Overview of the popHealth® open source population health and CQM Reporting system. Includes information on eHealthConnecticut FQHC implementation of popHealth®. Description of CCDs and QRDAs as well as pros and cons of using each. Includes popHealth® screen shots. Presented by Jackie Mulhall, eHCT, at Connecting Michigan for Health Conference June 2014.

1. CCDs or QRDA’s for
eCQM Reporting?

2. 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

3. 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

4. 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

5. 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

6. ■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

7. ■ 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

8. ■ 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

9. ■ 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

10. ■ 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

11. 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

12. 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

13. 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

14. 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.

15. 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.

16. ■ 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?

17. 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

18. Main Dashboard

19. Individual Provider Statistics

20. Individual Provider Dashboard

21. Measure Criteria

22. List of Applicable Patients for a Measure

23. Patient Summary