Public Health Data Standards Consortium
http://www.phdsc.org
Public Health Data Standards Consortium
CDA EHDI Pilot Project
Clinical Document Architecture (CDA) for
Public Health
Educational Webinar
CDA State EHDI Pilot Projects:
Interoperability landscape
Overview
Background of Health IT Standards
 Overview of Standards Organizations
 IHE Organization, QRPH Domain
 Interoperability Standards

 Profiles
that Support Public Health
 EHDI Pilot Related Profiles: RFD, NANI, PCC
Medical Summaries, EHCP, QME-EH
 Shared Value Sets
CDA EHDI Pilot Project: Newborn Hearing Screening
Use Case
Newborn Hearing Screening
Actors:
Business Actors
Technical Actors
Newborn, Caregiver, Clinicians, Public Health Program Staff
EHR, HIE, Public Health (PH) EHDI IS
Flow of Events
1.
2.
3.
4.
5.
6.
Child is delivered.
Clinician conducts initial physical exam
Newborn is due for <hearing test>
Clinician orders an <hearing test>
Hospital staff conducts <hearing test>
Hospital staff enter data on the <hearing test> in the
EHR database and generate <Newborn Hearing
Screening (NHS) Outcome Report>
7.
Information is electronically sent on <NHS Outcome
Report > to the PH EHDI IS directly or via HIE
8. PH program EHDI IS receives Notification of Report
Availability
9. PH programs’ staff reviews the report and create PH
EHDI IS record on a child in PH EHDI IS and upload <NHS
Outcome Report > in PH EHDI IS
10. PH IS sends Acknowledgement of Receipt of the Report
to EHR directly or via HIE.
Pre-Conditions:
EHR System, Health Information Exchange (HIE)
Post-Conditions:
Public Health Information System <EHDI IS>
Preferred Timing
Daily updates
Data Categories
1&2. Demographics, Labor &
Delivery Record, Newborn EHR
3. Consent
4. Standing Order
5. Hearing Test Results
6. Hearing Test Results, NHS
Outcome Report
7. NHS Outcome Report
8. Notification of Report Availability
9. Updated Pubic Health EHDI
Record
10. Acknowledgement of Receipt
CDA EHDI Pilot Project Design
State-Specific EHDI Reporting Design
Birthing
Facility
EHR
(Vendors?)
CDA
NHS
Outcome
Report
Health
Information
Exchange
(HIE)
Or
Public
Health
Gateway
(Vendors?)
CDA
NHS
Outcome
Report
State
EHDI
Information
System
(Vendors?
)
CDA-based Actor Diagram
Care
Plan
PCP/
Pediatrician
Interoperability Standards for
CDA EHDI pilots
CDA
 CCD
 EHCP
 PCD01
 RFD
 XDR
 XDS
 LOINC


Vocabulary
 LOINC
 SNOMED-CT
Health Informatics
Standards Bodies

ASTM – American Standards for Testing and Materials





E31.15 Healthcare Information Capture and Documentation
E31.25 Healthcare Data Management, Security, Confidentiality, and
Privacy
E31.35 Healthcare Data Analysis
E31.90 Executive
ISO TC215 – Health Informatics

WG 1 Data Structure
 WG 2 Data Messaging
 WG 3 Semantics Content
 WG 4 Security, Safety, and Privacy
 WG 5 Health Cards
 WG 6 Pharmacy and Medication Business
 WG 7 Devices
 WG 8 Business Requirements for an EHR
 WG 9 Joint Initiative Council
 Operations, Harmonization, Executive Council
Health Informatics
Standards Bodies
HL-7 – Health Level 7












CCOW
Clinical Decision Support
Control/Query
Education (admin)
Financial Mgmt
Electronic Health
Records
Implementation (admin)
Marketing (admin)
Medical Records
Modeling & Methodology
Orders/Observations
Personnel Management











Patient Administration
Patient Care
Process Improvement
(admin)
Public Health and
Emergency Response
Publishing (admin)
Regulated Clinical
Research Info Mgmt.
Security
Scheduling & Logistics
Structured Documents
Tooling (admin)
Vocabulary
Health Informatics
Standards Bodies

NCPDP – National Council for Prescription Drug
Programs
WG1 Telecommunication
WG2 Product Identification
WG3 Standard Identifiers
WG4 Provider/Member Enrollment
WG5 Payment Reconciliation
WG7 Manufacturer Rebates
WG9 Government Programs
WG10 Professional Pharmacy Services
WG11 Prescriber/Pharmacist Interface
WG12 Education - Legislation and Regulation
WG14 Long Term Care
MC Maintenance and Control
Health Informatics
Standards Bodies

