Download - Cypress nlm himss13_03042013
Improving the Clinical Quality Measure Tes8ng and Cer8fica8on Process
HIMSS13 March 4, 2013
Agenda
• Cypress v2 Overview • Feedback on CQM Tes:ng and Cer:fica:on • Improvements to Cer:fica:on Process – Jacob Reider, Office of the Na8onal Coordinator for Health Informa8on Technology (ONC)
– Saul Kravitz, MITRE – Steve Emrick, Na8onal Library of Medicine – Bob Dolin, Lantana Consul8ng Group
• Open Discussion
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• Meaningful Use (MU) Stage 2 Clinical Quality Measure (CQM) Tes:ng and Cer:fica:on Tool – ONC championed ac8vity
– MITRE designed and stewarded free open source soVware
• Enables repeatable tes:ng that an EHRs’ ability to calculate Eligible Professional (EP) CQMs, Eligible Hospital (EH) CQMs, and Quality Repor:ng Document Architecture (QRDA) XML is accurate and aligned with MU Stage 2 1. Capture and Export 2. Import and Calculate 3. Electronic Submission
Cypress Overview
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Status of Cypress and MU Stage 2 CQMs
• Cypress released to Authorized Tes:ng Labs (ATLs) – V2.0.0 released 12/21/2012 – V2.1.0 released 2/28/2013
• ONC’s 2014 HIT Cer:fica:on Program opera:onal January 2, 2013
• ATLs have successfully cer:fied vendors using the new CQM tes:ng procedure and Cypress
• We are receiving feedback from vendors and ATLs – 125+ discussions on the public open source email list – 200+ issues on ONC’s Jira tool
• We are improving the cer:fica:on tools and process based on your feedback
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Types of Feedback Collected
• eCQM Logic • Value Sets • QRDA-‐I Test Data (Capture/Export) • QRDA-‐III Test Data (Compute)
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eCQM Logic Feedback
• Many ques:ons regarding proper interpreta:on of MU2 eCQMs
• Ques:ons about specific eCQMs, e.g.: – Measure X doesn’t reflect the clinical guidelines
• General Ques:ons, e.g.: – How to interpret specific occurrence idioms? – How are episode of care eCQMs computed?
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Response to eCQM Feedback
• Short-‐Term Ac:ons – V1.1 of eCQM Implementa8on Guide on CMS Website – eCQMs updated as part of 2013 annual update
• Longer-‐Term Ac:ons – Publica8on of test data for use by vendors to demonstrate intended behavior for each measure
– Improvements to logic syntax – Incorpora8on of automated tes8ng in MU3 eCQM development process
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Value Set Authority Center (VSAC)
• Provides Value Sets that support MU Stage 2 CQMs – Requires UMLS Metathesaurus License for access to GUI and download files
• Received lots of useful feedback and input from users, e.g.: – How can I obtain pre-‐packaged value sets for all eCQMs? – Can’t you sort these in various ways – CMS ID, QDM category? – How can I filter my search results by code system (SNOMED CT, RxNorm, etc), in the user interface?
– How do I find out about updates to value sets or the VSAC?
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Value Set Authority Center (VSAC)
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Consumption Authorship Web page population for human consumption
Integration with Authoring Tool(s) to support value set authorship
Web download / web services for machine consumption
Free-standing, web-based value set authoring tool(s)
API
Phase 1 Phase 2
API
Controlled Value Set Repository & Validation Engine
Value Set / Measure Authors Consensus Organization(s)
NLM ONC Consensus Org(s)
NLM
Vendors Providers Public Health Orgs
Curation Delivery
Value Sets – Downloadable Resources Table
CMS ID Value Set Name QDM Category
Packages available for EP, EH, and EP+EH measures
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Value Sets – Code System Filter
Show only value sets containing RxNorm codes
Statin prescribed at discharge
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VSAC: Ongoing Work
• Development of VSAC authoring environment – Improve quality of value sets – Improve authoring produc8vity
• Value set harmoniza:on – Gather ‘purpose’ of all value sets as structured metadata – Will provide ‘seman8c boundaries’ of value sets, which could be helpful on determining overlap of value sets, new code appropriateness, etc.
