HIT STANDARDS COMMITTEE -CLINICAL QUALITY MEASURE

UPDATE

Thomas Tsang, MD, MPHONC February 16, 2011

Background

• Stage 1 Meaningful Use requires 3 core and 3 additional CQMs for EPs and 15 CQMs for hospitals to be reported (aggregate level data for numerator, denominator and exclusions through attestation)

• Stage 1 contains 44 ambulatory care measures for EPs

• Stage 2 incorporates a transparent and collaborative process for prioritization for measure concept/selection process

• HIT PC QWG-six tiger teams created

Clinical Quality Measures

Confidential For Internal Use Only

Establish National Priorities

Identify Measure Gaps

Public Comment

Identify Measures

Harmonize and Coordinate

Measure Development

Retooling Process

Vocabulary Sets required for

Certified EHRs

Testing/Validation of e-Specifications

Interagency Input and Public

Comment

Incorporate into Final Rule

Quality Measures Workgroup− National Coordinator for Health IT− Pacific Business Group on Health− Medstar− National Partnership for Women & Families− Skyline Family Practice, VA

− Poudre Valley Critical Access Hospital, CO− National Quality Forum− Institute for Family Health− Markle Foundation− Partners Healthcare

− Colorado Beacon Consortium− Greater Tulsa Health Access Network, OK− WellPoint, Inc.− American Medical Association− McKinsey & Co.

− University of Wisconsin− Regenstrief Institute− Baylor University− AllScripts− NCQA

− MedAssurant− NYC Department of Health− Palo Alto Medical Foundation− Brookings Institute− Geisinger− Kaiser Permanente

David Blumenthal, ChairDavid Lansky, Co-Chair

Peter BaschChristine Bechtel

Trip Bradd

Russ BranzellHelen Burstin

Neil CalmanCarol DiamondTimothy Ferris

Patrick Gordon David Kendrick

Charles KennedyKaren Kmetik

Robert Kocher

Norma LangJ. Marc Overhage

Laura PetersenJacob Reider

Sarah Scholla

Cary SennettJesse Singer

Paul TangJoachim RostiJames WalkerPaul Wallace

Partners

Federal Ex Officio Members−AHRQ -HRSA−SAMSHA -ASPE−ONC−IHS−AHRQ−CMS

HIT POLICY COMMITTEE / QUALITY WORK GROUP:

Confidential For Internal Use Only

eQM Criteria

STATE OF READINESS

– state of measure development and pipeline/endorsement status

HIT-SENSITIVE – evidence that measure can be built into EHR-systems

PARSIMONY – applicable across multiple types of providers, care settings and conditions

PREVENTABLE BURDEN

– evidence that measurement can support potential improvements in population health and reduce burden of illness

LONGITUDINAL MEASUREMENT

– enables assessment of a longitudinal, condition-specific, patient-focused episodes of care.

*National Quality Forum, 2013 eQM Report Confidential For Internal Use Only

Stage 2 Priority Measure Concepts

Confidential For Internal Use Only

Findings from Request for Comment

• A total of 134 respondents – 112 organizations and 22 individuals not associated with an organization – responded to the RFC

• 85 organizations and 5 individuals not associated with an organization submitted comments using the online tool

• 27 organizations and 17 individuals not associated with an organization submitted comments via email and/or blog only

Organizations

Organizations

Criteria for Measure Selection

STATE OF READINESS

– state of measure development and pipeline/endorsement status

HIT-SENSITIVE – evidence that measure can be built into EHR-systems

PARSIMONY – applicable across multiple types of providers, care settings and conditions

PREVENTABLE BURDEN

– evidence that measurement can support potential improvements in population health and reduce burden of illness

HEALTH RISK STATUS AND

OUTCOMES MEASUREMENT

– supports assessment of patient health risks that can be used for risk adjusting other measures and assessing change in outcomes

LONGITUDINAL MEASUREMENT

– enables assessment of a longitudinal, condition-specific, patient-focused episode of care.

*National Quality Forum, 2010 Gretsky Group Report

Measure Domain Areas

• Patient & Family Engagement• Clinical Appropriateness/Efficiency• Care Coordination• Patient Safety• Population & Public Health

Findings: Measure Recommendations

1100 recommended measures

491 unique measures recommended113 already

retooled measures

overlap of 79 retooled measures

draft superset of Stage 2

and 3 measures

Patient & Family Engagement

Most Promising Measures• Patient experience of care & HIT connection with

providers• Measurement of functional status & health risk• Patient activation and self-management skills

Methodological Issues• Defining discrete measures from larger validated

instruments• Data platform for patient-reported measures• Sampling versus census approach to data collection

Clinical Appropriateness/Efficiency

Most Promising Measures• Lipid Control using Framingham risk score • Measure assessing the appropriate use of diagnostic

imaging procedures, with measures for redundancy, cumulative exposure, and appropriateness

• Measure assessing appropriate medication treatments, including overuse and/or underuse

Methodological Issues• Readmissions measures currently are using claims and

administrative data (incorporation of claims)• Measures using risk assessment scores and algorithms

will need further work

Next Steps• A superset of measure

concepts/measures to be recommended

• Individual Tiger Team meetings for final recommendations

• Further workgroup attention to:• Capturing patient-reported measures• Integration of multiple, longitudinal data sources• Framework for quality measures reporting

(core/menu)

Enabling Quality Through Measurement and Interoperability

Electronic Quality Measures using the QDS

Universal Interoperable Health IT Standards using

the QDS

Quality Data Set (QDS) element

Environm

entR

esourcesC

linical Care

CliniciansHealthcare Organizations

IndividualFamilySocial Context

CommunitiesPublic Health

EHR

PHR

registry

*NQF 2010

Issues for HIT Standards

• Recommendation and feedback of data elements for future e-measures (using the QDS model developed by NQF, funded by HHS)

• Guidance and recommendation needed on evolution of QDS

• Guidance on vocabulary sets for e-measures• Recommendations on methodologic issues

related to eQMs (e.g.-patient self reported measures, delta measures)