CCDs or QRDA’s for

eCQM Reporting?

FQHC popHealth Pool Project

■ popHealth is an Open-Source Clinical Quality Measure database

and reporting engine presented through a web-based interface

■ Centralized repository of clinical data

■ Data is sent from EHRs via nationally recognized standards

– Consolidated Clinical Data Architecture (C-CDA) Architecture Continuity of

Care (CCD)Document or QRDA Cat 1

■ Clinical Quality Measures (CQMs) are calculated for providers

and presented through a web-based interface

– Drill down ability to the provider and patient-level data

– Ability to compare a provider to the aggregate

■ Track trends in quality and health over time

■ Identify areas for improvement in workflow and data capture

Data Flow for Population Health Management

Population Health

Reporting Tool

Providers Collaborate on Patient Health

Electronic Medical

Records Database for

Practice

Clinicians Enter Patient

Data into EMR

Secure Transfer of

Patient Data

popHealth Today for FQHCs

CCD Data

Aggregate Data

popHealth Database

FQHC 1 Data

FQHC 2 Data

FQHC 3 Data

FQHC 4 Data

popHealth

Reporting Tool

Role-based web access

MU Stage 1 and 2

Reports

Overall measures with

ability to drill down

HIPAA compliant

Aggregated population

health reports

FQHC 1

EHR

CCD DataFQHC 2

EHR

CCD DataFQHC 3

EHR

CCD DataFQHC 4

EHR

CCD via Batch

Aggregate Data

popHealth Database

Provider Data

Hospital Data

FQHC Data

Other Data

popHealth

Reporting Tool

Provider CQMs

DPH Reporting

DSS/Medicaid

QRDA Cat III Docs

Comparison to cohort

Grant CQMs

PCMH

ACO

EHR 1

CCD via DirectEHR 2

QRDA Cat 1EHR 3

QRDA via DirectEHR 4

popHealth Next Generation

■HL7 - Health Level Seven International

■CDA – Clinical Document Architecture (An architecture

with templates for clinical documents e.g. CCDs)

■CCDA – Consolidated Clinical Document Architecture

(Similar to CDA)

■CCD – Continuity of Care Document (A summary

document for a single patient)

■QRDA – Quality Reporting Document Architecture

■HQMF - Health Quality Measure Format (eMeasure)

■eCQM – Electronic Clinical Quality Measure

■CIPCI – Connecticut Institute for Primary Care

Innovation

Acronyms

■ Output of the effort to create one guide that could be used for implementation and analysis of documents within the CDA standard

■ The Consolidated CDA solution is a library of reusable CDA templates

■ Templates can be utilized at multiple levels within a CDA document:

– Level 1: Document Level Templates, such as CCD or Discharge Summary, can be utilized to define a template for the document as a whole.

– Level 2: Section Level Templates, such as Allergies or Medications, can be utilized to define what specific information will be included in each section.

– Level 3: Entry Level Templates, such as specific Observations or Procedures, can be utilized to define how the information is encoded within each section.

■ Consolidated CDA has a document level template for CCD

■ QRDA uses parts of C-CDA framework but is not a template

Consolidated CDA

■ HL7 QRDA is a standard document format for the exchange of electronic clinical quality measure (eCQM) data.

■ QRDA reports contain data extracted from electronic health records (EHRs) and other information technology systems. QRDA reports are used for the exchange of eCQM data between systems for a variety of quality measurement and reporting initiatives.

■ QRDA makes use of CDA templates, which are business rules for representing clinical data consistently. Many QRDA templates are reused from the HL7 Consolidated CDA (C-CDA) standard.

■ Templates defined in the QRDA Category I and III enable consistent representations of quality reporting data to streamline implementations and promote interoperability.

QRDA Architecture

■ A QRDA Category I report is an individual patient quality report. Each report contains quality data for one patient for one or more eCQMs, where the data elements in the report are defined by the particular measure(s) being reported. A QRDA Category I report contains raw applicable patient data (e.g., the specific dates of an encounter, the clinical condition) using standardized coded data (e.g., ICD-9-CM, SNOMED CT®). When pooled and analyzed, each report contributes the quality data.

■ A QRDA Category III report is a standard structure to use in reporting aggregate quality measure data. Each report contains aggregate quality data for one provider for one or more eCQMs. a necessary to calculate population measure metrics.