ASC X12N – Insurance/TG02-HEALTHCARE










WG1-HEALTH CARE ELIGIBILITY
WG2-HEALTHCARE CLAIMS
WG3-CLAIM PAYMENTS
WG4-ENROLLMENTS
WG5-CLAIMS STATUS
WG9-PATIENT INFORMATION
WG10-HEALTH CARE SERVICES REVIEW
WG12-INTERACTIVE HEALTHCARE CLAIMS
WG15-PROVIDER INFORMATION
WG20-INSURANCE TRANSACTION ACKNOWLEDGEMENT
Health Informatics
Standards Bodies
DICOM – Digital Imaging and Communications in Medicine
WG-01: Cardiac and Vascular
Information
WG-02: Projection Radiography
and Angiography
WG-03: Nuclear Medicine
WG-04: Compression
WG-05: Exchange Media
WG-06: Base Standard
WG-07: Radiotherapy
WG-08: Structured Reporting
WG-09: Ophthalmology
WG-10: Strategic Advisory
WG-11: Display Function Standard
WG-12: Ultrasound
WG-13: Visible Light
WG-14: Security
WG-15: Digital Mammography
and CAD
WG-16: Magnetic Resonance
WG-17: 3D
WG-18: Clinical Trials and
Education
WG-19: Dermatologic Standards
WG-20: Integration of Imaging
and Information Systems
WG-21: Computed Tomography
WG-22: Dentistry
WG-23: Application Hosting
Health Informatics
Standards Bodies

IHE – Interconnecting the Health Care Enterprise
 IT
Infrastructure
 Radiology
 Laboratory
 Cardiology
 Discussing Pharmacy
 Patient Care Coordination (Content)
 Quality Public Health and Research
 Pharmacy
 Anatomic Pathology
 Eye care
Health Informatics
Standards Bodies
SCDI – Standards Committee on Dental
Informatics
 Vocabulary standards (e.g. ICD, CPT,
SNOMED, NCPDP, LOINC, RxNorm…)
 National, Geographical Standards (e.g. CEN,
COACH, …)
 USP – United States Pharmacopeia
 Health Information Standards Technology
Panel
 ONC Health IT Standards Committee
 ONC IT Policy Committee

Associations, Membership
Organizations

Healthcare Information and Management Systems Society (HIMSS)


organization exclusively focused on providing leadership for the optimal use of
healthcare information technology and management systems for the betterment
of human health.
HIMSS Electronic Health Record Vendor Association (EHRVA)

The EHR Vendor Association (EHRVA) is a trade group comprised of vendors
who develop, market and support electronic health records software. Our
objective is to promote the adoption of EHR systems to support improved
efficiency and patient care in the healthcare delivery system.
 Annual HIMSS Conference attracts 22,000 attendees generally at CIO level

Medical Records Institute (MRI)

Mission is to promote and enhance the journey towards electronic health
records, e-health, mobile health, and related applications of information
technologies
 Annual TEPR Conference attracts 3,500 attendees of varying categories
(vendors, CIOs, IT Managers, Medical Records Managers, vendors, clinicians)

American Medical Informatics Association (AMIA) / International
Medical Informatics Association (IMIA)

dedicated to the development and application of medical informatics in the
support of patient care, teaching, research, and health care administration
 Annual Conference attracts 2,000 professionals, physicians, researchers, Health
Librarians, Technologists in an academic venue
Associations, Membership
Organizations

American Medical Association (AMA)



American Hospital Association (AHA)


The ADA is the professional association of dentists committed to the public's oral health,
ethics, science and professional advancement; leading a unified profession through
initiatives in advocacy, education, research and the development of standards.
American Academy of Family Practitioners (AAFP)


national organization that represents and serves all types of hospitals, health care networks,
and their patients and communities (focus on advocacy)
America Dental Association (ADA)


The American Medical Association speaks out on issues important to patients and the
nation's health (focus on advocacy)
Username/Password roaming digital id based on Verisign (historically Intel/AMA initiative)
The mission of the AAFP is to improve the health of patients, families, and communities by
serving the needs of members with professionalism and creativity through advocacy,
education, and practice enhancement
American Health Information Management Association (AHIMA)

community of professionals engaged in health information management, providing support to
members and strengthening the industry and profession.





Provides career, professional development and practice resources
Sets standards for education and certification
Advocates public policy that advances HIM practice
Facilitates member communication
Promotes the contributions of its members
What is “Integrating the Healthcare Enterprise”?

A 12-year public-private global initiative driven by end-users worldwide

Clinicians
Non-profit organizations



State & Federal agencies & related entities


State Depts Public Health
Governments:




USA: OASIS, CORE
France: GIP-DMP - French Ministry of Health
USA: American Heart Association
Worldwide: HIMSS, RSNA
Professional Societies

Representing 270,000+ individual members:
 HIMSS, RSNA, PHIN, ACC, ACP, AAO, ACCE, ASTRO, etc

Standards Development Orgs (SDOs):


HL7, DICOM, CDISC, W3C, IEEE, Etc.
Vendors & consultants (imaging, EHRs, Cardio, devices, etc)
Copyright IHE International
2009
17
IHE Mission




