CCD templates involves the validation against the respective
Schematron files, which are also available with HL7 CCD standard. The QRDA Implementation Guide has not yet published the
Schematron files for the constraints imposed by QRDA; hence we
had created the Schematron files to validate the incoming QRDA
files against the QRDA Category – I constraints. See the Figure- 4
for validation process diagram.
QRDA IMPLEMENTATION—THE WISHLIST
Following are some of the nice to have components/features:
It would be nice if HL7 publishes the Schematron files for
QRDA Category-I , II, and III constraints for easier adoption of
the QRDA standard by the user community.
Even though HL7 published a way to extend the Provider’s
National Provider Identifier (NPI) to generate the Root Object
identifier (OID) for the Provider, still there are gaps in the implementation. As per HL7, for providers in the US that do not already
have an OID from another source, an OID can be constructed
from the National Provider Identifier assigned to an organization
or individual provider by concatenating the assigned NPI to the
string “HL7-NPI-AUTOMATIC-OID-ROOT.” It would be nice if
HL7 replaces this placeholder string with true OID, so that Providers can generate their own OIDs.
QRDA IMPLEMENTATION—A PEEK INTO THE FUTURE
Currently Quality reporting in the healthcare world is undergoing
tremendous changes both due to political will as well as techno-
logical innovations. Some of the trends that might happen in the
next couple of years are as follows:
With the implementation of Health Quality Measures Format
(HQMF) standard by HL7 and NQF, the “eMeasure” documents
will come to the main steam, which could enable the EHR systems
to perform measure calculations on their end consistently with-
out any ambiguity. That results in generating measure specific
quality data (QRDA Category-II reports) rather than raw clinical
data (QRDA Category-I report). So we feel emergence of QRDA
Category-II reports are coupled with the progress of HQMF stan-
dard. The QRDA Category-II reports are beneficial for both pro-
viders as well as consumer organizations, as they know before
hand where they stand with respect to quality implementation.
Currently the Quality Aggregate reports, such as those generated by Registries, are developed using the proprietary data formats,
which could be replaced in the near future by the QRDA Category-III reports. We also feel that the emergence of QRDA Category-III
reports is coupled to the success of the HQMF standard.
The content of this publication does not necessarily reflect the
views or policies of the Department of Health & Human Services,
nor does mention of trade names, commercial products or organizations imply endorsement by the government.
I would like to thank my colleagues Chad Bennett, Director
(Health Informatics), Thomas Schaeffer, Senior Manager (
Enterprise Services) and Brian Barry, Director (Product Development)
for their continued support and valuable insight, while we are
working with the QRDA standard. Special thanks to Shauna
Kerby, Kathy Kain and Laxmikanth Samudrala for their sincerity
and commitment, while implementing a new standard. JHIM
Srinivas;Velamuri is a software architect at IFMC. He is a HL7 Certified CDA
Specialist. He has 21 years of technical experience.
HL7 Implementation Guidance for Unique Object Identifiers (OIDs), Release
1, Informative Document, First Ballot, September 2008
Implementation Guide for CDA Release 2 Quality Reporting Document
Architecture (QRDA) Release 1, Based on HL7 CDA Release 2.0, (U.S.
Realm), Draft Standard for Trial Use, April 2009
eMeasure: Representation of the Health Quality Measures Format (HQMF),
Design Document, (DRAFT : June 30, 2009)
HL7 Clinical Document Architecture (CDA) Release 2, Normative Edition:
HL7 Implementation Guide: CDA Release 2 - Continuity of Care Document
(CCD), A CDA implementation of ASTM E2369-05 Standard Specification
for Continuity of Care Record© (CCR) which may be used in lieu of ASTM
ADJE2369, April 01, 2007