IHE Quality, Research and Public Health – QRPH domain November 05, 2008 Changing the Way Healthcare Connects Ana ESTELRICH, GIP-DMP, FRANCE.

IHE Quality, Research and Public Health – QRPH IHE Quality, Research and Public Health – QRPH domaindomain

November 05, 2008November 05, 2008Changing the Way Healthcare ConnectsChanging the Way Healthcare Connects

Ana ESTELRICH, GIP-DMP, FRANCEAna ESTELRICH, GIP-DMP, FRANCE

IT Infrastructure Planning CommitteeIT Infrastructure Planning Committee

Description of the domain

• Newest IHE domainNewest IHE domain• Quality Reporting for accreditationQuality Reporting for accreditation• Public Health Case ReportingPublic Health Case Reporting• Public Health ImmunizationPublic Health Immunization• BiosurveilanceBiosurveilance• Case Reporting to CDC with EMR AlertCase Reporting to CDC with EMR Alert• Cancer RegistryCancer Registry• Patient Safety Reporting Patient Safety Reporting • Drug Safety ReportingDrug Safety Reporting


Overview of the domain

• QualityQuality – Repurposing of data – Repurposing of data• Clinical Research Clinical Research – Secondary use of data– Secondary use of data• Public Health Public Health – Population base surveillance– Population base surveillance

• Focuses on the workflow cycle of queries for data and selection of Focuses on the workflow cycle of queries for data and selection of population cohorts from within the clinical record.population cohorts from within the clinical record.

• Incorporation of output from the query specification within the clinical Incorporation of output from the query specification within the clinical system workflow to enable clinical decision support. system workflow to enable clinical decision support.

• Defining profiles for adverse event reporting especially with reference Defining profiles for adverse event reporting especially with reference to medication-related adverse outcomesto medication-related adverse outcomes.


Quality

• Exchanging data between concurrent and retrospective Exchanging data between concurrent and retrospective data collection initiatives data collection initiatives

• Exchanging data according to and beyond the core Exchanging data according to and beyond the core measures of:measures of:• Joint Commission (The Joint Commission is a private sector United Joint Commission (The Joint Commission is a private sector United

States-based non-profit organization)States-based non-profit organization)

• CMS Core Measures (Centers for Medicare and Medicaid Services)CMS Core Measures (Centers for Medicare and Medicaid Services)

• Quality standardsQuality standards

• AccreditationAccreditation

• CertificationCertification

• Determining site standards in data exchange models when Determining site standards in data exchange models when sites are participating at different levels in different sites are participating at different levels in different programs programs


Quality

• Monitors patients co-morbidities in disease driven effortsMonitors patients co-morbidities in disease driven efforts

• Do we have the right measure for the reporting effort in Do we have the right measure for the reporting effort in hospital-level quality improvement initiative?hospital-level quality improvement initiative?


Public Health, Biosurveillance

• Patient B gets treated by Hospital A for certain symptoms, corresponding to a Patient B gets treated by Hospital A for certain symptoms, corresponding to a potential reportable condition. potential reportable condition.

• This will be captured in the document/submission set/folder metadata This will be captured in the document/submission set/folder metadata eventCodeListeventCodeList

• Hospital A sends a required report to the appropriate Public Health agency P, Hospital A sends a required report to the appropriate Public Health agency P, and also sends an ED Encounter Summary (EDES) to the local XDS and also sends an ED Encounter Summary (EDES) to the local XDS repository. repository.

• Public Health determines that a review of recent ED encounters for patients Public Health determines that a review of recent ED encounters for patients with similar symptoms is necessary.with similar symptoms is necessary.

• A list of patients with the appropriate symptoms will be obtain, their potential A list of patients with the appropriate symptoms will be obtain, their potential contacts and other associated documentscontacts and other associated documents

• Public Health Officials will decide how to handle the situationPublic Health Officials will decide how to handle the situation


Public Health, Biosurveillance

• Patient B gets treated by Hospital A for certain symptoms, corresponding to a Patient B gets treated by Hospital A for certain symptoms, corresponding to a potential reportable condition. potential reportable condition.

• This will be captured in the document/submission set/folder metadata This will be captured in the document/submission set/folder metadata eventCodeListeventCodeList

• Hospital A sends a required report to the appropriate Public Health agency P, Hospital A sends a required report to the appropriate Public Health agency P, and also sends an ED Encounter Summary (EDES) to the local XDS and also sends an ED Encounter Summary (EDES) to the local XDS repository. repository.

