HL7 Crossing The Chasm FE 20Apr2009
Quality MeasurementHL7 Crossing the ChasmApril 20, 2009Floyd Eisenberg, MD, MPH, FACPSenior Vice President, Health Information Technologyfeisenberg@qualityforum.orgNational Quality Forumwww.qualityforum.org
Content » NQF » Mission improve the quality of American healthcare by settingnational priorities and goals for performanceimprovement endorse national consensus standards for measuringand publicly reporting on performance promote the attainment of national goals througheducation and outreach programs2www.qualityforum.org
Content » ParticipantsAHRQFoundationsQIOsRegional CollaborativesProvidersOversight OrganizationsEmployersHealth PlansFed/State GovtHealth PlansEmployersConsumersProvidersNQF National Priority Partnersevaluatehealth rities1. High QualityConsumer2. EquitableOutcomes3. Affordable4. sFed/State Govt.Health implement, testand aggregateresultsQASCRegional CollaborativesRHIOs/HIEsCMSStatesHealth Data StewardsDRAFT - Quality Alliance Steering CommitteecreatemeasuresNCQAThe Joint CommissionAMA PCPIMedical SocietiesMedical Specialty BoardsCMSAHRQOthers**NQFQASCQuality AlliancesJoint CommissionNCQAMedical SpecialtyBoards3www.qualityforum.org
Content » NQF » Membership A private, non-profit voluntary consensus standards-settingorganizationBroad membership (350 members) organized into 8 Councils that– Provide stakeholder perspectives to all NQF deliberations;– Enable various groups within a council to convene, identifyissues and relay information in a unified voice; and– Promote collaboration among different groups within astakeholder perspective.Councils:– Consumers– Health Care Professionals– Health Plans– Provider Organizations– Public/Community Health Agencies– Purchasers– Research and Quality Improvement Organizations– Supplier & Industry4www.qualityforum.org
Content » NQF » Selected ProjectsNational Voluntary Consensus Standards forNursing Home CareHospital CareHealthcare-associated InfectionsESRD CareAmbulatory CareHealth IT Structural Measures5www.qualityforum.org
Content » NQF » National Priority Partnersnationalpriorities establish national priorities and goals for performancemeasurement and public reporting focus measurement and improvement efforts onachievement of these goals multi-stakeholder Committee with representation from 27leadership organizations6www.qualityforum.org
Content » NQF » National Priority Partners27 multi-stakeholder organizations Consumers PurchasersQuality alliancesHealth professionals/providersPublic sector: CMS, NGA, CDC, AHRQ, NIHAccreditation/certification groupsHealth plansCo-Chairs:Donald BerwickInstitute for Healthcare ImprovementMargaret O'KaneNational Committee for Quality Assurance7www.qualityforum.org
Content » NQF National Priority rmEradicateDisparities8www.qualityforum.org
Content » NQF » National Priority PartnersHigh Impact Areas Patient and family engagementPopulation healthSafetyPalliative careCare coordinationOveruseManagement of patient-focused episodes9www.qualityforum.org
Content » NQF » NPP Framework10www.qualityforum.org
Content » NQF » Strategic Goals high system performance composite measurement outcomes disparities11www.qualityforum.org
Quality and Information TechnologyF712www.qualityforum.org
Structure » Quality MeasureA “well-defined quality measure” iscomposed of a set of common data elements,encoded using standard taxonomies,structured logically into a standardizedexpressionthat can be shared and applied to patient dataand reported13www.qualityforum.org
Structure » Active Project – 26 MeasuresCMS HITSP Project – Spring 2009Standardize specifications for three (3) inpatient measure sets:1. Venous Thromboembolism (VTE - 8)2. Stroke (STK – 6)3. Emergency Department (ED – 2)4. Physician Quality Reporting Initiative (PQRI) AmbulatoryMeasures (PQRI – 10)5. Demonstration6. Certification14www.qualityforum.org
Inpatient MeasuresVenous Thromboembolism (VTE)-1 This measure assesses the number of patientswho received VTE prophylaxis or havedocumentation why no VTE prophylaxis wasgiven the day of or the day after hospitaladmission or surgery end date for surgeries thatstart the day of or the day after hospitaladmission.15www.qualityforum.org
Inpatient MeasuresVTE Prophylaxis MedicationWarfarin eHeparin SubQ onlyCalcileanHeparin SubQ onlyHEPHeparin SubQ onlyHepaleanHeparin SubQ onlyHeparinHeparin SubQ onlyHeparin CalciumHeparin SubQ onlyHeparin LeoHeparin SubQ onlyHeparin NaHeparin SubQ onlyHeparin SodHeparin SubQ onlyHeparin SodiumHeparin SubQ onlyHeparin Sodium Inj.Heparin SubQ onlyHeparin Sodium Inj. PorkHeparin SubQ onlyHeparin Subcu/ SQ/SC/SubQHeparin SubQ onlyLiquaeminHeparin SubQ rin CalciumDanaparoidLMWHHeparin LeoEnoxaparinLMWHHeparin NaFragminLMWHHeparin SodInnohepLMWHHeparin SodiumLovenoxLMWHHeparin Sodium Inj.NormifloLMWHHeparin Sodium Inj. PorkOrgaranLMWHHeparin Subcu/ SQ/SCTinzaparinLMWHLiquaeminHepaleanArgatroban (Acova)HeparinBivalirudin (Angiomax)Heparin CalciumLepirudin (recombinanthirudin) (RefludanHeparin LeoArixtraHeparin SodHeparin NaHeparin SodiumFondaparinuxsodiumCalciparineHeparin Sodium Inj.Heparin Sodium Inj. PorkHeparin Subcu/ SQ/SCCalcileanHEPLiquaemin16www.qualityforum.org
