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Cypress nlm himss13_03042013



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  • 1. Improving  the  Clinical  Quality  Measure   Tes8ng  and  Cer8fica8on  Process     HIMSS13   March  4,  2013  
  • 2. 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   2  
  • 3. Cypress  Overview   •  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   3  
  • 4. 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     4  
  • 5. Types  of  Feedback  Collected   •  eCQM  Logic   •  Value  Sets   •  QRDA-­‐I  Test  Data    (Capture/Export)   •  QRDA-­‐III  Test  Data  (Compute)   5  
  • 6. 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?   6  
  • 7. 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   7  
  • 8. 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?   8  
  • 9. Value  Set  Authority  Center  (VSAC)   Phase 2 Phase 1 Authorship Curation Delivery Consumption Integration with Web page Authoring Tool(s) to Controlled population for support value set Value Set human authorship Repository consumption API & Validation Engine Web download / Free-standing, web- API web services for based value set machine authoring tool(s) NLM consumption ONC Value Set / Measure NLM Vendors Consensus Authors Providers Org(s) Consensus Public Health Organization(s) Orgs 9  
  • 10. Value  Sets  –  Downloadable  Resources  Table   Packages available for EP, EH, and EP+EH measures CMS ID Value Set Name QDM Category 10  
  • 11. Value  Sets  –  Code  System  Filter   Statin prescribed at discharge Show only value sets containing RxNorm codes 11  
  • 12. 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   12  
  • 13. 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   13  
  • 14. 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   14  
  • 15. 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   15  
  • 16. Response  to    QRDA-­‐III  Cer:fica:on  Feedback   •  Feedback  to  HL7  HQMF  revision  process   •  Sofware  fixes   •  Feedback  to  eCQM  update  process   16  
  • 17. 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   17  
  • 18. 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   18  
  • 19. Communica:ons  Channels   •  Cypress  Email  Lists   –  -­‐  public  e-­‐mail  list   –  -­‐  broadcast  list   –  Details  on  hqp://   –  ONC  Tes8ng  and  Cer8fica8on  Team   •  ONC  Jira  for  Issue  Tracking   –  General  CQM  Tracker   hqps://cqm-­‐issue-­‐   –  Cypress-­‐specific  Tracker hqps://cqm-­‐issue-­‐   •  VSAC  updates  listserv     –  Go  to  hqps://­‐bin/wa.exe?A0=nlm_vsac_updates   –  Click  on  ‘Subscribe  or  Unsubscribe’   –  Enter  your  name,  e-­‐mail,  and  click  ‘Subscribe  (NLM_VSAC_UPDATES)’   19  
  • 21. BACKUP   21  
  • 22. Capture  and  Export    Current  Concept  of  Opera:ons   22  
  • 23. Import,  Calculate  and  Electronic  Submission  Concept  of  Opera:ons   23  
  • 24. 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     24  
  • 25. 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   25