• Public Health determines that a review of recent ED encounters for patients Public Health determines that a review of recent ED encounters for patients with similar symptoms is necessary.with similar symptoms is necessary.

• A list of patients with the appropriate symptoms will be obtain, their potential A list of patients with the appropriate symptoms will be obtain, their potential contacts and other associated documentscontacts and other associated documents

• Public Health Officials will decide how to handle the situationPublic Health Officials will decide how to handle the situation


Clinical Research

• QRPH implementation profiles could be employed in QRPH implementation profiles could be employed in clinical trials clinical trials

• Selected patients are grouped based on certain criterias, Selected patients are grouped based on certain criterias, such as pathologysuch as pathology

• Pharmaceuticals trials Pharmaceuticals trials


llustration


Public Health Information Affinity Domain

Public Health Information Affinity Domain (PHIAD)?


The relationship between QRPH and other domains

Form Manager

Form Receiver

Form Archiver

Form Filler

Form Filler

Patient Encounter Source

Patient Encounter Consumer

Data Repository

Clinical Data Consumer

Information Source

Display

Document Registry

Document Consumer

Document Repository

Document Source

Enterprise Report Repository

Report Creator

Care Delivery

Information System Actors`

Actors Grouped for

Options

Document Source

Document Recipient

Monitoring Agent / Destination Agency

Submit Report [Reserved]

Provide and Register Document Set [ITI-14]

Retrieve Document [ITI-17]

Registry Stored Query[ITI-18]

Retrieve Document for Display [ITI-12]

Retrieve Specific Info for Display [ITI-11]

Patient Encounter Management [ITI-31]

Query For Existing Data[PCC-nn]

Retrieve Form [ITI-34]

Submit Form [ITI-35]

Archive Form [ITI-36]

Submit Aggregate Data [reserved]

Provide and Register Document Set [ITI-14]

Measure Definition [reserved]

Patient Admin Management (PAM)

Query for Existing Data(QED)

Retrieve Into for Display(RID)

Cross-Enterprise Document Sharing(XDS)

Cross-Enterprise Document Reliable Interchange (XDR)

Retrieve Form for Data Capture(RFD)

Key Actors from Other Profiles


Work accomplished by the domain

• Clinical Research Data CaptureClinical Research Data Capture– describes the content and format to be used within the describes the content and format to be used within the

Prepopulation Data transaction described within the RFD Prepopulation Data transaction described within the RFD Integration Profile. Integration Profile.

– The purpose of this profile is to support a standard set of data in The purpose of this profile is to support a standard set of data in CCD format which the Form Filler provides for use in CCD format which the Form Filler provides for use in Clinical Clinical Research. Research.

– In addition this profile will reference the ability to convert this output In addition this profile will reference the ability to convert this output into a into a standard case report form standard case report form (Standard CRF) consisting of (Standard CRF) consisting of ODM and CDASHODM and CDASH



• Drug Safety ContentDrug Safety Content– describes the content and format to be used within the describes the content and format to be used within the

Prepopulation Data transaction described within the RFD Prepopulation Data transaction described within the RFD Integration Profile. Integration Profile.

– supports a standard set of data in the Continuity of Care Document supports a standard set of data in the Continuity of Care Document (CCD) format which the Form Filler provides for use in reporting (CCD) format which the Form Filler provides for use in reporting adverse events adverse events as it relates to as it relates to Drug SafetyDrug Safety. .

– C-76 by HITSP.C-76 by HITSP.

– In addition, as potential reference implementation this profile will In addition, as potential reference implementation this profile will reference the ability to convert this output into the ICH E2B M reference the ability to convert this output into the ICH E2B M standard. standard.



• Performance Measurement Data Element Structured for Performance Measurement Data Element Structured for EHR ExtractionEHR Extraction– describes mechanisms to communicate patient-level data to local describes mechanisms to communicate patient-level data to local

or third-party analyzer systems for management, aggregation and or third-party analyzer systems for management, aggregation and reporting of quantitative quality indicators or measurements to reporting of quantitative quality indicators or measurements to destination systems. destination systems.

– describes a data set for the measurement of a quality indicator describes a data set for the measurement of a quality indicator defined by the American Heart Association (AHA) and American defined by the American Heart Association (AHA) and American College of Cardiology (ACC). College of Cardiology (ACC).

