Cypress: New Features, Clinical Quality Language Support ... · | 3 | Background Cypress Cypress is...

Approved for Public Release; Distribution Unlimited. Case Number 18-0578. © 2018, The MITRE Corporation. All Rights Reserved.

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.

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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


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Background

Cypress

▪ 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.


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Background

How is Cypress made available?

▪ 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

• https://cypress.healthit.gov/

• https://cypressvalidator.healthit.gov/

▪ Distribution model allows for EHR’s vendors to install and use Cypress locally within their

organization’s firewalls to prior to certification


https://cypress.healthit.gov/

https://cypressvalidator.healthit.gov/

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Background

Cypress Software Release Timeline

Cypress 2.6.0 (2.6.1)

2015 Reporting/Performance Period

Cypress 2.7.02016 Reporting/Performance PeriodPrecertification Testing Only

Cypress 3.0.0 (3.0.1, 3.0.2, 3.0.3, 3.1.0)

2017 Reporting/Performance Period, 2015 Edition Certification

Cypress 3.2.0 (3.2.1, 3.2.2, 3.2.3)

2018 Reporting/Performance Period

Cypress 4.0.0 2019 Reporting/Performance Period, CQL

2015 2016 2017 2018


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Background

Certified Health IT Products and Vendors

Cypress v3

Cypress v3.2.3 released December 2017, supporting both 2014 and 2015 Edition Certification, allowing retirement of Cypress v2.

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. https://chpl.healthit.gov/#/resources/overview

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2015 Edition Certification Overview

The CMS/ONC eCQM Lifecycle of Testing & Certification

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

CMS, ONC, & MITRE develop technology to

test standards and certification criteria

ONC-ATLs oversee testing events of HIT

ONC-Authorized Certification Bodies

(ONC-ACB) grant certification to HIT that

passes testing

Providers using certified HIT submit eCQMs to

CMS

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Using Cypress to Reduce Vendor and Provider Burden

CMS defines eCQMs that EHs & EPs must

meet to demonstrate MU of HIT

ONC specifies standards and certification criteria

for HIT

CMS, ONC & MITRE develop technology to

test standards and certification criteria

ONC-ATLs oversee testing events of HIT

ONC-ACBs grant certification to HIT that

passes testing

Providers using certified HIT submit eCQMs to

CMS

Cypress, the Cypress Validation Utility, and the

Cypress test decks are made freely available for pre-

certification testing.

Cypress is developed using agile methodologies to quickly incorporate improvements to

certification workflow.

Cypress Validation Utility provides early access to

CMS Implementation Guides and schematron for pre-submission validation.


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2015 EHR Certification Rule

▪ Cypress Certification Criteria – 170.315(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 (QRDA) Category I

– eCQM Filtering


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How Does Cypress Test the 2015 Certification Rule

▪ Given a set of patients and eCQMs, Cypress tests the ability of an EHR to:

Capture the information required to calculate the selected eCQM

QRDA

Export the information required to calculate the selected eCQM

Patient

recordPatient

record

QRDA

Calculate the results of the selected eCQM

Patient

record

Report the calculated result of the selected eCQM

QRDA

1 2

3 4Report eCQM data that has been filtered

QRDA

5


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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


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Cypress Features to Reduce Burden

Pre-certification Testing

▪ Controlled Testing

– Non-randomized patient data

– Disable de-duplication

– Sample files provided


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Cypress Application Programming Interface (API)

▪ JSON API for performing certification tests

▪ Allows vendors to perform all tests using only the API


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Testing with the Cypress Validation Utility

▪ The Cypress Validation Utility (CVU) allows users to validate their own test patients against:

– HL7 QRDA Cat I and III Implementation Guide and Schematron

– CMS QRDA Cat I and III Implementation Guides

▪ CVU Supports testing to the requirements for the 2016, 2017, and 2018 performance/reporting periods


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Testing with the Cypress Validation Utility (continued)

▪ Record Import and Calculation built into Cypress Validation Utility

– Can be used to debug measure calculation and QRDA generation


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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


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Cypress v4

CQL and Cypress

▪ CQL will not directly impact the certification workflow

– Standardized information exchanges (QRDA) insulate systems from change

▪ However, CQL will greatly impact the internal measure calculation for Cypress and vendor systems

