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Looking ahead several years to Meaningful Use Stage 3, the ONC Health IT Policy Committee is considering both e-clinical quality measures and the data intermediaries and standards to support them.
The Policy Committee’s Quality Measures Workgroup is tasked with developing recommendations for data intermediaries — and first and foremost to offer ONC leaders a sense of what the healthcare and health IT communities envision for intermediaries’ roles.
Helen Burstin, a VP for performance measures at the National Quality Forum, chairs the Quality Measures Workgroup with Terry Cullen, MD, director of informatics at the Veterans Health Administration, and they recently asked health and health IT leaders at a workgroup meeting for opinions on how to proceed with e-clinical quality measures and how to treat data intermediaries.
They started by asking about creating a voluntary “innovation track” for meaningful use clinical quality measurement reporting in stage 3. Forty respondents said they’d support the idea, seven supported it with some reservation and 8 objected.
Burstin and Cullen then asked if they should pursue a “conservative approach” that limits development of the measures to professional societies and integrated delivery networks, or an “alternative approach” that opens the process to any eligible health professional?
Twenty-two of the respondents favored the conservative approach, and 33 favored the alternative approach.
A final question Burstin and Cullen asked: “Should we constrain development in the innovation track with standards for e-measures that are already in place?”
Forty-four respondents said e-measure standards should be constrained, while 11 said constraints should be avoided.
Marc Probst, CIO of Intermountain Healthcare and a member of Health IT Policy Committee, said he favors the alternative approach, with few constraints. “As hard as everyone is working and as fast as we are trying to go with the evolution of quality measures, we need to go faster, further, deeper,” Probst said.
The Quality Measures Workgroup will release a set of recommendations on those and related issues in August, but they offered the Health IT Policy Committee several tentative suggestions.
One that may get more discussion between now and August involves the types of measures providers will get meaningful use credit for.
In the short term, Burstin and Cullen said, providers should “only receive credit for measures that are part of the EHR Incentive Program.” In the long term, though, they suggested using a “minimal set of standardized quality measures” that approximate core MU measures, with data intermediaries required to import, calculate and report data elements to HHS.
At the same time data intermediaries will be encouraged to develop proprietary measurements — or novel ways of measuring quality, as some members of the Health IT Policy Committee described it — those methods should be reviewed, Burstin and Cullen recommended. Those measurements also should be limited to several criteria, including measurements that are “outcomes focused” or include “process measures that have close proximity to a desired outcome measure.“
Indeed, as Christine Bechtel, an advisor with the National Partnership for Women & Families, said in a discussion, quality measurement needs to focus much more on quality outcomes for patients, as opposed to provider processes — part of the long transition to patient-centered healthcare in America.
“Measures designed under today’s fee-for-service system are not the most progressive or patient-centered or aspirational as they could be,” Bechtel said. “Our hope was that potentially by getting the motivation closer to the patients, through providers, some innovation could occur in areas where there frankly are not that many measures or developers or funders.”
Somewhat similar to the issue of “showing your work” for a math problem — IT attribution logic — Burstin and Cullens suggested that data intermediaries, who may be developing proprietary methods, eventually be required to disclose their attribution methods to providers and the ONC, and that it be publicly available.
For accepting EHR data, the short term goal should be to have data intermediaries function as certified EHR modules, Burstin and Cullen said. In the long term, “for the sake of encouraging consistent implementation and calculation” of meaningful use clinical quality measures, direct intermediates should accept quality data that can conform to future standards, like the CDA-based standard Quality Reporting Document Architecture, and to be flexible enough to receive multi-source data capture.
For ensuring the data quality, in the short term, the two recommended, data intermediates should be subject to import and export testing for certification, as they are in meaningful use stage 2. In the long term, intermediaries should “attest that the data they report to HHS truthfully describe clinical care and are faithful to data received from providers.”
Another issue that may get some debate before the final recommendations come out is whether or not meaningful use e-clinical quality measures should be made public.
In the short term, they should not be, Burstin and Cullen suggest. But in the long term they should, at least in part, they said. “Public report requirements will mimic the reporting required by HHS for MU. Innovative measure data should eventually be visible to public.”
That data could be useful to health researchers and patients alike — as Christine Bechtel suggested — because in meaningful use stage 3, the data intermediaries are set to compile reports scoring providers on various performance and error rates.