The Quality Data Warehouse Project

Many folks involved in healthcare IT and interoperability agree that we should not implement technology for technology's sake, instead we should focus on specific outcomes empowered by technology.

As we've implemented EHRs at Beth Israel Deaconess and throughout the state via the Massachusetts eHealth Collaborative, we've focused on the "model office" and process redesign. We build in decision support and quality measurement as part of the design.

How do you measure quality for an entire community?

I've written about the work of HITEP/HITEP II to create minimum quality data sets and about HITSP's work on the Quality Use case.

These efforts have been foundational to our thinking in Massachusetts.

Over the past year, the Massachusetts e-Health Collaborative has implemented a quality warehouse for the 300 practices in 3 communities and now we're adding the 1000 clinicians from Beth Israel Deaconess and BIDPO to this infrastructure. We think this kind of health information exchange is exactly the type of interoperability encouraged (and required by) the American Recovery and Reinvestment Act.

Here's how we're doing it.

The Massachusetts eHealth Collaborative rolled out EHRs from several vendors (eClinicalWorks, NextGen, Centricity, Allscripts) to 300 practices in 3 communities. Working with the communities, MAeHC created citywide health information exchanges. North Adams runs a Continuity of Care Record-based exchange created by eClinicalWorks. Brockton and Newburyport run an XDS-based clinical exchange created by Wellogic. All these exchanges submit quality data via HL7 2.x messaging and web services transport into a quality warehouse operating by MaeHC and hosted at the Massachusetts Medical Society.

Information exchanged includes

Problems
Procedures
Allergies
Medications
Demographics (encrypted identifiers)
Smoking status
Visits
Diagnosis
Lab results
Rad results

As we take this infrastructure to the next step, we are embracing the HITEP work and HITSP standards to implement quality reporting for the 700 clinicians using Beth Israel Deaconess' home-built EHR called webOMR and the 300 community-based clinicians using our our hosted eClinicalWorks Software as a Service offering. We'll use the Clinical Document Architecture/Continuity of Care Document to standardize the content of the data and we'll use the CAQH Core standards/SOAP for secure transport. The MA-Share/NEHEN gateways that we've used for all other data exchange in the state will provide the infrastructure/architecture to do this.

For all the details on the quality measures, the reporting, and the architecture, we've created this Powerpoint presentation.

This project has five goals for our community
1. Beth Israel Deaconess and its clinicians need to measure quality as a community to ensure we are clinical integrated and to quality for pay for performance incentives offered by our payers
2. The Eastern Massachusetts Healthcare Initiative, a collaboration of all the healthcare stakeholders in Eastern Massachusetts has prioritized quality measurement as one of our regional IT goals for 2009
3. The American Recovery and Reinvestment Act highlights the need for clinicians to exchange quality measurement data in order to qualify for incentives
4. The National Quality Forum/HITEP II would welcome a testbed for their work
5. The Massachusetts Medical Society wants to pilot quality measurement reporting for its members using the MAeHC

Thus, a focus on quality measurement, leveraging the MA-Share/NEHEN infrastructure and building up on the MAeHC warehouse will meet the goals of many stakeholders. It's a perfect storm.