IHE improves patient care by harmonizing electronic
health information exchange
Enables approved standards to seamlessly pass health
information among care providers on a local, regional
and national level
IHE Frameworks are freely available to all
Ok, now translate – what does that really mean?
Copyright IHE
International 2009
e-HealthSign
18
Big concept = package approved standards into usable “tool kit or
package”
Package standards in usable packages (called profiles)
 Standards are a great thing to have, but how to best
assemble and use them? Example: Child car seats





Standard = All children younger than certain age had to
be in a car seat
Location: Not prescribed
Front seat - OK
New standard packaged the concept
Child in car seat + strapped in + facing backwards +
better sizing
Copyright IHE
International 2009
e-HealthSign
19
10 IHE Development Domains - Helping Public
Health More Directly
Pharmacy
NEW 2009
11 Years of Steady Evolution 1998 – 2010
Radiology
since 1998
Cardiology
since 2004
Pathology
since 2006
Eye Care
since 2006
(Healthcare)
IT Infrastructure
since 2003
Quality
Research & Public Health
since 2006
Patient Care Devices
since 2005
Copyright IHE International
2009
20
Laboratory
since 2004
Radiation Oncology
since 2004
Patient Care Coordination
since 2004
International Growth of IHE




Australia
Local Deployment
National Extensions
Promotional & Live Demonstration Events
Funding
Austria
Spain
China
Netherlands
Norway
Taiwan
Korea
Canada
UK
Japan
Italy
Germany
France
2088
2007
2006
2005
2004
2003
2002
2001
2000
1999
USA
Pragmatic global standards harmonization + best practices sharing
21
21
National and Regional Projects Using IHE Profiles
Lower
Austria
Netherland
Amsterdam
UK CfH
(Radiology WF)
France
DMP
Denmark (Funen)
Italy (Veneto)
Spain (Aragon)
Italy
(Conto Corrente Salute)
Austria
Quebec, Ontario,
Alberta, British Columbia
Canada Health Infoway
VITL-Vermont
Boston Medical
Center - MA
Philadelphia HIE
CPHIC –
Pennsylvania
CareSpark – TN & VA
South Africa
CHINA-Shanghai
Imaging Info Sharing
Malaysia
CHINA-MoH
Lab results sharing
JAPAN-Nagoya
Imaging Info Sharing
22
THINC- New York
NCHICA – N. Carolina
22
IHE, Global Standards-Based Profiles
Adopted in National & Regional Projects
Quebec, Toronto,
Alberta, British Columbia
Canada Infoway
VITL-Vermont
Harrison Med
Center
SouthShore
Decatur Hosp
& Practices
Boston Medical
Center - MA
Providence
HIE
MedVirginia-SSA
Philadelphia HIE
SHARP
Community
KeyHIE
Pennsylvania
Wake Forest
California
Prisons
http://tinyurl.com/WWXDS
NHIN – Kaiser/VA
CareSpark
– TN & VA
Central
Florida
THINC- New York
NCHICA – N. Carolina
IHE Profiles Drafted &
Revised
Test at IHE
Connectathons
Trial
Implementation
Published Posted
For Public
Comment
IHE Technical
Framework
Developed
Profile Selection by
Committees
IHE Call for
Proposals Opens
1-5 mos.
3/22/2016
Publish in IHE’s
Product Registry
14-18 mos.
Demonstrate at a
6-13 mos.
IHE Improves,
Safety, Quality
and Efficiency
in Clinical
Settings.
24
Install
Interoperabl
e products in
Clinical
Settings
worldwide
IHE Vendor Integration
Statements
Copyright IHE International
2009
25
CDA EHDI Pilot Project Design
State-Specific EHDI Reporting Design
Birthing
Facility
EHR
(Vendors?)
CDA
NHS
Outcome
Report
Health
Information
Exchange
(HIE)
Or
CDA
NHS
Outcome
Report
Public
Health
Gateway
(Vendors?)
CDA-based Actor Diagram
State EHDI
Information
System
(Vendors?)
QRPH Domain Overview
IHE QRPH Mission
The IHE Quality, Research, and Public Health
Domain will apply the proven, Use Case driven IHE
processes to:
 Deliver
the technical framework for the IHE-QRPH
domain profiles and white papers;
 Test
conformance of IHE-QRPH profile
implementations via Connectathons; and
 Demonstrate
shows.
marketable solutions at public trade
QRPH Domain Overview
QRPH Profile Primary Objectives:

Heterogeneity –
… coexistence in a multi-vendor & multi-modality
world, leveraging shared infrastructure

Semantic Interoperability –
… from the sensor to the EHR to the secondary
use of data