• Gathering of non-‐MU value sets – e.g., Route of Administra8on – Could eventually be used in some MU context
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QRDA-‐I Cer:fica:on Feedback
• “Excessive” data entry burden • Test data incompa:ble with clinical applica:ons
• QRDA-‐I specifica:on issues • Many spurious valida:on errors and warnings
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Response to QRDA-‐I Cer:fica:on Feedback
• Near Term (Following 2/28 release) – Addi8onal QRDA-‐I implementa8on guidance – Revise test procedure to reuse Logic Test Deck for QRDA-‐I Tes8ng • Ini8al focus on syntac8c correctness only • Elimina8on of MANY warnings
• Longer Term (With 4/26 release) – SoVware changes to check that QRDA-‐I files are within upper and lower bounds of informa8on content
– Minor revision to test procedure
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QRDA-‐III Cer:fica:on Feedback
• Comments on the challenge of working with HQMF files
• Ques:ons about correctness of eCQM interpreta:on
• Spurious valida:on errors on QRDA-‐III output
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Response to QRDA-‐III Cer:fica:on Feedback
• Feedback to HL7 HQMF revision process • Sofware fixes • Feedback to eCQM update process
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Changes to QRDA-‐III Test Deck
• For EH and EP Cer:fica:on: – Moved dates off of January 1st – All ‘ac8ve’ states have a dura8on – Tried to use widely supported codes – Avoid unprescribable medica8ons* – Moved all events inside of business hours – Moved all events inside encounters
• For EH Cer:fica:on: – Reduced length of stay
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Cypress Timeline
• Version 2.0 – 12/21/2012 • Version 2.1.0 – 2/28/2013
– Addresses all resolved QRDA-‐I valida8on issues – Supports shiV to use of Logic Test Decks for QRDA-‐I Cer8fica8on – Updates to EH and EP test decks based on feedback – Support ATL tes8ng of mul8ple eCQM releases with a single Cypress installa8on
• Version 2.2.0 – 4/26/2013 – Support for ‘dynamic’ logic tes8ng for all measures – Improved QRDA-‐I tes8ng based on Logic Test Decks – Support for 2013 EH Update, versioned value sets
• Updated Test Decks – EH – Early May 2013 – EP – Early July 2013
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Communica:ons Channels
• Cypress Email Lists – [email protected] -‐ public e-‐mail list – [email protected] -‐ broadcast list – Details on hqp://projectcypress.org/faq.html – ONC Tes8ng and Cer8fica8on Team [email protected]
• ONC Jira for Issue Tracking – General CQM Tracker
hqps://cqm-‐issue-‐tracker.atlassian.net/browse/CQM – Cypress-‐specific Tracker
hqps://cqm-‐issue-‐tracker.atlassian.net/browse/CYPRESS
• VSAC updates listserv – Go to hqps://list.nih.gov/cgi-‐bin/wa.exe?A0=nlm_vsac_updates – Click on ‘Subscribe or Unsubscribe’ – Enter your name, e-‐mail, and click ‘Subscribe (NLM_VSAC_UPDATES)’
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QUESTIONS AND FEEDBACK AND FEEDBACK
BACKUP
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Capture and Export Current Concept of Opera:ons
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Import, Calculate and Electronic Submission Concept of Opera:ons
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Release Notes for Cypress V2.1.0 Test Deck Changes
• Measurement period updated from 2010 to 2012, ending Dec 31, 2012 at 23:59 • Code provided for each data element trigger logic in a consistent manner across all
measures • Added code descrip8on mouse overs to the HTML pa8ent records (RxNorm
descrip8ons and all other code sets) • Length of stay for encounters minimized for EP • Pa8ent data with the status of "ac8ve" given a dura8on in the test deck • EP and EH events occur during business hours • EP and EH Test deck events occur during encounters • EP GP_Peds, E immuniza8on end 8me fixed • EH Newborn, A and Newborn, B birthdate and delivery 8mes brought into sync • Value sets added to the Cypress bundle to allow coordina8ng value set & measure
releases • EH Newborn, A/B and OB A/B updated admit and discharge 8mes on encounter to
match start/end 8mes
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Release Notes for Cypress V2.1.0 Cypress Sofware Changes
• Quality Measure Engine: – Dynamic Support for CV measures in EH and EP – Bundle Import code Moved to Health Data Standards library
• Measures: – Reloaded measure defini8ons from CMS to fix issue with measure popula8on criteria ids
• Cypress: – Added support for mul8ple bundles to be loaded simultaniously – Fixed double quoate bug in resources/schematron/qrda/qrda_cat_1/measure_specific/
d78ce034-‐8288-‐4012-‐a31e-‐7f485a74f2a9.sch – Removed xsi:type='CE' checks from generic Cat I schematron rules – Updated schematron rule for CONF:7618 – to remove check for unit='1' – Added ability to import bundle from within the applica8on – Updated QRDA Cat I test pa8ent generator to eliminate duplicate entries
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