1. A Unified Quality Measure
Execution Engine (UQME)
for the Philips HSDP
Pelagia Sykoudi
PDEng Thesis Presentation
September 18, 2015
SAI TU/e Software Technology Program
4. Quality of
healthcare
services
Healthcare
Services
Patients
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
4
Patients need to be provided appropriate healthcare services.
In order to ensure this, we need to measure quality of delivering healthcare services.
It is not just a matter of what is provided but also how they are provided and what is the
experience of patients.
5. What is Quality?
• Healthcare delivery must be safe
• Healthcare delivery must be effective
• Healthcare delivery must be patient-centered
• Healthcare delivery must be timely
• Healthcare delivery must be efficient
• Healthcare delivery must be equitable
5
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
7. 7
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
In order to measure quality we need to first unambiguously define “Quality Measure.”
Quality Measures are tools that help us measure or quantify healthcare processes,
outcomes, patient perceptions, organizational structure.
What is a Quality Measure or Indicator?
Example: the number of re-admittances for heart failure patients who were administered
aspirin in Emergency Department (ED) over the ones not administered aspirin in ED.
8. 8
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
How are Quality Measures defined?
Clinical
Practice
Guidelines
Quality
Measures
• What did
happen
• What should
happen
How are they executed or used in a uniform fashion against the healthcare
data sources e.g. EMRs?
Healthcare
Standards
• Uniformity of health data
• Interoperability
9. Example Quality Measure: Ratio of adult obese non-smoker patients, who follow
physical activities.
9
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
Initial
Population
Denominator
Denominator
Exclusion
Numerator
10. 10
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
Example Quality Measure: Ratio of adult obese non-smoker patients, who follow
physical activities.
12. What is HL7 International?
12
HL7 International is an ANSI non-profit organization focusing on healthcare standards development.
Providing specifications or protocols oriented to healthcare domains such as:
Pharmacy Claims
Processing
Devices
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
13. 13
To improve healthcare delivery in terms of its workflow
To transfer knowledge between different providers
To establish the best and most widely used standards in healthcare
HL7 objective?
HL7 publishes: Health Quality Measure Format
(HQMF)
Quality Report Document Architecture
(QRDA)
Defines a quality measure
Reports the results of a
quality measure
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
14. HQMF
It represents internationally the clinical quality measure metadata, data elements and logic.
HQMF defines quality measure as:
14
Ratio/Proportion
Cohort
Continuous
Variable
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
16. HQMF
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
HQMF Body
HQMF Header
HQMF Document Structure
Table of Contents
• Data Criteria Section
• Population Criteria Section
Title: Adult obese non-smoker patients, who follow physical activities.
Measure Period: 01/01/2014 – 31/12/2014
Measure id: 0012
Measure Type: Process
Measure Scoring: Proportion
Data Criteria Section
• Obese patients (diagnosis)
• Patients older than 18 years old (patients characteristic)
• Patients who smoke (patients characteristic)
• Patients who follow physical activities (participation activities)
• Patients race (patients characteristic)
• Patient gender (patients characteristic)
HQMF Body
Population Criteria Section
• Initial Patient Population
All True
At least one true
Obese patients
• Denominator
All True
At least one true
Patients older than 18 years old
• Denominator Exclusion
All True
At least one true
Patients who smokes
• Numerator
All True
At least one true
Patients who follow physical activities
• Numerator Exclusion
None
1 2
16
Patients weighted more than 80 kg
17. 17
QRDA
It is a template healthcare standard document used to report the results of indicators
computed by HQMF documents.
QRDA
reports results
Populations:
Initial Population
Denominator
Numerators
Exclusions
Stratifiers
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
21. “The design and development of a standard-based unified quality measure
execution engine, using HL7 standards, providing scalable quality measurements in
interoperable health data, integrated with the Philips HSDP.”
21
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
Why do we need a uniform standard-based solution?
• Multiple businesses inside Philips have need to provide quality measure
dashboards to their customers
• HSDP need a scalable quality measure execution engine that could address
needs of different business using HSDP
23. 23
1. A medical practitioner will be able to select a clinical or claims quality measures from a
list for executing quality measures
2. A medical practitioner will be able to use a document quality measures in HQMF R1/R2
or R2.1 document
3. The system will be able to map HQMF elements to executable queries
4. A medical practitioner will be able to view the results of quality measures through
graphs
Requirements
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
31. HQMF elements to Query transformation
31
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
Data criterion
Population criteria
Condition
Combined
Condition
WHERE statement
Combined WHERE
statements using
Logical Operators
34. 34
Health – data – standards
Cypress:
UQMEE is a web application software solution with the
following technologies:
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
35. Prototype Data model
35
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
Activities
Patients
Diagnosis
Encounters
Costs
Measurements
Medications
Participations
Transfers
Programs
Procedures
1..n
0..n
0..n
n
1
0..n
1..n
1 n 1
1
1
0..n
0..n
0..n
40. What was the problem?
There was a need to design and implement a standard-based
(HL7) quality measure execution engine for HSDP.
What we get?
Gain knowledge in healthcare quality measure standards
Provide an architecture and implementation of a UQMEE
Use HQMF R1, R2, R2.1 and QRDA (HL 7)
QMI and QME decoupling
Conclusions
40
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
41. 41
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
Lessons learnt
• The domain is vast, multiple concepts included, many
extensible options exist
• Healthcare standards contain a high level of complexity
and require extensive study
• Rapid Prototyping for quick hypothesis validation vs long
term product development
42. • Integration with HSDP
• Development of authoring measures environment
• Further investigation in open source solutions
• Enable security features
Recommendations
42
1. Context
2. Intro to Quality
Measure Standards
3. Problem Statement 4. Requirements 5. Architecture 6. Implementation 7. Demo 8. Conclusions
43. 43
Philips Research
Steffen Pauws
Asim Muhammad
Charalampos Xanthopoulakis
People from the office
OOTI program
Ad Aerts
Harold Weffers
Acknowledgements..
Cypress Community
Open source and internet community