– This quality indicator is based on the prescription of an Angiotensin This quality indicator is based on the prescription of an Angiotensin Converting Enzyme Inhibitor <ACEI> or Angiotensin Receptor Converting Enzyme Inhibitor <ACEI> or Angiotensin Receptor Blocker <ARB> on discharge for a patient with an episode of Acute Blocker <ARB> on discharge for a patient with an episode of Acute Myocardial Infarction <AMI>, who exhibits Left Ventricular Systolic Myocardial Infarction <AMI>, who exhibits Left Ventricular Systolic Dysfunction <LVSD>. Dysfunction <LVSD>.



• Performance Measurement Data Element Structured for Performance Measurement Data Element Structured for EHR ExtractionEHR Extraction– describes the content and format to be used within the Prepopulation describes the content and format to be used within the Prepopulation

Data transaction described within the RFD Integration Profile. Data transaction described within the RFD Integration Profile.

– supports a standard set of data in the Continuity of Care Document supports a standard set of data in the Continuity of Care Document (CCD) format which the Form Filler provides for use in reporting (CCD) format which the Form Filler provides for use in reporting adverse events adverse events as it relates to as it relates to Drug SafetyDrug Safety. .

– C-76 by HITSP.C-76 by HITSP.

– In addition, as potential reference implementation this profile will In addition, as potential reference implementation this profile will reference the ability to convert this output into the ICH E2B M reference the ability to convert this output into the ICH E2B M standard. standard.


Work considered for the new cycle

• Chronic Disease Management Reporting (CDMR)Chronic Disease Management Reporting (CDMR)• Cross-system protocol insertion (CSPI)Cross-system protocol insertion (CSPI)• Maternal Child Health – coordination with PCCMaternal Child Health – coordination with PCC• Diabetes Care ManagementDiabetes Care Management• New-born screening – passed onto Planning committeeNew-born screening – passed onto Planning committee• Performance Quality ReportPerformance Quality Report

• Maintenance work:Maintenance work:– Update of the CRD based on the CDASH v 1.0Update of the CRD based on the CDASH v 1.0– Update of the technical framework PEQDUpdate of the technical framework PEQD– Drug Safety Profile - work following public commentsDrug Safety Profile - work following public comments

• ITI ITI – ITI Pseudonymization ITI Pseudonymization – Muliple Patient Queries Muliple Patient Queries


Infrastructure used in CRDC - RFD

• RFD - Retrieve Form for Data CaptureRFD - Retrieve Form for Data Capture– provides a method for gathering data within a user’s current provides a method for gathering data within a user’s current

application to meet the requirements of an external system. application to meet the requirements of an external system.

– supports the retrieval of forms from a form source, display and supports the retrieval of forms from a form source, display and completion of a form, and return of instance data from the display completion of a form, and return of instance data from the display application to the source application.application to the source application.

– relies upon XForms technology to support negotiation between the relies upon XForms technology to support negotiation between the form display and form provider systemsform display and form provider systems

• form selectionform selection

• completion of a series of formscompletion of a series of forms

• partial completion of formspartial completion of forms

• returning to forms partially filled out in earlier sessions. returning to forms partially filled out in earlier sessions.

• supports archiving a copy of the completed form. supports archiving a copy of the completed form.


Infrastructure used in QRPH – Publish and Subscribe

• Publish and subscribePublish and subscribe– Allows for event-based notificationsAllows for event-based notifications– Currently an implementable white paper for XDS-based Pub/SubCurrently an implementable white paper for XDS-based Pub/Sub– XDS-based pub/sub uses Stored Query as the topics of XDS-based pub/sub uses Stored Query as the topics of

subscription, currently limited to single patientssubscription, currently limited to single patients– With the proposed multi-patient stored query, more general topics With the proposed multi-patient stored query, more general topics

will be availablewill be available– This year a generalized pub/sub infrastructure is being proposed in This year a generalized pub/sub infrastructure is being proposed in

ITIITI


Content Profiles used in QRPH

• PCCPCC• PathologyPathology• LaboratoryLaboratory• RadiologyRadiology• ALL….ALL….• An umbrella or a means of coordination for:An umbrella or a means of coordination for:

– Secondary use of dataSecondary use of data– Population safetyPopulation safety– Repurposing of dataRepurposing of data


Questions?

[email protected]@sante.gouv.fr

IHE Quality, Research and Public Health – QRPH domain November 05, 2008 Changing the Way Healthcare Connects Ana ESTELRICH, GIP-DMP, FRANCE.

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