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Enabling Quality Measurement. Daniel Rosenthal, MD MSc MPH Program Director, Health Information Technology National Quality Forum. Quality. HIT. +. *. promotion. content. structure. How do we get quality measurement into and out of EHRs?. - PowerPoint PPT Presentation
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www.qualityforum.org
Enabling Quality Measurement
Daniel Rosenthal, MD MSc MPHProgram Director, Health Information TechnologyNational Quality Forum
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Content » Participants
national priorities
create measures
endorse measures
implementation strategies
implement, test and aggregate
results
public reports
evaluate health care
improve quality
incentive policies
Consumer
Outcomes
1. High Quality 2. Equitable 3. Affordable4. Patient-Centered
AHRQ Foundations
QIOs Regional Collaboratives Providers Oversight Organizations Employers Health Plans Fed/State Govt Health Plans Employers Consumers Providers
Regional Collaboratives Fed/State Govt. Health Plans Others
QASC Quality Alliances Joint Commission NCQA Medical Specialty Boards
NCQA The Joint Commission AMA PCPI Medical Societies Medical Specialty Boards CMS AHRQ Others**
NQF National Priority Partners
NQF
QASC Regional Collaboratives RHIOs/HIEs CMS States Health Data Stewards
NQF
DRAFT - Quality Alliance Steering Committee
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Content » NQF » Mission
• improve the quality of American healthcare by setting national priorities and goals for performance improvement
• endorse national consensus standards for measuring and publicly reporting on performance
• promote the attainment of national goals through education and outreach programs
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Content » NQF » Consensus Standards
National Technology and Transfer Advancement of Act of 1995 (NTTAA)
– five key attributes of a “voluntary consensus standards-setting body:” openness, balance of interest, due process, consensus, and an appeals process
– obligates federal government to adopt voluntary consensus standards
– encourages federal government to participate in setting voluntary consensus standards
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Content » NQF » Membership
• A private, non-profit voluntary consensus standards-setting organization
• Broad membership (350+ members) organized into 8 Councils that– Provide stakeholder perspectives to all NQF deliberations;– Enable various groups within a council to convene,
identify issues and relay information in a unified voice; and
– Promote collaboration among different groups within a stakeholder perspective.
• Councils:– Consumers– Health Care Professionals– Health Plans– Provider Organizations– Public/Community Health Agencies– Purchasers– Research and Quality Improvement Organizations– Supplier & Industry
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Content » NQF » Selected Projects
National Voluntary Consensus Standards for
Nursing Home Care
Hospital Care
Healthcare-associated Infections
ESRD Care
Ambulatory Care
Health IT Structural Measures
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Content » NQF » National Priority Partners
national priorities
• establish national priorities and goals for performance measurement and public reporting
• focus measurement and improvement efforts on achievement of these goals
• multi-stakeholder Committee with representation from 27 leadership organizations
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Content » NQF » National Priority Partners
27 multi-stakeholder organizations• Consumers• Purchasers• Quality alliances• Health professionals/providers• Public sector: CMS, NGA, CDC, AHRQ, NIH• Accreditation/certification groups• Health plans
Co-Chairs:Donald BerwickInstitute for Healthcare ImprovementMargaret O'Kane National Committee for Quality Assurance
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Content » NQF » National Priority Partners
CONSUMERS• National Partnership for Women and Families• Consumers Union• AARP• AFL-CIO
PURCHASERS• National Business Group on Health • The Leapfrog Group• Pacific Business Group on Health • Chamber of Commerce
PUBLIC SECTOR• Centers for Disease Control and Prevention • Centers for Medicare and Medicaid Services • Agency for Healthcare Research and Quality • National Institutes of Health • National Governors Association
QUALITY ALLIANCES• AQA• Hospital Quality Alliance• Quality Alliance Steering Committee• Alliance for Pediatric Quality
HEALTH PROFESSIONALS/PROVIDERS• AMA’s PCPI • American Nurses Association • National Association of Community Health Centers
ACCREDITATION/CERTIFICATION• American Board of Medical Specialties • The Joint Commission• National Committee for Quality
Assurance • Certification Commission for
Healthcare Information Technology
OTHERS• America’s Health Insurance Plans• Institute for Healthcare
Improvement• Institute of Medicine
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Content » NQF National Priority Partners
Provide Effective
Care
EliminateHarm
EradicateDisparities
RemoveWaste
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Content » NQF » National Priority Partners
• Patient and family engagement• Population health • Safety• Palliative care• Care coordination• Overuse • Management of patient-focused
episodes
High Impact Areas
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Content » NQF » Measures
national priorities
create measures
endorse measures
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Content » NQF » Strategic Goals
• high system performance
• composite measurement
• outcomes
• disparities
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Content » NQF » Consensus Development Process
• importance
• scientific acceptability
• usability
• feasibility
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Content » NQF » CDP
specs
evaluate
endorse
do not endorse
share
submit
supportinginformation
specs
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Structure » Interoperable Measure
A “well-defined quality measure” is
composed of a set of common data elements,
encoded using standard taxonomies,
structured logically into a standardized expression
that can be shared and applied to patient data
and reported
NQF HITEP
HITSP
AMA-NCQA Collaborative
PQA QRDA
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Structure » HITEP » Goals
QASC charged NQF to establish a Health IT Expert panel for:
1. Establishment of a priority order for a subset of existing AQA and HQA measures;
2. Development of a generic prioritization framework that could be used across many clinical conditions; and
3. Identification of a set of common data elements to be standardized to enable automation of AQA and HQA measures through electronic health records and health information exchange.
