Transcript The National Quality Forum

Enabling Quality Measurement
Daniel Rosenthal, MD MSc MPH
Program Director, Health Information Technology
National Quality Forum
www.qualityforum.org
Quality
content
+
HIT
structure
*
promotion
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How do we get quality
measurement into and
out of EHRs?
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Content » Participants
AHRQ
Foundations
QIOs
Regional Collaboratives
Providers
Oversight Organizations
Employers
Health Plans
Fed/State Govt
Health Plans
Employers
Consumers
Providers
NQF National Priority Partners
evaluate
health care
improve
quality
incentive
policies
national
priorities
NQF
1. High Quality
Consumer
2. Equitable
Outcomes
3. Affordable
4. Patient-Centered
public
reports
Regional
Collaboratives
Fed/State Govt.
Health Plans
Others
endorse
measures
implementation
strategies
implement, test
and aggregate
results
QASC
Regional Collaboratives
RHIOs/HIEs
CMS
States
Health Data Stewards
DRAFT - Quality Alliance Steering Committee
create
measures
NCQA
The Joint Commission
AMA PCPI
Medical Societies
Medical Specialty Boards
CMS
AHRQ
Others**
NQF
QASC
Quality Alliances
Joint Commission
NCQA
Medical Specialty
Boards
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Content
NQF
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Content » NQF » Mission
•
improve the quality of American healthcare by setting
national priorities and goals for performance
improvement
•
endorse national consensus standards for measuring
and publicly reporting on performance
•
promote the attainment of national goals through
education and outreach programs
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Content » NQF » Consensus Standards
National Technology and Transfer Advancement of Act of 1995 (NTTAA)
– five key attributes of a “voluntary consensus standards-setting
body:” openness, balance of interest, due process, consensus, and
an appeals process
– obligates federal government to adopt voluntary consensus standards
– encourages federal government to participate in setting voluntary
consensus standards
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Content » NQF » Membership
•
•
•
A private, non-profit voluntary consensus standards-setting
organization
Broad membership (350+ members) organized into 8 Councils that
– Provide stakeholder perspectives to all NQF deliberations;
– Enable various groups within a council to convene, identify
issues and relay information in a unified voice; and
– Promote collaboration among different groups within a
stakeholder perspective.
Councils:
– Consumers
– Health Care Professionals
– Health Plans
– Provider Organizations
– Public/Community Health Agencies
– Purchasers
– Research and Quality Improvement Organizations
– Supplier & Industry
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Content » NQF » Selected Projects
National Voluntary Consensus Standards for
Nursing Home Care
Hospital Care
Healthcare-associated Infections
ESRD Care
Ambulatory Care
Health IT Structural Measures
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Content » NQF » National Priority Partners
• establish national priorities and goals for performance
national
measurement and public reporting priorities
• focus measurement and improvement efforts on
achievement of these goals
• multi-stakeholder Committee with representation from 27
leadership organizations
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Content » NQF » National Priority Partners
27 multi-stakeholder organizations
• Consumers
• Purchasers
• Quality alliances
• Health professionals/providers
• Public sector: CMS, NGA, CDC, AHRQ, NIH
• Accreditation/certification groups
• Health plans
Co-Chairs:
Donald Berwick
Institute for Healthcare Improvement
Margaret O'Kane
National Committee for Quality Assurance
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Content » NQF » National Priority Partners
CONSUMERS
• National Partnership for Women and Families
• Consumers Union
• AARP
• AFL-CIO
PURCHASERS
• National Business Group on Health
• The Leapfrog Group
• Pacific Business Group on Health
• Chamber of Commerce
HEALTH PROFESSIONALS/PROVIDERS
• AMA’s PCPI
• American Nurses Association
• National Association of Community Health Centers
QUALITY ALLIANCES
• AQA
• Hospital Quality Alliance
• Quality Alliance Steering Committee
• Alliance for Pediatric Quality
PUBLIC SECTOR
• Centers for Disease Control and Prevention
• Centers for Medicare and Medicaid Services
• Agency for Healthcare Research and Quality
• National Institutes of Health
• National Governors Association
ACCREDITATION/CERTIFICATION
• American Board of Medical Specialties
• The Joint Commission
• National Committee for Quality Assurance
• Certification Commission for Healthcare
Information Technology
OTHERS
• America’s Health Insurance Plans
• Institute for Healthcare Improvement
• Institute of Medicine
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Content » NQF National Priority Partners
Provide
Effective
Care
Remove
Waste
Eliminate
Harm
Eradicate
Disparities
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Content » NQF » National Priority Partners
High Impact Areas
•
•
•
•
•
•
•
Patient and family engagement
Population health
Safety
Palliative care
Care coordination
Overuse
Management of patient-focused episodes
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Content » NQF » NPP Framework
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Content » NQF » Measures
national
priorities
create
measures
endorse
measures
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Content » NQF » endorsed measures
120
100
80
60
40
20
0
2005
2006
2007
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Content » NQF » Strategic Goals
• high system performance
• composite measurement
• outcomes
• disparities
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Content » NQF » Consensus Development Process
• importance
• scientific acceptability
• usability
• feasibility
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Content » NQF » CDP
submit
specs
supporting
information
evaluate
do not
endorse
endorse
share
specs
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Structure
How do we get quality
measurement into and
out of EHRs?
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Structure
Measure
Specifications
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Structure
Clinical
Guidelines
Quality
Measures
Decision
Support
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Structure » Interoperable Measure
A “well-defined quality measure” is
composed of a set of common data elements,
NQF HITEP
encoded using standard taxonomies,
HITSP
structured logically into a standardized expression
AMA-NCQA Collaborative
that can be shared and applied to patient data
and reported
PQA QRDA
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Structure » HITEP » Goals
QASC charged NQF to establish a Health IT Expert panel for:
1. Establishment of a priority order for a subset of existing AQA
and HQA measures;
2. Development of a generic prioritization framework that could
be used across many clinical conditions; and
3. Identification of a set of common data elements to be
standardized to enable automation of AQA and HQA measures
through electronic health records and health information
exchange.
