Friday, August 28, 2009

Quality, Meaningful Use, and Interoperability

A reporter recently asked me to describe the quality measures and standards that are part of meaningful use. Floyd Eisenberg, Senior Vice President, Health Information Technology at the National Quality Forum, summarized the work nicely:

"The National Quality Forum (NQF), with support from the Agency for Healthcare Research and Quality (AHRQ) convened the Health Information Technology Expert Panel (HITEP) to develop a data model for quality measurement. The HITEP developed a framework, the quality data set (QDS), to manage the terms (value set), the context of use (quality data type) and the data flow (data source, recorder, setting, health record field) for each element used to build a quality measure. A quality data element combines the value set with the quality data type to directly express the definition of every term used to calculate a measure. HITEP finalized the quality data types July 31, 2009. During the August 25-27 face-to-face meeting HITSP reviewed all of these data types, defining the standard interoperable segment and taxonomy to represent each. While some areas require harmonization and others represent gaps, a significant portion of data types were sufficiently defined to allow their use in quality measures in the near term. These findings are reflected in updates to the IS 06 Quality Interoperability Specification to be presented to the HITSP Panel September 15. These data type interoperability determinations will also be used in the retooling process for those quality measures recommended for meaningful use by the HIT Standards Committee based on areas for measurement identified by the HIT Policy Committee. Completion of the retooling effort before the end of 2009 will allow time for EHR vendors and local EHR implementations to address these retooled measures in 2010 for reporting in 2011.

HITSP has also established constructs to address two prior gaps in the IS 06 interoperability specifications. There had previously been no standard for reporting of quality measures to a requesting entity. HITSP has now completed public comment for C105 (Patient Level Quality Document Using HL7 Quality Reporting Document Architecture (QRDA)) and revisions will be presented to the HITSP Panel on September 15. This component allows standardization of reporting structure. The HIT Standards Committee elected to allow more testing of QRDA before requiring its use will reconsider it for 2013 based on testing. HITSP also published a provisional component, C106 (Measure Criteria Document) that addresses a currently balloted HL7 to standardize the structure of all quality measures. The HL7 ballot, eMeasure, addresses the HITEP quality data types mentioned above.

In addition to these efforts, under contract from ONC, HITSP has retooled 16 inpatient measures for electronic use, each has also addressed the HITEP data types. A technical note with the details of these retooled measures will be available for public comment in September. Two of these measures are in the list of meaningful use measures suggested by the HIT Policy and Standards Committees. "

Thanks Floyd!


David said...

Thanks for the post. Will HITSP do or say anything to incorporate the CMS PQRI XML format as recommended for 2011 MU and certification by the HIT Standards Committee on August 20th, or will it just "aim ahead" for 2013 with C105?

Debbie said...

Can the 10% CPOE MU standard be met for a facility in the emergency department?

Alex I said...

Is the Emergency Department embedded under Eligible Providers (EP) or Hospitals (IP) on the Meaningful Use Matrix? My guess is that it's on the Hospital side and that EP is for Physician Practices only?