Using Clinical Data Standards to Measure Quality: A New Approach

Background  Value-based payment for care requires the consistent, objective calculation of care quality. Previous initiatives to calculate ambulatory quality measures have relied on billing data or individual electronic health records (EHRs) to calculate and report performance. New methods for quality measure calculation promoted by federal regulations allow qualified clinical data registries to report quality outcomes based on data aggregated across facilities and EHRs using interoperability standards. Objective  This research evaluates the use of clinical document interchange standards as the basis for quality measurement. Methods  Using data on 1,100 patients from 11 ambulatory care facilities and 5 different EHRs, challenges to quality measurement are identified and addressed for 17 certified quality measures. Results  Iterative solutions were identified for 14 measures that improved patient inclusion and measure calculation accuracy. Findings validate this approach to improving measure accuracy while maintaining measure certification. Conclusion  Organizations that report care quality should be aware of how identified issues affect quality measure selection and calculation. Quality measure authors should consider increasing real-world validation and the consistency of measure logic in respect to issues identified in this research.

[1]  Mark McClellan,et al.  Implementing MACRA: Implications for Physicians and for Physician Leadership. , 2016, JAMA.

[2]  P. Torda,et al.  Achieving the Promise of Electronic Health Record-enabled Quality Measurement: a Measure Developer’s Perspective , 2013, EGEMS.

[3]  Sarah Cottington.  PopHealth primer. ONC funds open-source software to streamline clinical quality measures reporting for meaningful use program. , 2011, Journal of AHIMA.

[4]  Hairong Yu,et al.  Structured data quality reports to improve EHR data quality , 2015, Int. J. Medical Informatics.

[5]  Jason Wang,et al.  Validity of electronic health record-derived quality measurement for performance monitoring , 2012, J. Am. Medical Informatics Assoc..

[6]  Kyoungrae Jung,et al.  The impact of information disclosure on quality of care in HMO markets. , 2010, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[7]  Farzad Mostashari,et al.  The future of quality measurement for improvement and accountability. , 2013, JAMA.

[8]  Kenneth D. Mandl,et al.  Are Meaningful Use Stage 2 certified EHRs ready for interoperability? Findings from the SMART C-CDA Collaborative , 2014, J. Am. Medical Informatics Assoc..

[9]  Sameer Malhotra,et al.  Accuracy of Electronically Reported “Meaningful Use” Clinical Quality Measures , 2013, Annals of Internal Medicine.

[10]  Kitty S. Chan,et al.  Review: Electronic Health Records and the Reliability and Validity of Quality Measures: A Review of the Literature , 2010, Medical care research and review : MCRR.

[11]  Dean F Sittig,et al.  The promise of the CCD: challenges and opportunity for quality improvement and population health. , 2011, AMIA ... Annual Symposium proceedings. AMIA Symposium.

[12]  Stuart Speedie,et al.  Quantifying the Effect of Data Quality on the Validity of an eMeasure , 2017, Applied Clinical Informatics.

[13]  Chun-Ju Hsiao,et al.  Most physicians were eligible for federal incentives in 2011, but few had EHR systems that met meaningful-use criteria. , 2012, Health affairs.

[14]  A G Mainous,et al.  Assessing quality of care via HEDIS 3.0. Is there a better way? , 1998, Archives of family medicine.

[15]  William Gardner,et al.  Using computer-extracted data from electronic health records to measure the quality of adolescent well-care. , 2014, Health services research.

[16]  K. G. Subramanian,et al.  Completeness, accuracy, and computability of National Quality Forum-specified eMeasures , 2015, J. Am. Medical Informatics Assoc..

[17]  Benjamin Eng,et al.  The potential effects of HEDIS performance measures on the quality of care. , 2008, Health affairs.

[18]  Ashish K. Jha,et al.  Patient Engagement Remain Low In Office Settings Despite Substantial Progress In EHR Adoption , Health Information Exchange And , 2014 .

[19]  Dawn Heisey-Grove,et al.  Electronic clinical quality measure reporting challenges: findings from the Medicare EHR Incentive Program’s Controlling High Blood Pressure Measure , 2018, J. Am. Medical Informatics Assoc..

[20]  R. G. Frank.  Centers for Medicare and Medicaid Service , 2017 .

[21]  Nilay D Shah,et al.  The Method for Performance Measurement Matters: Diabetes Care Quality as Measured by Administrative Claims and Institutional Registry. , 2016, Health services research.