Real-time Availability –
… facilitating more timely clinical decisions
Ultimately providing improved –
… safety, quality of care & workflow efficiency
Cross Enterprise Document Sharing
Community or
sub-network
Clinic Record
Hospital Record
Repository of
Documents
Repository of
Documents
3-Records
Returned
4-Patient data
presented to
Physician
Clinical IT System
Aggregate
Patient Info
Clinical Encounter
1-Reference
to records
Specialist Record
Index of
patients records
Sharing System
2-Reference
to Records
for Inquiry 29
Patient Identity Management
PDQ Query to Acquire Affinity Domain
Patient ID
Patient Identity XRef Mgr
Patient Identity Feed
Patient Identity Feed
A87631
M8354673993
M8354673993
M8354673993
L-716
L-716
Physician Office
Patient Identity Feed
M8354673993
ED Application
Patient Identity Feed
PIX
Document
Query
Registry
XDS
Document
Repository
L-716
A87631
Affinity Domain Patient
Identity Source
EHR System
PIX
Query
Lab Info.
System
PACS
A87631
XDS
Document
Repository
Query Document (using Pt Id)
PACS
PACS
14355
Register (using Pt ID)
Retrieve Document
EHR System
Provide & Register Docs
Teaching Hospital
Community Clinic
ATNA Audit
record repository
CT Time server
30
Securing Communciations
EHR System PMS
ED Application
Physician Office
XDS
Document
Repository
XDS
Document
Registry
PACS
XDS
Document
Repository
Query Document
Register Document
Secured Messaging
PACS
EHR System
Retrieve Document
Maintain Time
Lab Info.
System
Community Clinic
Record Audit
Event
Record Audit
Event
Maintain
Time
ATNA Audit
CT Time server
record repository
Maintain
Time
Provide & Register Docs
Teaching Hospital
Record Audit
Event
31
IT Infrastructure Components Supporting Public Health

Cross-Enterprise Document Sharing

Cross-Enterprise Document Reliable Interchange (XDR)

Cross-Enterprise Document Media Interchange (XDM)

Patient Identifier Cross Reference Manager (PIX)

Patient Demographics Supplier (PDQ)

Retrieve Form for Data Capture (RFD)

Audit Record Repository (ATNA)

Time Server (CT)

Personnel White Pages (PWP)

Cross-Enterprise User Assertion (XUA)


Cross Community Access (XCA)
Basic Patient Privacy Consents (BPPC)
Cross-enterprise Sharing of Scanned Documents (XDS-SD)

Document Digital Signature (DSG)

IT Infrastructure Profiles Supporting Public Health
•
Pediatric Demographics
•
•
Expands patient demographics for PIX/PDQ to include supported
attributes of interest to immunization registries
Referral Requests
•
Addresses a means to a way to convey the referral request in a
form suitable for automatic processing
• Key to improved coordination of care (e.g. safety-net, underinsured, uninsured)
•
Emergency Contact Registry
•
•
White paper addressing bridge between the emergency response
person identification and health record systems
Next of kin contact is a first step in a longer term interoperability
initiative in support of emergency response
33
IT Infrastructure Profiles Supporting Public Health
•
Sharing Value Sets
•
Addresses synchronization of content terminologies across applications
• Key to semantic interoperability for quality, research and public health
analysis.
•
Publish/Subscribe Infrastructure for XDS.b
•
Currently, required to poll the Document Registry for new documents &
updates
•
Add support for a publish/subscribe method of receiving new
information for patients of interest.
• e.g. Public Health Monitoring for certain conditions
• e.g. Subscribe to neighboring state conditions of interest
•
Cross-Enterprise Workflow
34
Hearing Screening Results
Forms-based Data Capture
Retrieve Form for Data Capture (RFD)
Retrieve Form [ITI-34] along with pre-population data
Continuity of
Care Document
(CCD)
Other CDA Document (Newborn Summary)
Form
Manager
Form
Filler
Form
Receiver
Form
Delivery of Form along with prepopulation data bound to the form
Reference Implementation
Form Manager
NHS Outcome Report
NHS Form Data
XSLT
35
Profiles & Technical Frameworks
QRPH: Existing Profile for Early Hearing
Detection and Intervention (EHDI)

Early Hearing Detection and Intervention: Screening,
Short-Term Care, and Clinical Surveillance for Hearing
Loss





Assists with the detection, documentation of and
intervention for newborn hearing loss with subsequent
short-term follow-up and clinical surveillance
Identifies standards and data requirements for newborn
hearing screening
Defines an Early Hearing Care Plan (EHCP) made
available to all authorized providers of care as
jurisdictionally directed by Public Health
Enables the reporting on quality measures to assure
more effective care
Enables public health and population health surveillance
to assure access to care and appropriate resources.
3/22/2016
36
Newborn Admission Notification Information
(NANI)
SCOPE
EHRs and Public Health (PH) Newborn Hearing Screening (NHS) information
systems (IS) seldom share information electronically to the detriment of
quality newborn hearing health care.



