HIT Standards CommitteeHIT Standards Committee

Report of the Clinical Quality WorkgroupReport of the Clinical Quality Workgroup

Janet Corrigan, Chair

Floyd Eisenberg

July 21, 2009

Clinical Quality Workgroup --Process

• CQ Workgroup conference calls – June 22, 2009– July 15, 2009

• Consultation/Coordination with Policy Committee– July 9, 2009 (Meaningful Use Workgroup)– July 16, 2009 (Policy Committee)

CQ Workgroup Initial Tasks

• Identify potential set of existing standardized performance measures that correspond to the Policy Committee’s quality measure concepts

• Identify the “data types” that must be captured to calculate the measures

• Handoff to Clinical Operations Workgroup to identify HIT standards

Sources of Measures

• National Quality Forum (NQF) Database – Over 500 endorsed measures– Pipeline measures

• Includes measures used by Centers for Medicare & Medicaid (CMS) (in PQRI and RHQDAPU), Hospital Quality Alliance, accrediting entities, and Physician Consortium for Performance Improvement

Identify Data Types

Health Information Technology Expert Panel (HITEP)

– Convened by NQF; supported by Agency for Healthcare Research and Quality (AHRQ)

– Identify a “Quality Data Set”

– Types of data necessary to calculate and report on performance

– Currently includes over 56 “data types”

Performance Measure Set for 2011

• Includes 27 performance measures (see handout)

• Provisional recommendations– Detailed review of measures by CQ Workgroup not yet

complete– CO Workgroup identification of HIT standards not yet complete

• Significant measure “retooling” required– Efforts underway to ascertain feasibility

• Seeking Standards Committee approval with understanding that there will need to be some changes

Performance Measures: Key Challenges

• Measure Gaps – E.g., % reportable lab results; % patients with access to

educational resources– For 2011 attestation is likely method of data collection

• Available measures developed assuming more limited availability of data– Fail to take advantage of clinically-rich data in EHRs– E.g., % patients at high risk for cardiac events on aspirin

prophylaxis

Performance Measures: Key Challenges

• Some measures rely on data types that will be challenging to capture in 2011 – E.g., BMI, vital signs– May be necessary to have different measure specifications for

2011 and 2013 (e.g., ICD-9 for 2011 and SNOMED for 2013)

• Some measures require data for which there is currently no standardized method of collecting– E.g., VTE (antithrombotic devices)

Performance Measures: Key Challenges

• Some measures require data that may be costly to collect– Lipid profile

• Significant harmonization issues– Measures should be patient-centered– Current measures vary across settings (e.g.,

hospital, ambulatory, LTC) and age groups (e.g., BMI measure for children differs from BMI for adults)

Next Steps

• Detailed review of individual measures underway– Identify any necessary changes in measures – Provide guidance to measure stewards regarding “retooling”

• Develop a 2-dimensinal framework for classifying measures– Degree of readiness of a measure for 2011 implementation– Level of performance expectations (i.e., threshold

considerations)