Inpatient MeasuresVTE Prophylaxis – Non-medicationPAS (Pulsatile anti- embolic stockings)IPCPlexipulse-calf/thighIPCPneumatic intermittent impulse compressiondeviceIPCAnti-Embolism stockingsGCSAnti-thrombosis stockingsGCSElastic support hoseGCSGraduated compression elastic stockingsGCSRapid inflation asymmetrical compression(RIAC) devicesIPCJobst stockingsGCSSequential compression deviceIPCSurgical hoseGCSSequential pneumatic hoseIPCTED hose (TEDs)GCSThromboguardIPCWhite hoseGCSThrombus pumps- calf/thighIPCThrombosis stockingsGCSVascuthermIPCAE pumps (anti-embolic pumps)- calf/thighIPCAlternating Leg Pressure (ALP)IPCVenodyne boots - calf/thighIPCAthrombic pumps- calf/thighIPCAE pumps-foot onlyFoot PumpDVT boots- calf/thighIPCA-V impulse systemFoot PumpEPC cuffs/ stockings- External pneumaticcompression- calf/thighFoot pumpFoot PumpIPCKendall AV impulse (foot)Foot PumpFlotron/ FlotronIPCKendall bootsFoot PumpDVT system- thigh highIPCPlantar venous plexus pump - foot onlyFoot PumpImpulse pump -thighIPCPlexiboots- foot onlyFoot PumpIntermittent pneumatic compression stockingsIPCPneumoboots – foot onlyFoot PumpIntermittent compression device (ICD)IPCSC boots- foot onlyFoot PumpKCI stockingsIPCSCD boots- foot onlyFoot PumpLeg pumpersIPCVasoPress DVT SystemVenous foot pumpIPC17www.qualityforum.orgFoot Pump
Inpatient Measures Exclusions:––––Clinical TrialComfort Measure OnlyMedical ReasonPatient Refusal18www.qualityforum.org
Inpatient Measures Other Measures – Selected Elements–––––Warfarin prescribed at dischargeTime last known wellMonitor using algorithmOverlap therapy – Heparin & WarfarinPre-arrival treatment with lipid loweringagent– Surgery end time– Assessed for Rehab Services– VTE confirmed19www.qualityforum.org
Inpatient MeasuresTotal 89 Data Elements#% of elementsEHR Issue4652%Measure Modification2022%Policy Issue2528%Direct Match1719%22%Unclear20www.qualityforum.org
Structure » Quality Data SetBuild Quality Data Set (QDS) from Existing Measures21www.qualityforum.org
Structure » Quality Data SetBuild Quality Data Set (QDS) from Existing MeasuresMedicationList Data Elements22www.qualityforum.org
Structure » Quality Data SetBuild Quality Data Set (QDS) from Existing MeasuresMedicationApply Data Elements toIndividual Measures(Reuse individual elements)23www.qualityforum.org
Structure » Quality Data SetBuild Quality Data Set (QDS) from Existing MeasuresAND Data FlowRecorder24www.qualityforum.org
Structure » Quality Data SetBuild Measures From Individual QDS Elements:Adding LogicCoronary ArteryAND DiabetesDiseaseAND / ORACE I PrescriptionOR ARB Prescription - ACE I Allergy ARB Allergy - Med Reason - EtcModerately or SeverelyDepressed Left VentricularSystolic Function25www.qualityforum.org
Connecting the rt26www.qualityforum.org
Venodyne boots- calf/thigh VasoPress DVT System IPC Vascutherm IPC Thrombus pumps - calf/thigh IPC Thromboguard IPC Sequential pneumatic hose IPC Sequential compression device IPC IPC Rapid inflation asymmetrical compression (RIAC) devices IPC Pneumatic intermittent impulse compression device Plexipulse-calf/thigh IPC
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
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HL7 Messaging Tool - EHR Vendor All new products will be listed under Your Product List. To start validating products go to the Validating EHR Projects/Versions section under Validating HL7 Messages. Validating HL7 Messages This section will go into detail on how to validate each EHR Product, Group HL7 Messages, and Practice HL7 Messages.
(EHR) system, and creating a data model for that database is challenging due to the EHR system's special nature. Because of complexity, spatial, sparseness, interrelation, temporal, . Entry PACS Billing HL7 & DICOM HL7 HL7 HL7 HL7 HL7 IJCSI International Journal of Computer Science Issues, Vol. 9, Issue 5, No 1, September 2012
On an exceptional basis, Member States may request UNESCO to provide thé candidates with access to thé platform so they can complète thé form by themselves. Thèse requests must be addressed to esd rize unesco. or by 15 A ril 2021 UNESCO will provide thé nomineewith accessto thé platform via their émail address.
̶The leading indicator of employee engagement is based on the quality of the relationship between employee and supervisor Empower your managers! ̶Help them understand the impact on the organization ̶Share important changes, plan options, tasks, and deadlines ̶Provide key messages and talking points ̶Prepare them to answer employee questions
Dr. Sunita Bharatwal** Dr. Pawan Garga*** Abstract Customer satisfaction is derived from thè functionalities and values, a product or Service can provide. The current study aims to segregate thè dimensions of ordine Service quality and gather insights on its impact on web shopping. The trends of purchases have
HL7 C-CDA v1.1 MU 2014 HL7 C-CDA v2.0 HL7 C-CDA v2.1 MU 2015 2011 Edition/Stage 1 MU 2014 Edition/Stage 2 MU: – HL7 Implementation Guide for CDA Release 2: IHE Health Story Consolidation, DSTU Release 1.1 (US Realm) Draft Standard for Trial Use – HL7 Implementat