What NANI does
Automates transfer of basic patient admission information on a newborn
from a Birthing Hospital EHR to PH
Describes the content to be communicated by a hospital EHR to PH
Facilitates effective communication among hospitals, PH, and PCPs
NANI is being implemented for PH’s NHS programs but could be used
for PH Immunization Programs, Critical Congenital Heart Disease,
Newborn Bloodspot Screening or Communicable Disease Reporting.
37
3/22/2016
Newborn Admission Notification Information
(NANI)
USE CASE




38
Baby Joe Smith is born at a hospital and is entered into hospital’s
EHR as an admission
Hospital EHR, acting as Newborn Admission Information Source
Actor, notifies Newborn Admission Notification Manager Actor
about Baby Joe
The Newborn Admission Information Manager Actor applies
criteria for target case selection, notifies PH NHS program, acting
as the Newborn Admission Information Subscriber Actor, about
Baby Joe
State NHS Program, acting as the Newborn Admission
Notification Source receives this Admission Information about
Joe from Newborn Admission Information Manager Actor
3/22/2016
Newborn Admission Notification Information
(NANI)
Value Proposition
 Reduces the burden of provider reporting
 Eliminates cost and error from duplicate manual data entry,
currently the norm when submitting data from a hospital to
PH
 Provides PH newborn programs with a timely and accurate
denominator of hospital births
 Improves care delivery as PH has timely information on births
 Facilitates evaluation of quality of care by PH, CMS, hospitals
or other third party systems
 Facilitates the evaluation of PH interventions
 Enables the flow of information that supports quality measure
reporting
39
3/22/2016
Newborn Admission Notification Information
(NANI)
 Hospital EHR can be
Different “actors” can be
implemented
by different Systems


40
3/22/2016
Admission Information
Source and Newborn
Admission Notification
Manager
PH can be Newborn
Admission Notification
Manager and Newborn
Admission Notification
Subscriber
HIE can be Newborn
Admission Notification
Manager
Newborn Admission Notification Information
(NANI)
Public
Health
• NANI Source
• NANI
Manager
• NANI
Subscriber
• NANI
Source
EHR
EHR
• NANI Source
Public
Health
• NANI Manager
• NANI
Subscriber
EHR
41
3/22/2016
HIE
• NANI
Manager
• NANI
Subscriber
Public
Health
Newborn Admission Notification Information
(NANI)
Implementations/Projects/Connectathons
tested




44
NANI implementation is currently in progress for the
State of Texas EHDI program from the hospital EHR to
the State’s NHS IS
NANI implementation is in the survey stage in the State
of North Dakota from the birthing hospital’s EHRs to the
State NHS IS
NANI implementation from a birthing hospital’s EHRs via
the State HIE to the Maryland NHS program is in the
planning stage
New Profile to be tested at IHE USA 2013 Connectathon
3/22/2016
Integration
Content
PCC Profiles
Medical Summaries
Functional
Status
Assessments
Emergency
Department
Referral
Exchanging
PHR
Content
Care Management
Request for
Clinical
Guidance
Emergency
Department
Encounter
Summary
Patient Plan
of Care
Labor and
Delivery
Record
EMS
Transfer of
Care
Antepartum
Care
Summary
Antepartum
Record
Immunization
Registry
Content
Query for Existing Data
2005-06
2006-07
2007-08
2008-09
2009-10
…
45
Library of Templates
Documents
Sections
Referral
XPHR
LAB
Entries
Parts
Severity
Problems
Problem
Vitals
Vital
Result
Obs
Early Hearing Care Plan (EHCP)
Scope
NHS results are not consistently communicated by hospitals to
Pediatric PCPs or from PH to Pediatric PCPs. Nearly 50 % of
infants needing additional care may not receive it. PH is the
jurisdiction responsible for assuring care for each infant. In this
profile, PH receives identifying information and screening results
from the Hospital, creates the EHCP, based on CDA-R2. The
EHCP content consumers are pediatric primary care physicians
(PCPs).
Value Proposition
Infants with late diagnosed hearing loss are at risk for cognitive and
language delays that could be prevented with effective
communication among hospitals, PCPs and PH following newborn
hearing screening.
The EHCP available to all authorized care providers as
jurisdictionally directed by PH NHS, will assist with detection,
documentation and intervention for hearing loss.
47
3/22/2016
Early Hearing Care Plan (EHCP)





USE CASE
PH receives NANI, NHS results and other jurisdictionally
defined data on Baby Joe from hospital
PH creates an EHCP (based on CDA R2) for Baby Joe with
newborn hearing screening results, hearing risk factors and
with decision support for PCPs on next steps
Baby Joe arrives for his first well-child check
Provider accesses EHCP via HIE
PCP reviews EHCP from PH with family to determine next
hearing care steps for each child


PCP reviews screening results
PCP reviews known risk indicators for hearing loss and assesses
whether there are additional risk indicators for hearing loss
 PCP is provided guidance that includes referrals for additional
screening or diagnostic audiology and for ongoing hearing health
care
48
3/22/2016
Early Hearing Care Plan (EHCP)
Actors/Transactions


EHCP Content Creator Actor SHALL be responsible for
creation of content and transmission of EHCP to a Content
Consumer
EHCP Content Consumer Actor SHALL be able to view,
import EHCP content
OPTIONS
ACTOR
49
Content Creator
None
Content Consumer
View
Document Import
Section Import
Discrete Data Import
3/22/2016
Early Hearing Care Plan (EHCP)
Transaction Diagram/Actors and Content Modules
Public Health
(Content Creator)
Primary Care Provider
(Content Consumer)
XD* (Care Plan)*
50
3/22/2016
Early Hearing Care Plan (EHCP)
Implementations/Projects/Connectathons
tested