QRDA Documents

■ Part of C-CDA Architecture

■ Extensive clinical data

– Allergies: RxNorm*, SNOMED-CT*

– Care Goals, Social History, Medical Equipment: SNOMED-CT*

– Conditions: SNOMED-CT*, ICD-9-CM, ICD-10-CM

– Encounters: CPT

– Immunizations, Medications: RxNorm*, CVX*

– Procedures: CPT, ICD-9-CM, ICD-10-CM, SNOMED-CT*

– Vitals, Results, Assessments: LOINC*, SNOMED-CT*

– Communications: SNOMED-CT

■ * preferred

■ All continuity of care entries are time-stamped

■ Results and vitals must be provided structured with units and

values

Continuity of Care Document

CCD/CCD 1.1

■ Clinical summary document for patient history of procedures, encounters, allergies, medications, etc.

■ Main body of data contains different sections for different clinical data components e.g. medical history, procedures, medications, etc.

■ The data sections are larger and have more general templates for procedures, encounters, etc.

CCD vs. QRDA Cat I

QRDA Cat 1

■ QRDA reports are generated based on a CQM request. The data contained in the QRDA file is specific to certain CQMs.

■ Main body of data is divided into three segments: -reporting measure(s) -reporting parameters (rep period) - patient data

■ Templates are more specific and thorough, with smaller general sub groups.

■ Newer standard – less tested

CDA and QRDA Comparison

Header (template IDs)

Author, Custodian,Informant, etc

Patient Information

Provider Information

Structured sections- Procedures- Medications- Problems/Allergies- Encounters- Results Etc.

Header (template IDs)

Author, Custodian,Legal Authenticator, etc.

Patient Information

Provider Information

Structured sections:- Procedures- Medications- Problems- Allergies- Encounters- Results Etc.

CCD (CDA) CCD 1.1 (CCDA)

Header (template IDs)

Author, Custodian, Legal Authenticator, etc

Patient Information

Provider Information

Three 'components'- Measures- Reporting parameters- Patient Data (aggregate of entries for various sections)

QRDA Cat 1

Similarities Between CCD and QRDA

■ 2014 CEHRT requires standardized vocabularies to promote the use of common definitions when sharing information across diverse clinical environments. Both CCDs and QRDAs benefit from the standardized vocabulary.

– SnowMed

– CPT

– Loin

– etc

■ QRDA and CCD/CCR overlap considerably in data content.

■ Both utilize C-CDA framework

Pros

■ QRDA Category I carries quality data tailored to a specific measure or measure set.

■ QRDA Cat Is align directly with QRDA Cat IIIs and eMeasures.

■ For widely used CQMs, they are the most direct and efficient way to calculate eCQMs.

QRDA Cat I Pros and Cons

Cons

■ QRDAs are new. The use of the QRDA Category 1 XML standard has been difficult due to lack of validation tests and example QRDA Category 1 XML files.

■ EHRs need to be programmed to create the QRDA data for each CQM. Most EHRs will not support all CQMs.

■ Limited to use for eCQMs

■ If you want to report on a new eQCM, EHRs need to be programmed to create the additional QRDA data set.

CCD Pros and Cons

Pros

■ CCDs carry single-patient data for transition of care. As a result they may contain some, but not all, of the data needed to determine whether or not a particular patient meets the population criteria within a particular measure.

■ CCD is a comprehensive clinical data set for a patient. This allows for ease of implementing new measures based on data collected in the EHR.

■ Broad set of clinical data which can be used outside of eMeasures.

Cons

■ CCD data is not always consistent from EHR to EHR.

■ Not developed specifically fro eCQMs.

■ There is no right answer – it depends on the use case you have

■ QRDA

– eCQM reporting

■ CCD

– Clinical data repository

– Reporting on eCQMs that are not part of MU

Which to Use?

EMRs to popHealth

http://worldvista.org/login_form

https://app.smartemr.com/patient_portal/pp_main.php

https://www.healthvault.com/us/en

http://cicats10.engr.uconn.edu:10081/ope

nemr

CCR/

CCD

CCR/

CCD

Main Dashboard

Individual Provider Statistics

Individual Provider Dashboard

Measure Criteria

List of Applicable Patients for a Measure

Patient Summary