Cypress: New Features, Clinical Quality Language Support, and Burden Reduction

Transcription

1 Cypress: New Features, Clinical Quality Language Support, and Burden Reduction David Czulada The MITRE Corporation, Lead Software Systems Engineer March 2018 The MITRE Corporation operates the Centers for Medicare & Medicaid Services (CMS) Alliance to Modernize Healthcare (CAMH), a federally funded research and development center (FFRDC) dedicated to strengthening the nation s health care system. MITRE operates CAMH in partnership with CMS and the Department of Health and Human Services.

2 2 Agenda Background 2015 Edition Certification Overview Single-measure Tests: C1, C2, C3 Cypress Features to Reduce Burden Pre-certification Testing Cypress Application Programming Interface (API) Cypress Validation Utility Cypress V4 Clinical Quality Language (CQL) Implementation Open Discussion: Feedback from Vendors and Authorized Testing Laboratories (ATL) Resources Other Related Presentations at HIMSS 2018

3 Background Cypress 3 Cypress is the rigorous and repeatable testing tool for Electronic Health Records (EHR) and EHR modules in calculating electronic clinical quality measures (ecqm). Cypress serves as the official testing tool for the EHR Certification program supported by the Office of the National Coordinator for Health IT (ONC). The Cypress tool is open source and freely available for use or adoption by the health IT community, including EHR vendors and testing labs. Cypress v4 will support the ecqms released in the Annual Update for 2019 Reporting/Performance, which will all be defined using CQL logic.

4 Background How is Cypress made available? 4 Cypress is developed as Open Source Source code is made freely available and may be redistributed and modified. Cypress releases are distributed as a: Virtual Machine A fully enclosed version which can be installed as-is on an organization s network Amazon Machine Imagine A virtual machine that can be run on Amazon s Elastic Compute Cloud Demo Server Publicly available instances of Cypress Distribution model allows for EHR s vendors to install and use Cypress locally within their organization s firewalls to prior to certification

5 Background Cypress Software Release Timeline Cypress (2.6.1) 2015 Reporting/Performance Period Cypress Reporting/Performance Period Precertification Testing Only Cypress (3.0.1, 3.0.2, 3.0.3, 3.1.0) 2017 Reporting/Performance Period, 2015 Edition Certification Cypress (3.2.1, 3.2.2, 3.2.3) 2018 Reporting/Performance Period Cypress Reporting/Performance Period, CQL

6 Background Certified Health IT Products and Vendors 6 Cypress v3.2.3 released December 2017, supporting both 2014 and 2015 Edition Certification, allowing retirement of Cypress v2. Cypress v3 The Certified Health IT Product List (CHPL) lists all certified Health Information Technology which has been successfully tested and certified by the ONC Health IT Certification program.

7 2015 Edition Certification Overview The CMS/ONC ecqm Lifecycle of Testing & Certification 7 CMS defines ecqms that EHs & EPs must meet to demonstrate Meaningful Use (MU) of Health Information Technology (HIT) ONC specifies standards and certification criteria for HIT Providers using certified HIT submit ecqms to CMS CMS, ONC, & MITRE develop technology to test standards and certification criteria ONC-Authorized Certification Bodies (ONC-ACB) grant certification to HIT that passes testing ONC-ATLs oversee testing events of HIT

8 2015 Edition Certification Overview Using Cypress to Reduce Vendor and Provider Burden 8 Cypress Validation Utility provides early access to CMS Implementation Guides and schematron for pre-submission validation. CMS defines ecqms that EHs & EPs must meet to demonstrate MU of HIT ONC specifies standards and certification criteria for HIT Providers using certified HIT submit ecqms to CMS Cypress is developed using agile methodologies to quickly incorporate improvements to certification workflow. CMS, ONC & MITRE develop technology to test standards and certification criteria ONC-ACBs grant certification to HIT that passes testing ONC-ATLs oversee testing events of HIT Cypress, the Cypress Validation Utility, and the Cypress test decks are made freely available for precertification testing.

9 2015 Edition Certification Overview 2015 EHR Certification Rule 9 Cypress Certification Criteria (c) C1 - Record and Export C2 - Import and Calculate C3 - Report C4 - Filter Goals Increased Test Rigor Modular/Optional Certification Automated Import/Export of Quality Reporting Document Architecture () Category I ecqm Filtering

10 2015 Edition Certification Overview How Does Cypress Test the 2015 Certification Rule 10 Given a set of patients and ecqms, Cypress tests the ability of an EHR to: Patient record Capture the information required to calculate the selected ecqm 1 2 Export the information required to calculate the selected ecqm Patient record Calculate the results of the selected ecqm 3 4 Report the calculated result of the selected ecqm Report ecqm data that has been filtered 5 Patient record

11 Edition Certification Overview Single-measure Tests: C1, C2, C3 Document Duplication Randomization of Name and Demographics Patient record split into multiple files Additional validations based on common submission requirements Program-specific submission errors displayed as warnings