51
EHCP was successfully tested at the IHE USA
Connectathons in 2011 and 2012
EHCP was demonstrated in the Public Health
Interoperability (PHI) Showcase at HIMSS 2011 and
2012
EHCP was successfully demonstrated at the CDC PHI
conference in 2011
3/22/2016
Early Hearing Care Plan (EHCP)
Key Content
• Contains the
information relevant to management of the early
screening evaluation and intervention process as defined by the
jurisdiction PH Authority:
•May use XD*, RFD
 Person Information
 Notifications, Reminders and
Alerts
 Consent Absence Directives
 Orders
 Assessment
 Past Medical History
 Diagnosis
 Surgical History
 Planning
 Family and Social History
 Implementation
 Reason for Referral
 Patient Education and
Consents
 Results
Quality Measure Execution-Early
Hearing (QME-EH)
Abstract/Scope
53

QME-EH specifies a Quality Reporting Document Architecture
(QRDA) Category I document for the Hearing Screening Prior to
Hospital Discharge (EHDI-1a) measure

A QRDA Category I document is a CDA document which
contains patient-level data that supports computation of an
established performance quality measure using data captured in
an electronic health record (EHR)

The Hearing Screening Prior to Hospital Discharge (EHDI-1a)
measure is a Clinical Quality Measure (CQM) which Centers for
Medicare an Medicaid Services (CMS) has included in their
Notice of Proposed Rulemaking (NPRM) specifying the Stage 2
quality measures for the EHR Incentive Program
3/22/2016
Quality Measure Execution-Early
Hearing (QME-EH)
Value Proposition
 Demonstrate
your system can generate the measure
data set required to calculate the Hearing Screening
Prior to Hospital Discharge (EHDI-1a) measure
 Gain early implementation experience on the use of
the QRDA specifications finalized by Health Level 7
(HL7) in July 2012
54
3/22/2016
Quality Measure Execution-Early
Hearing (QME-EH)
Actors/Transactions
A Content Consumer actor SHALL consume the discrete data in the
machine readable entries contained in the
QualityMeasureExecutionEarlyHearingReport.
The Content Consumer SHALL be able to show, via a humanly
verifiable means, (1) the identifier of the data set consumed, (2) an
indication if the data set should be counted in the denominator, and (3)
an indication if the data set should be counted in numerator, given the
measure definition.
55
3/22/2016
Quality Measure Execution-Early
Hearing (QME-EH)
Implementations/Projects/Connectathons tested
 First
tested at IHE USA Connectathon 2011
 Demonstrated at HIMSS Interoperability Showcase
2011 and 2012
 Enhanced Profile version will be tested at IHE USA
Connectathon 2013
 Pilot project through the Public Health Data
Standards Consortium (PHDSC) in 2013
56
3/22/2016
(EHDI) Patient-Level Quality
Measure Report Key Content
• the
information relevant to computing EHDI quality measures for
the early screening evaluation and intervention Using HL7 QRDA
•May use XD*, RFD





Measure Set Information
Measure Information
Reporting Parameter
Information
Encounter Information
Person Information



