The following are some suggestions to mitigate some the mentioned barriers to the rapid and efficient use of quality measures to improve performance:
- Harmonize, harmonize, harmonize. As mentioned, measure harmonization is critical to the future of quality measurement and reporting. In a health care system with increasingly limited resources, it is important to shift resources from quality measurement and reporting to quality improvement, which is the ultimately goal of measurement. The burden on providers and vendors is immense, and harmonization among private and public payers, public health departments, and independent accreditation agencies will enable providers to focus on increasing value in the most high impact areas. Providers and hospitals will participate in a multitude of national, state and local programs such as PQRS, Value Based Purchasing (VBP), Inpatient Hospital Quality Reporting System, Patient Centered Medical Homes, Accountable Care Organizations (ACOs), HEDIS, state initiatives and commercial private payer initiatives. It seems logical to find a common set of measures based on common clinical priorities such as the Million Hearts Initiative or Partnership for Patient Safety. Meaningful Use Stage 1 has used a core plus menu model, which allows for a combination of standardized and customized reporting.
- Develop a standardized minimal data set to enable calculation of 80 percent of the measures. Another challenge is the discrepancy between the data captured by various EHRs. The MAP’s pre-rulemaking report and many others in the measurement community often speak of the need for a “core set” of measures that could be broadly applied across multiple settings and providers. For an eQM to be part of this core there must be a standardized, minimum set of data that all EHRs capture. Much work is needed in identifying this data set and then integrating data capture seamlessly with workflow. With hundreds of certified EHR products in use, a standardized minimal data set will enable the calculation of 80 percent of the measures and will allow for rapid implementation and extraction of data within provider workflows. It will also allow State and local measure reporting requirements be aligned with Federal requirements.
- Use data intermediaries to report quality measures. Even if strides are made toward measure alignment and data capture, there still will likely be a significant reporting burden placed on health care providers. Given the potential complexity of calculating eQMs, one solution would be foster the creation of data intermediaries. These organizations could import data from disparate sources from providers, calculate quality measures, and then feed the results back to the provider for quality improvement and to the relevant third parties. The Physician Quality Reporting System (PQRS) currently has a feedback loop to providers using claims data that averages 18 months; this lengthy delay impedes on any real time quality improvement. Data intermediaries could be piggybacked to State Health Information Exchanges, Regional Extensional Centers, or Quality Improvement Organizations to service ACOs and health homes enabling real time improvement while helping providers/hospitals report to Federal and State agencies.
The field of eQMs is still in its infancy, but we believe it is the future of quality measurement. ONC, CMS and NQF deserve accolades for their extensive work creating the foundation for this future. The realization of the potential of eQMs will require a number of challenges to be addressed through creative and innovative solutions. Measure harmonization, the creation of minimal data set, and fostering the development of data intermediaries are steps toward this realization.
Faraz Ahmad, MD is a third year internal medicine resident in the Healthcare Leadership in Quality Track at the University of Pennsylvania and a member of the Center for Healthcare Improvement and Patient Safety.
Thomas Tsang, MD, MPH, FACP, is currently the Senior Advisor to the Governor of Hawaii for Healthcare Transformation and a CMMI Innovations Advisor. He was formerly the Medical Director, Meaningful Use and Quality at the Office of the National Coordinator for Health Information Technology and served on the Committee on Ways and Means.
This article post was first published at the Health Affairs Blog on February 21, 2012.