Cypress Web Application

Vendor System

Sends Test Data

Sends Test Results


QRDACat I

QRDACat I

QRDACat III

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Cypress v4

Transitioning from QDM to CQL in Cypress

Cypress v3

Measure Calculation and

QRDA Cat I export

QRDA Cat I import and Measure Calculation

QDMeCQM

HQMFParser

MeasureData Store

RecordData Store HDS

Model

MeasureEvaluator

QRDAGenerator

QRDACat I

CalculationResult

MeasureData Store

RecordData Store

QRDAParser

MeasureEvaluator

QRDACat I

HDSModel

Approved for Public Release; Distribution Unlimited. Case Number 18-0578. © 2018, The MITRE Corporation. All Rights Reserved. Changing in Cypress v4

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Cypress v4

Transitioning from QDM to CQL in Cypress

Cypress v4

Measure Calculation and

QRDA Cat I export

QRDA Cat I import and Measure Calculation

CQLeCQM

ELMParser

MeasureData Store

RecordData Store QDM

Model

QRDACat I

CalculationResult

MeasureData Store

RecordData Store QDM

Model

QRDAParser

MeasureEvaluator

QRDACat I


MeasureEvaluator

QRDAGenerator

New in Cypress v4

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Open Discussion: Feedback from Vendors and ATLs- Provider attribution

- CQL


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Resources

▪ Cypress Talk List

– [email protected]

▪ Cypress Bi-Weekly Tech Talks

– Next session March 13, 2018

– https://attendee.gotowebinar.com/register/8110364277730751489

▪ ONC JIRA

– http://oncprojectracking.healthit.gov/

▪ GitHub

– https://www.github.com/projectcypress/cypress

▪ Website

– https://healthit.gov/cypress

▪ Demo Server

– https://cypressdemo.healthit.gov

– https://cypressvalidator.healthit.gov


mailto:[email protected]

https://attendee.gotowebinar.com/register/8110364277730751489

http://oncprojectracking.healthit.gov/

https://www.github.com/projectcypress/cypress

https://healthit.gov/cypress

https://cypressdemo.healthit.gov/

https://cypressvalidator.healthit.gov/

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Other Related Presentations at HIMSS 2018

March 7, 2018

2:00 PM – 3:30 PM PT

CMS eCQM Strategy: The Future of eCQMs

March 8, 2018

10:30 AM – 12:00 PM PT

CMS eCQM Strategy: The Future of eCQMs

Sessions will be held in the MITRE Government Relations Room (Zeno 4608)


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Follow up


To download a copy of this presentation, visit:

https://health.mitre.org/himss18

Data Interoperability to Reduce Clinician Burden

Follow us on social media: @MITREhealth

https://health.mitre.org/himss18

https://www.facebook.com/search/top/?q=mitrehealth

https://twitter.com/MITREhealth

https://www.linkedin.com/company/mitre/

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Questions?


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Backup Slides


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Standards Supported (Cypress and CVU)

CMS Measure

SpecificationQRDA Implementation Guides

eCQM Specifications for Eligible

Professionals May 2017

• CMS Implementation Guide for Quality Reporting Document Architecture Category III,

Implementation Guide for 2018

• HL7 CDA® R2 IG: Quality Reporting Document Architecture Category I (QRDA I);

Release 1, DSTU Release 4

• HL7 CDA® R2 Implementation Guide: Quality Reporting Document Architecture (QRDA

III), Release 1, STU Release 2.1


Hospitals May 2017

• CMS Implementation Guide for Quality Reporting Document Architecture Category I,

Implementation Guide for 2018


Release 1, DSTU Release 4




Professionals April 2016

• 2017 CMS QRDA III Implementation Guide for Eligible Clinicians Reporting v1


Release 1, DSTU Release 3.1




Hospitals April 2016

• 2017 CMS QRDA Implementation Guide for Hospital Quality Reporting


Release 1, DSTU Release 3.1




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Cypress Test Deck

2016 2017 2018

# of Measures 93 71 71

Eligible Clinicians

Patients

81 205 205

Eligible Hospitals

Patients

81 78 78

Minimum

Coverage

80% 95% 95%

Populations Every patient population covered by test deck


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