Procedure Information
Problem Information
Diagnosis Information
Copyright IHE International 2009
58
Evidence of Hearing Screening Performed Value Set
Sequence
LOINC® Code
Value Set :
1.3.6.1.4.1.19376.1.7.
3.1.1.15.2.18
Vocabulary:
2.16.840.1.113883.6.1
Answer Code
Description
1
LA10392-1
164059009
Pass
2
LA10393-9
183924009
Refer
Newborn Hearing Procedure Value Set
:
Value Set : 1.3.6.1.4.1.19376.1.7.3.1.
1.15.2.17
Vocabulary: 2.16.840.1.113883.6.96
Sequ
ence
1
SNOMEDCT Code
417491009
Description
Neonatal hearing test
(procedure)
NB hearing scn –R:Result Type
Hearing Screen Right Value Set
Value Set :
Sequence
1
Vocabulary:
LOINC® Code
53109-4
1.3.6.1.4.1.19376.1.7.3
.1.1.15.2.9
2.16.840.1.113883.6.1
Description
Newborn Hearing
Screen Right
Hearing Screen Left Value Set
Value Set :
Sequence
1
Vocabulary:
1.3.6.1.4.1.19376.1.7.3.1.
1.15.2.8
2.16.840.1.113883.6.1
LOINC® Code
Description
53108-6
Newborn Hearing Screen
Left
Newborn Hearing Screening Method Value Set:
LOINC® 54106-0
Sequenc
e
Value Set :
1.3.6.1.4.1.193
76.1.7.3.1.1.15.
2.4
Vocabulary:
2.16.840.1.113
883.6.1
LOINC®
Code
Answer Code
Description
1
LA10387-1
AABR
Automated auditory brainstem
response
2
LA10388-9
ABR
Auditory brain stem response
3
LA10389-7
OAE
4
LA10390-5
DPOAE
Otoacoustic emissions
Distortion product otoacoustic
emissions
5
LA10391-3
TOAE
Transient otoacoustic emissions
6
LA12406-7
Methodology unknown
•JCIH-EHDI Inpatient Screening Results not Performed Value Set
Value Set : 1.3.6.1.4.1.19376.1.7.
3.1.1.15.2.10
Vocabulary: 2.16.840.1.113883.6.1
Sequence
LOINC®
Code
1
LA12408-3
2
LA7304-4
3
LA12409-1
Description
Attempted, but
unsuccessful technical fail
Not performed
Not performed,
medical exclusion not indicated
Global ID
10370900
8
26200800
8
41053400
3
Global ID
Code
System
SN
SN
SN
•Joint Commission Medical Reason Value Set
EHDI specifies the re-use of the existing Medical Reason Value
Set used by the Joint Commission measures.
Value Set :
1.3.6.1.4.1.33895.1.3.0.75
Vocabulary:
2.16.840.1.113883.6.96
Seque SNOMEDDescription
nce
CT Code
1
397745006 Medical contraindication (finding)
2
Surgical contraindication
397773008 (finding)
JCIH-EHDI Procedure Declined Value Set:
Value Set :
Vocabulary:
Seque SNOMED-CT
nce
Code
1
183949008
2
183945002
3
183948000
397709008
4
1.3.6.1.4.1.19376.1.7.3.1.
1.15.2.20
2.16.840.1.113883.6.96
Description
Assessment examination
refused (situation)
Procedure refused religion (situation)
Refused procedure parent's wish (situation)
Patient died (finding)
JCIH-EHDI Newborn Hearing Screening Abnormal Results Value Set:
Value Set :
Vocabulary:
Seque
nce
SNOMED-CT
Code
1.3.6.1.4.1.19376.1.7.3.1.1.15.
2.23
2.16.840.1.113883.6.96
Description
1
313203003
2
308409008
3
185577006
4
185579009
Hearing test abnormal (finding)
Child hearing screening failure
(finding)
Child hearing screening first failure
(finding)
Child hearing screening second
failure (finding)
185580007
Child hearing screening failure
referred to specialist (finding)
5
Reason for no Hearing Loss Diagnosis
Sequence
Value Set :
1.3.6.1.4.1.19376.1.7.3.1.1.15.2.15
Vocabulary:
SNOMED Code
2.16.840.1.113883.6.96
Description
EHDI Concept
1
397709008
Patient died (finding)
No screening or diagnosis: Infant died
2
360885002
Change of residence status (finding)
No diagnosis: Moved or gone elsewhere
3
184112005
Patient address unknown (finding)
No diagnosis: Unable to Contact Family
4
184118009
No diagnosis: Unable to Contact Family
5
183638004
Patient telephone number unknown
(finding)
Follow-up refused
6
183946001
Procedure refused-uncooperative
No diagnosis: Parents Declined Services
-Procedure refused - uncooperative
7
413319007
Persistent non-attender
8
399307001
Loss to follow-up
9
419984006
Inconclusive (qualifier value)
10
185332005
Appointment cancelled by patient
(finding)
No diagnosis: Unresponsive - Persistent
non-attender
No diagnosis: Unknown - Loss to followup
No diagnosis: Audiologic Diagnosis in
Process
No diagnosis: Audiologic Diagnosis in
Process - Rescheduled appointment
11
185333000
Appointment cancelled by doctor (finding)
No diagnosis: Audiologic Diagnosis in
Process - Rescheduled appointment
12
281399006
Did not attend
No diagnosis: Audiologic Diagnosis in
Process - Did not attend
No screening diagnosis: Parents
Declined Services - Follow-up refused
LOINC® 58232-0 Hearing Loss Risk Indicator
Sequence
Value Set :
1.3.6.1.4.1.19376.1.7.3.1.1.15.2.24
Vocabulary:
2.16.840.1.113883.6.1
LOINC® Code
Description
1
2
3
4
5
6
7
8
9
10
LA137-2
LA12667-4
LA12668-2
LA12669-0
LA12670-8
LA12671-6
LA12672-4
LA12673-2
LA12674-0
LA12675-7
11
12
13
14
15
16
LA12681-5
LA12676-5
LA12677-3
LA12678-1
LA12679-9
LA6172-6
None
Caregiver concern about hearing
Family Hx of hearing loss
NICU stay > 5 days
ECMO
Assisted ventilation
Ototoxic medication use
Exchange transfusion for Hyperbilirubinemia
