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Thursday, November 14, 2013

Principles of Standards Selection for use by the HITSC Clinical Quality Workgroup

One of the work items that I was asked to develop for the Clinical Quality Workgroup was to consolidate the principles I presented a couple of weeks ago into a short list of generally applicable principles.
  • Fits into the existing/planned architecture
  • Meets program goals and requirements
  • Is well-suited and/or designed for the purpose
  • Widely recognized, well-established, mature
  • Has, or is expected to have implementation, adoption and use
  • Testable and tested
  • Has SDO support
  • Readily available w/o encumbrances
  • Low Complexity
  • Extensible
Building from that are a list of questions that we could use to help with that assessment.

  • What is our Architecture?
    • The $64,000 question
  • What are we trying to do?
    • Does our architecture need to change to support that?
  • Is this standard designed to do that?
    • If not, why is it still a good fit?
  • What risks are we willing to take?
    • How mature is it?
      • If new, does it build on previous knowledge?
      • Has it ever been used in real world environment?
      • Has it been tested?
      • Can I get it today?
    • Who maintains it?
  • Is it easily and inexpensively implemented?
  • Is it future-proof and adaptable to change?

My recommendation is that we present this to the HIT Standards Committee as something that could be considered as a process that is generally applicable.  Also, that a work stream be started to understand the architecture that we have.  I'd love to see a short slide deck presenting a block diagram that shows at a very high level what we currently have, and how the pieces already fit together.  I think the NwHIN Power Team and the Security/Privacy Work group already have the necessary expertise to address these issues relatively quickly.

On the what we are trying to do question, I was asked to explain what I meant by that.  From my perspective the question our workgroup was tasked with amounts to this:
What are the standards that support prospective assessment of what we need to do to provide quality care, and what we need to do to assess whether or not quality care was provided.  We typically call the former Clinical Decision Support, and the latter Clinical Quality Measures.

As I mentioned a couple weeks ago, there is ongoing work to harmonize the CDS and CQM standards within HL7, and we will see some of those outputs in the coming months.  I believe these efforts are better placed to support where we should be headed in the future, and they are a progression of existing standards HeD and HQMF Release 2 that we could start getting experience with in the next round.


P.S.  I'm know I'm behind on posting, but I think I've finally caught up with myself.


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