Convened twice in Washington, DC on May 31, 2007 and September 24, 2007.
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Structure » HITEP » Priority Order
AQA/HQA NQF-Endorsed™ measures related to IOM Priority Conditions defined by maximal impact, improvability, and inclusiveness:
1. Asthma2. Cancer screening3. Care coordination 4. Diabetes 5. End-of-life6. Frailty associated with old age7. Immunization8. Ischemic heart disease 9. Major depression10. Medical management11. Pregnancy and childbirth 12. Severe and persistent mental illness13. Stroke14. Tobacco dependence treatment in
adults
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Structure » HITEP » outcome
• concepts HITSP Quality Interoperability Specifications
• measure quality ~ fx(data quality)
• billing code problem list
• allergy != side effect
• coded diagnostic summary
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Structure » HITEP » NQF
limited medical record review
clinically enriched administrative data
EHR functional requirements
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Structure » HITEP » next steps
develop a Quality Data Set that provides the core data elements needed for quality measurement and clinical decision support built off of clinical guidelines
collect and synthesize clinical workflows within and across healthcare settings
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Structure » Interoperable Measure
A “well-defined quality measure” is
composed of a set of common data elements,
encoded using standard taxonomies,
structured logically into a standardized expression
that can be shared and applied to patient data
and reported
NQF HITEP
HITSP
AMA-NCQA Collaborative
PQA QRDA
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Structure » Interoperable Measure
NQF HITEP
HITSP
AMA-NCQA Collaborative
PQA QRDA
Task Example
common data elements
diagnosis_outpt_problist, laboratory_result
common data element coding
ICD-9, SNOMED-CT, LOINC
measure logic representation
IF (diagnosis_outpt_problist A) AND NOT (diagnosis_outpt_problist B) THEN (laboratory_result)
patient data representation
Pt Jones: DM, HTN, HgA1c
NQF HITEP
HITSP
AMA-NCQA Collaborative
PQA QRDA
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Structure » Measure consumption
specs
evaluate
endorse
do not endorse
share
submit
supportinginformation
specs
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Promotion » Goals
1. e-Prescribing, including drug interactions, safety alerts, and formulary management tools;
2. Electronic Health Records (EHRs), including capability for interoperability;
3. Evidence-based clinical decision support systems (CDSS);
4. e-Referrals (consultations, diagnostic studies);
5. computerized provider-order entry (CPOE);
6. reporting to clinical registries and tracking systems that, in addition to a data repository function, analyze and report process and outcomes data that
• provides feedback to member practitioners for quality improvement; or
• are used in quality recognition programs; or • are used for maintenance of board certification.
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Promotion » Measures
e-prescribing1. decision support (including stand-alone/non-EHR applications) 2. in EHR
EHR interoperability3. adoption of CCHIT or core-functional EHR4. receive labs electronically
care management 5. @ point of care 6. between visits
quality reporting registry 7. local 8. national
9. medical home
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Promotion » CCHIT a. CCHIT certified EHR at the time of measurement, or
b. if CCHIT certification is available (in primary care or a specialty) on or before
August 1, 2008, but the system in use is not CCHIT certified, the EHR must
meet the following criteria:1. Ability to manage a medication list AND2. Ability to manage a problem list AND3. Ability to manually enter or electronically receive, store and display laboratory results as discrete searchable data elements AND4. Ability to meet basic privacy and security elements AND5. the EHR must be CCHIT certified on or before August 1st 2011 or
another CCHIT certified product must be in use for compliance after August 1, 2011 or
c. if CCHIT certification is not available for a specialty on August 1, 2008 the
EHR must have capabilities 1, 2, 3, AND 4 in section b above.
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promote the development and use of electronic health records that contain functions for automated collection, aggregation, and transmission of performance measures
“
”
(Content + Structure) x Promotion
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