12 12 Cypress Features to Reduce Burden Pre-certification Testing Controlled Testing Non-randomized patient data Disable de-duplication Sample files provided

13 Cypress Features to Reduce Burden Cypress Application Programming Interface (API) 13 JSON API for performing certification tests Allows vendors to perform all tests using only the API

14 Cypress Features to Reduce Burden Testing with the Cypress Validation Utility 14 The Cypress Validation Utility (CVU) allows users to validate their own test patients against: HL7 Cat I and III Implementation Guide and Schematron CMS Cat I and III Implementation Guides CVU Supports testing to the requirements for the 2016, 2017, and 2018 performance/reporting periods

15 15 Cypress Features to Reduce Burden Testing with the Cypress Validation Utility (continued) Record Import and Calculation built into Cypress Validation Utility Can be used to debug measure calculation and generation

16 16 Cypress v4 Release planned for July 2018 Alpha and Beta releases in Spring 2018 Support for Clinical Quality Language (CQL) and CQL-based measures CQL is an HL7 standard. It is part of the effort to harmonize standards used for ecqms and clinical decision support (CDS). CQL replaces the measure logic expressions currently defined in the Quality Data Model (QDM). The ecqms released in the Annual Update for 2019 Reporting/Performance will all be defined using CQL logic. No planned certification process changes Seeking community input on features Pre-Certification Certification Debugging

17 Cypress v4 CQL and Cypress 17 CQL will not directly impact the certification workflow Standardized information exchanges () insulate systems from change However, CQL will greatly impact the internal measure calculation for Cypress and vendor systems Cypress Web Application Sends Test Data Cat I Vendor System Sends Test Results Cat I Cat III

18 Cypress v4 Transitioning from QDM to CQL in Cypress 18 Cypress v3 QDM ecqm HQMF Parser Measure Data Store Record Data Store HDS Model Measure Evaluator Generator Cat I Measure Calculation and Cat I export Calculation Result Measure Evaluator Measure Data Store Record Data Store HDS Model Parser Cat I Cat I import and Measure Calculation Changing in Cypress v4

19 Cypress v4 Transitioning from QDM to CQL in Cypress 19 Cypress v4 CQL ecqm ELM Parser Measure Data Store Record Data Store QDM Model Measure Evaluator Generator Cat I Measure Calculation and Cat I export Calculation Result Measure Evaluator Measure Data Store Record Data Store QDM Model Parser Cat I Cat I import and Measure Calculation New in Cypress v4

20 20 Open Discussion: Feedback from Vendors and ATLs - Provider attribution - CQL

21 21 Resources Cypress Talk List Cypress Bi-Weekly Tech Talks Next session March 13, ONC JIRA GitHub Website Demo Server

22 22 Other Related Presentations at HIMSS 2018 Sessions will be held in the MITRE Government Relations Room (Zeno 4608) March 7, :00 PM 3:30 PM PT CMS ecqm Strategy: The Future of ecqms March 8, :30 AM 12:00 PM PT CMS ecqm Strategy: The Future of ecqms

23 23 Follow up To download a copy of this presentation, visit: Data Interoperability to Reduce Clinician Burden Follow us on social

24 24 Questions?

25 25 Backup Slides

26 26 Standards Supported (Cypress and CVU) CMS Measure Specification ecqm Specifications for Eligible Professionals May 2017 ecqm Specifications for Eligible Hospitals May 2017 ecqm Specifications for Eligible Professionals April 2016 ecqm Specifications for Eligible Hospitals April 2016 Implementation Guides CMS Implementation Guide for Quality Reporting Document Architecture Category III, Implementation Guide for 2018 HL7 CDA R2 IG: Quality Reporting Document Architecture Category I ( I); Release 1, DSTU Release 4 HL7 CDA R2 Implementation Guide: Quality Reporting Document Architecture ( III), Release 1, STU Release 2.1 CMS Implementation Guide for Quality Reporting Document Architecture Category I, Implementation Guide for 2018 HL7 CDA R2 IG: Quality Reporting Document Architecture Category I ( I); Release 1, DSTU Release 4 HL7 CDA R2 Implementation Guide: Quality Reporting Document Architecture ( III), Release 1, STU Release CMS III Implementation Guide for Eligible Clinicians Reporting v1 HL7 CDA R2 IG: Quality Reporting Document Architecture Category I ( I); Release 1, DSTU Release 3.1 HL7 CDA R2 Implementation Guide: Quality Reporting Document Architecture ( III), Release 1, STU Release CMS Implementation Guide for Hospital Quality Reporting HL7 CDA R2 IG: Quality Reporting Document Architecture Category I ( I); Release 1, DSTU Release 3.1 HL7 CDA R2 Implementation Guide: Quality Reporting Document Architecture ( III), Release 1, STU Release 2.1

27 27 Cypress Test Deck # of Measures Eligible Clinicians Patients Eligible Hospitals Patients Minimum Coverage Populations % 95% 95% Every patient population covered by test deck