Convened twice in Washington, DC on May 31, 2007 and
September 24, 2007.
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Structure » HITEP » Priority Order
AQA/HQA NQF-Endorsed™ measures related to IOM Priority Conditions
defined by maximal impact, improvability, and inclusiveness:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Asthma
Cancer screening
Care coordination
Diabetes
End-of-life
Frailty associated with old age
Immunization
Ischemic heart disease
Major depression
Medical management
Pregnancy and childbirth
Severe and persistent mental illness
Stroke
Tobacco dependence treatment in adults
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Structure » HITEP » Priority Framework
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Structure » HITEP » Priority Framework
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Structure » HITEP » Priority Framework
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Structure » HITEP » Priority Framework
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Structure » HITEP » Priority Framework
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Structure » HITEP » Common Data Types
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Structure » HITEP » Common Data Types
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Structure » HITEP » Pareto
Numerators, Denominators, Exclusions
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Structure » HITEP » Pareto
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Structure » HITEP » Pareto
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Structure » HITEP » Pareto
Exclusions only
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Structure » HITEP » Measure Scores
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Structure » HITEP » Measure Scores
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Structure » HITEP » outcome
• concepts  HITSP Quality Interoperability Specifications
• measure quality ~ fx(data quality)
• billing code  problem list
• allergy != side effect
• coded diagnostic summary
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Structure » HITEP » NQF
limited medical record review
clinically enriched administrative data
EHR functional requirements
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Structure » HITEP » next steps
develop a Quality Data Set that provides the core data
elements needed for quality measurement and clinical decision
support built off of clinical guidelines
collect and synthesize clinical workflows within and across
healthcare settings
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Structure » Interoperable Measure
A “well-defined quality measure” is
composed of a set of common data elements,
NQF HITEP
encoded using standard taxonomies,
HITSP
structured logically into a standardized expression
AMA-NCQA Collaborative
that can be shared and applied to patient data
and reported
PQA QRDA
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Structure » Interoperable Measure
NQF HITEP
HITSP
Task
Example
common data
elements
diagnosis_outpt_problist,
laboratory_result
common data
element coding
NQF HITEP
ICD-9, SNOMED-CT, LOINC
HITSP
AMA-NCQA Collaborative
AMA-NCQA
Collaborative
PQA QRDA
measure logic
representation
IF (diagnosis_outpt_problist A)
PQA QRDA
AND NOT
(diagnosis_outpt_problist B)
THEN (laboratory_result)
patient data
representation
Pt Jones: DM, HTN, HgA1c
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Structure
Where do we find
quality measurement
specifications for our
EHR?
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Structure
One-stop
shopping for
measures
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Structure » Measure consumption
submit
specs
supporting
information
evaluate
do not
endorse
endorse
share
specs
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specs
NQMC
?
QMIS
specs
specs
specs
NQF
specs
NQMC
?
QMIS
specs
specs
specs
NQF
1. content
2. representation
specs
4. reconciliation
xml
3. transmission
1. content
2. representation
specs
4. reconciliation
xml
3. transmission
1. content
2. representation
specs
4. reconciliation
xml
3. transmission
1. content
2. representation
specs
4. reconciliation
xml
3. transmission
Promotion
Why should we enable
quality measurement
within our EHR?
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Promotion
HIT
Structural
Measures
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Promotion » Goals
1.
e-Prescribing, including drug interactions, safety alerts, and formulary
management tools;
2.
Electronic Health Records (EHRs), including capability for
interoperability;
3.
Evidence-based clinical decision support systems (CDSS);
4.
e-Referrals (consultations, diagnostic studies);
5.
computerized provider-order entry (CPOE);
6.
reporting to clinical registries and tracking systems that, in addition to
a data repository function, analyze and report process and outcomes
data that
• provides feedback to member practitioners for quality
improvement; or
• are used in quality recognition programs; or
• are used for maintenance of board certification.
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population
Promotion » Adoption
#1
HIT adoption
#2
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Promotion » Measures
e-prescribing
1. decision support (including stand-alone/non-EHR applications)
2. in EHR
EHR interoperability
3. adoption of CCHIT or core-functional EHR
4. receive labs electronically
care management
5. @ point of care
6. between visits
quality reporting registry
7. local
8. national
9. medical home
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Promotion » CCHIT
a. CCHIT certified EHR at the time of measurement, or
b. if CCHIT certification is available (in primary care or a specialty) on or
before
August 1, 2008, but the system in use is not CCHIT certified, the EHR must
meet the following criteria:
1. Ability to manage a medication list AND
2. Ability to manage a problem list AND
3. Ability to manually enter or electronically receive, store and
display laboratory results as discrete searchable data elements AND
4. Ability to meet basic privacy and security elements AND
5. the EHR must be CCHIT certified on or before August 1st 2011 or
another CCHIT certified product must be in use for compliance after
August 1, 2011 or
c. if CCHIT certification is not available for a specialty on August 1, 2008 the
EHR must have capabilities 1, 2, 3, AND 4 in section b above.
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Quality
content
+
HIT
structure
*
promotion
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(Content + Structure) x Promotion
“ promote the development
and use of electronic health
records that contain
functions for automated
collection, aggregation, and
transmission of performance
measures
”
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Daniel Rosenthal, MD MSc MPH
Program Director, Health Information Technology
[email protected]
National Quality Forum
www.qualityforum.org