In utero infection(s)
Craniofacial anomalies
Physical findings of syndromes that include hearing
loss
Syndromes associated with hearing loss
Neurodegenerative disorders
Postnatal infections
Head trauma
Chemotherapy
SNOMED-CT Risk Indicators for Hearing Loss Value Set
Sequence
Value Set :
1.3.6.1.4.1.19376.1.7.3.1.1.15.2.11
Vocabulary:
2.16.840.1.113883.6.96
SNOMED-CT Code
Description
1
439750006
Family history of hearing loss (situation)
2
441899004
History of therapy with ototoxic medication (situation)
3
276687002
Conjugated hyperbilirubinemia in infancy (disorder)
4
281610001
Neonatal hyperbilirubinemia (disorder)
5
281612009
Neonatal conjugated hyperbilirubinemia (disorder)
6
281611002
Neonatal unconjugated hyperbilirubinemia (disorder)
7
206363004
Intra-amniotic fetal infection (disorder) (Deprecated, replaced
by 11618000)
8
206331005
Infections specific to perinatal period (disorder)
9
206005002
Fetus or neonate affected by maternal infection (disorder)
10
80690008
Degenerative disease of the central nervous system (disorder)
11
178280004
Postnatal infection (disorder)
12
312972009
Neonatal extracranial head trauma (disorder)
13
161653008
14
11618000
History of - chemotherapy (situation)
Intra-amniotic infection of fetus (disorder) (Replaces
206363004)
Risk Indicators for Hearing Loss - Procedures Set
Value Set :
Vocabulary:
Sequen
ce
SNOMED-CT
Code
1
266700009
2
233573008
1.3.6.1.4.1.19376.1.7.3.1.1.15.
2.12
2.16.840.1.113883.6.96
Description
Assisted breathing (procedure)
Extracorporeal membrane
oxygenation (procedure)
•Indicators for Hearing Loss
Note that additional specificity for this value set is under way and will
result in an update to this value set. Further coded values are sought to
represent the following:
None
Caregiver concern about hearing
Craniofacial anomalies
Physical findings of syndromes that include hearing loss
Syndromes associated with hearing loss
EHDI Newborn Hearing Loss Reason for no Follow-up Value Set
Value Set :
1.3.6.1.4.1.19376.1.7.3.1.1.15.2
.7
2.16.840.1.113883.6.96
Description
Patient died (finding)
1
Vocabulary:
SNOMED Code
397709008
2
360885002
3
184112005
4
184118009
5
183638004
6
183946001
Procedure refuseduncooperative
7
413319007
Persistent non-attender
8
399307001
Loss to follow-up
9
185332005
10
185333000
11
281399006
Appointment cancelled by
patient (finding)
Appointment cancelled by
doctor (finding)
Did not attend
Sequence
Change of residence status
(finding)
Patient address unknown
(finding)
Patient telephone number
unknown (finding)
Follow-up refused
EHDI Concept
Incomplete outpatient screen:
Infant died
Incomplete outpatient screen:
Moved or gone elsewhere
Incomplete outpatient screen:
Unable to contact family
Incomplete outpatient screen:
Unable to contact family
Incomplete outpatient screen:
Follow-up refused
Incomplete outpatient screen:
Procedure refuseduncooperative
Incomplete outpatient screen:
Persistent non-attender
Incomplete outpatient screen:
Loss to follow-up
Incomplete outpatient screen:
Rescheduled appointment
Incomplete outpatient screen:
Rescheduled appointment
Incomplete outpatient screen:
Did not attend
CDA EHDI Pilot Project: State-Specific Use Case
Use Case
Actors:
Business Actors
Technical Actors
Flow of Events
Newborn Hearing Screening
Newborn, Caregiver, Clinicians, Public Health Program Staff
EHR, HIE, Public Health (PH) EHDI IS
1.
2.
3.
4.
5.
6.
Child is delivered.
Clinician conducts initial physical exam
Newborn is due for <hearing test>
Clinician orders an <hearing test>
Hospital staff conducts <hearing test>
Hospital staff enter data on the <hearing test> in the
EHR database and generate <Newborn Hearing
Screening (NHS) Outcome Report>
7.
Information is electronically sent on <NHS Outcome
Report > to the PH EHDI IS directly or via HIE
8. PH program EHDI IS receives Notification of Report
Availability
9. PH programs’ staff reviews the report and create PH
EHDI IS record on a child in PH EHDI IS and upload <NHS
Outcome Report > in PH EHDI IS
10. PH IS sends Acknowledgement of Receipt of the Report
to EHR directly or via HIE.
Pre-Conditions:
EHR System, Health Information Exchange (HIE)
Post-Conditions:
Public Health Information System <EHDI IS>
Preferred Timing
Daily updates
Data Categories
1&2. Demographics, Labor &
Delivery Record, Newborn EHR
3. Consent
4. Standing Order
5. Hearing Test Results
6. Hearing Test Results, NHS
Outcome Report
7. NHS Outcome Report
8. Notification of Report Availability
9. Updated Pubic Health EHDI
Record
10. Acknowledgement of Receipt
CDA EHDI Pilot Project Design
State-Specific EHDI Reporting Design
Birthing
Facility
EHR
(Vendors?)
CDA
NHS
Outcome
Report
Health
Information
Exchange
(HIE)
Or
CDA
NHS
Outcome
Report
Public
Health
Gateway
(Vendors?)
CDA-based Actor Diagram
State EHDI
Information
System
(Vendors?)
CDA EHDI Pilot Project
Questions?