Wednesday, February 25, 2009

A Quality Data Set for the Country

In yesterday's blog about novel data sources for quality measurement, I emphasized the need to embrace clinical data sets for measuring quality. To accelerate this effort, we must first develop a standardized quality data set (QDS) and identify healthcare workflow changes to enable automation of performance measures through electronic health records and health information exchanges.

The National Quality Forum's Health Information Technology Expert Panel has already laid the foundation for the use of clinical data in quality measurement.

Yesterday, the NQF convened HITEP II to build upon this work. I have the privilege of being part of HITEP II and I wanted to share with you the background and charges to the workgroups.

Background
In 2007, the Agency for Healthcare Research and Quality (AHRQ) commissioned the NQF to convene HITEP to address the ability of EHRs to create and aggregate data for quality measurement. HITEP recommended a high-priority set of quality measures; identified a set of required data types that were incorporated into the Healthcare IT Standards Panel (HITSP) Interoperability Specification for Quality; developed a framework for evaluating the quality of these data types; and, identified gaps and made recommendations to enable automated quality measurement. The American Health Information Community (AHIC) Quality Workgroup recommended further development of these data types into the QDS. In addition to improving quality measurement, the QDS will provide a base of core data needed to bridge clinical guidelines with Clinical Decision Support (CDS), the key effector arm for quality improvement using EHRs in clinical settings The AHIC Quality Workgroup further recommended an environmental scan of existing automated quality reporting initiatives to identify existing and preferred workflows to generate data needed for performance measurement. The second HITEP will identify workflows and recommend the QDS to quality stakeholders including HITSP. NQF will also incorporate HITEP recommendations into the NQF measure endorsement process.

HITEP‐II Quality Data Set (QDS) Workgroup Objective
NQF, through HITEP, will define a draft quality data set framework that would support quality measurement that is automated, patient‐centric, and longitudinal. NQF and HITEP will review existing data sets used for quality measurement, including those developed by the Centers for Medicare and Medicaid Services for its CARE tool, by the HITEP in its initial work, by the Joint
Commission for transfers of care, and by others as appropriate, as the basis of a harmonized minimum set of data types or elements that can be used for automating quality measures. HITEP should also incorporate into the draft harmonized quality data set those data types or elements needed to support measure sets and national priority areas. HITEP should assign a data quality score and a priority level to each data type or element within the draft quality data set as an aid to implementation. The draft quality data set will be populated with quality data elements for the high priority conditions defined in HITEP I, and include, at a minimum, relevant data captured during inpatient and physician office visits, and data required to support transitions of care among other provider settings.

HITEP‐II Quality Data Set (QDS) Workgroup Objective
Provide a centralized, maintained repository of quality data requirements (concepts, data types, data elements, code sets) and data definitions used by multiple stakeholders to develop, specify, and use quality measures.

HITEP-II Workflow Workgroup Objective
The Workflow Workgroup will explore ways of describing efficient capture of standard data elements from appropriate sources. The work product will define the qualitative and quantitative aspects of data by examining quality data flow maps. Such quality data management will address three requirements for data: validity (the authority and accountability of the source), integrity (the methods for maintaining validity of the data), and appropriateness of secondary use of the data.

HITEP-II Workflow Workgroup Objective
The workgroup will determine mechanisms and opportunities within quality data management workflows for identifying patients who meet inclusion criteria in measure populations, for gathering performance measurement data, and for providing clinical decision support to optimize performance in targeted areas. In addition to a generic framework that could be used across many clinical conditions, the deliverable should include at least one scenario for how the workflows operate for targeted conditions.

I am confident that HITEP II will provide the detailed Quality Data Set specifications that will enable HITSP to refine its previous work on Quality measurement. Over time, these standards will be required as part of EHR certification and will be incorporated into health information exchanges. HITEP II's work will ensure that we can measure the quality impact of the accelerated EHR rollout funded by the American Recovery and Reinvestment Act. Once we can measure quality, we can then reform healthcare, paying for quality instead of quantity. HITEP II's work is critical to that vision.

3 comments:

Brian said...

This is a good step in the right direction. As these standards are more formalized it is my hope that the governance to enforce these quality standards is put in place; supported by all healthcare stakeholders (e.g., payers, providers, government, etc...)
To date in many cases the quality initiatives and datasets that support them are vague; interpreted in many ways. Take Medication Reconciliation for example, every organization I go to has a separate interpretation of the process and timing it takes to support the JCAHO guidelines. This seems to be the same with many other quality initiatives set out by the many governing organizations IHI, JCAHO, CMS, etc...
I would also hope that we in the healthcare arena and as HIT practitioners will continue to lobby for nomenclature standards like Snomed CT to support standard automated reporting at both the local and government levels; clear cut implementation of the workflow's to support them. I am optimistic to the future of this, but we need all hands on deck to support this group, to achieve the desired outcomes.

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