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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	
  

                                                                               2	
  
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	
  
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	
  
Types	
  of	
  Feedback	
  Collected	
  


  •    eCQM	
  Logic	
  
  •    Value	
  Sets	
  
  •    QRDA-­‐I	
  Test	
  Data	
  	
  (Capture/Export)	
  
  •    QRDA-­‐III	
  Test	
  Data	
  (Compute)	
  




                                                              5	
  
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	
  
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	
  
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	
  
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	
  
Value	
  Sets	
  –	
  Downloadable	
  Resources	
  Table	
  


                                       Packages available for EP, EH, and EP+EH measures

                                         CMS ID       Value Set Name QDM Category




                                                                                           10	
  
Value	
  Sets	
  –	
  Code	
  System	
  Filter	
  


                                                     Statin prescribed at discharge




                                           Show only value sets containing RxNorm codes




                                                                                          11	
  
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	
  
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	
  
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	
  
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	
  
Response	
  to	
  	
  
QRDA-­‐III	
  Cer:fica:on	
  Feedback	
  


  •  Feedback	
  to	
  HL7	
  HQMF	
  revision	
  process	
  
  •  Sofware	
  fixes	
  
  •  Feedback	
  to	
  eCQM	
  update	
  process	
  




                                                                16	
  
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	
  
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	
  
Communica:ons	
  Channels	
  

 •  Cypress	
  Email	
  Lists	
  
      –  talk@projectcypress.org	
  -­‐	
  public	
  e-­‐mail	
  list	
  
      –  announcement@projectcypress.org	
  -­‐	
  broadcast	
  list	
  
      –  Details	
  on	
  hqp://projectcypress.org/faq.html	
  
      –  ONC	
  Tes8ng	
  and	
  Cer8fica8on	
  Team	
  ONC.Cer8fica8on@hhs.gov	
  

 •  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)’	
  


                                                                                                        19	
  
QUESTIONS	
  AND	
  FEEDBACK	
  AND	
  
FEEDBACK	
  
BACKUP	
  


             21	
  
Capture	
  and	
  Export	
  	
  
Current	
  Concept	
  of	
  Opera:ons	
  




                                            22	
  
Import,	
  Calculate	
  and	
  Electronic	
  Submission	
  
Concept	
  of	
  Opera:ons	
  




                                                              23	
  
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	
  
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	
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Cypress nlm himss13_03042013

  • 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   –  talk@projectcypress.org  -­‐  public  e-­‐mail  list   –  announcement@projectcypress.org  -­‐  broadcast  list   –  Details  on  hqp://projectcypress.org/faq.html   –  ONC  Tes8ng  and  Cer8fica8on  Team  ONC.Cer8fica8on@hhs.gov   •  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)’   19  
  • 20. QUESTIONS  AND  FEEDBACK  AND   FEEDBACK  
  • 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