment Models Reimbursement for Services Provided Reimbursement for Quality of Care Provided Claims Data Electronic Health Records Chart Abstraction Quality Measurement Sampling Total Population
7 Background Open Source Software for Clinical Quality Measures Freely available via an Apache 2.0 Open Source distribution license Industry friendly and permissive for integrators and use of code Attribution only requirement for use, integration and redistribution Three Open Source Tools are available to support clinical quality measures Bonnie Cypress pophealth Meaningful Use CQM definitions are the only exception to the Apache 2.0 license CQM measure questions should be directed to the measure stewards Approved for Public Release: (Insert PR ). Distribution Unlimited 7
8 Background Open Source Software for Clinical Quality Measures Objective: Grow a community of contributors with transparent governance spanning U.S. Government, commercial vendors, healthcare providers and stakeholders, academic and nonprofit organizations and individual contributors Approved for Public Release: (Insert PR ). Distribution Unlimited 8
9 Standards Stage 2 Standardization of code sets: Logical Observation Identifiers Names and Codes (LOINC ) Systemized Nomenclature of Medicine (SNOMED) International Statistical Classification of Diseases and Related Health Problems (ICD)-9 and ICD-10 RxNorm (normalized names for clinical drugs) CVX Codes (vaccine administered codes) Current Procedural Terminology (CPT) Health Quality Measures Format (HQMF) R1 introduced (ecqm representation) Quality Reporting Data Architecture (QRDA) Category 1 (Single patient output) QRDA Category 3 (Aggregate output)
10 Use of CQM Standards emeasure HQMF format Patient Data Patient data EHR Quality Reports Calculations Summary Reports Other inputs Data capture defined by QDM Data exported to QRDA Category I reports Calculation of ecqms in HQMF QRDA Cat III Reports
11 Use of CQM Standards emeasure HQMF format Patient Data Patient data EHR Quality Reports Calculations Summary Reports Other inputs Data capture defined by QDM Data exported to QRDA Category I reports Calculation of ecqms in HQMF QRDA Cat III Reports
12 Bonnie What is Bonnie? A testing tool for ecqms sponsored by Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) Software Goals Support streamlined and efficient pretesting of ecqms End Users The developers of ecqms 12
13 Testing Process Bonnie Testing Tool Measure Authoring Tool Define Data Elements Associate Value Sets Build ecqm Logic Export ecqm Load/Update ecqm Review Logic Package ecqm Define Expectations Value Set Authority Center Define Value Sets Failed Update ecqm Build Test Patients Calculate Test Results Passed
14 Impact Testing is critical to the accuracy of ecqms Automation provides an efficient and scalable process Calculation as part of testing ensures a discrete execution path prior to vendor implementation and certification A dynamic testing application allows better insight and understanding of how ecqms behave 14
15 Use of CQM Standards emeasure HQMF format Patient Data Patient data EHR Quality Reports Calculations Summary Reports Other inputs Data capture defined by QDM Data exported to QRDA Category I reports Calculation of ecqms in HQMF QRDA Cat III Reports
16 Cypress What is Cypress? The official ecqm testing tool for the 2014 EHR Certification program Software Goals Provide rigorous and repeatable open source testing tool for verifying the calculation of Meaningful Use Stage 2 CQMs End Users Defined Impact ONC Authorized Testing Labs Vendors Used to certify over 58 EHR systems 16
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18 Certified Health IT Product List (CHPL) Certified technologies under the ONC HIT Certification Program are eligible to be used for the CMS EHR Incentive Programs Authoritative, comprehensive listing of complete EHRs and EHR Modules Tested and certified under the ONC Health Information Technology (HIT) Certification Program Certification ensures secure, functional technologies Each module has been tested and certified Maintained by ONC Certification ID provided
19 Use of CQM Standards emeasure HQMF format Patient Data Patient data EHR Quality Reports Calculations Summary Reports Other inputs Data capture defined by QDM Data exported to QRDA Category I reports Calculation of ecqms in HQMF QRDA Cat III Reports
20 Reporting Stage 2 CQMs are core part of being a meaningful user of Health IT Providers now submit quality reports to CMS Patient level and summary reports Reports include supplemental information (race, age, sex, etc.)
21 pophealth What is pophealth? An open source reference implementation for Meaningful Use Stage 2 clinical quality measures Software Goals Empower healthcare providers to understand their clinical quality measures Enables commercial vendors to calculate clinical quality measures for Meaningful Use End Users Defined Impact Healthcare providers EHR vendors Being used by a federal agency to support their MU certification within their distributed ecosystem 21
22 Tools: pophealth
23 Reporting: QRDA Category III Summary, population level results for one or more ecqms Stratification by supplemental data Replaces the PQRI Registry XML specification used in MU1 Guides for QRDA implementation and reporting can be found at and
24 Getting Help: Links Where do I find details? CMS Guidance/Legislation/EHRIncentivePrograms/ ecqm_library.html USHIK ONC CHPL NLM / VSAC AHRQ NQF _tools.aspx Whom do I ask questions? CMS CQI resource center / Jira ONC S&I/SITE Regional Extension Center Staff HITRC
25 Contact Information and Questions Beth Halley, MBA, RN, FHIMSS Renee Rookwood, MS, RN Sharon Sebastian, MS, RN-BC, PMP, CPHIMS 25
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