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HIT STANDARDS COMMITTEE CLINICAL QUALITY MEASURE UPDATE Thomas Tsang, MD, MPH ONC February 16, 2011 Background • Stage 1 Meaningful Use requires 3 core and 3 additional CQMs for EPs and 15 CQMs for hospitals to be reported (aggregate level data for numerator, denominator and exclusions through attestation) • Stage 1 contains 44 ambulatory care measures for EPs • Stage 2 incorporates a transparent and collaborative process for prioritization for measure concept/selection process • HIT PC QWG-six tiger teams created Clinical Quality Measures Establish National Priorities Identify Measures Harmonize and Coordinate Testing/Validation of e-Specifications Identify Measure Gaps Measure Development Retooling Process Interagency Input and Public Comment Public Comment Vocabulary Sets required for Certified EHRs Incorporate into Final Rule Confidential For Internal Use Only Quality Measures Workgroup David Blumenthal, Chair David Lansky, Co-Chair Peter Basch Christine Bechtel Trip Bradd Russ Branzell Helen Burstin Neil Calman Carol Diamond Timothy Ferris Patrick Gordon David Kendrick Charles Kennedy Karen Kmetik Robert Kocher Norma Lang J. Marc Overhage Laura Petersen Jacob Reider Sarah Scholla Cary Sennett Jesse Singer Paul Tang Joachim Rosti James Walker Paul Wallace − − − − − − − − − − − − − − − − − − − − − − − − − − National Coordinator for Health IT Pacific Business Group on Health Medstar National Partnership for Women & Families Skyline Family Practice, VA Poudre Valley Critical Access Hospital, CO National Quality Forum Institute for Family Health Markle Foundation Partners Healthcare Colorado Beacon Consortium Greater Tulsa Health Access Network, OK WellPoint, Inc. American Medical Association McKinsey & Co. University of Wisconsin Regenstrief Institute Baylor University AllScripts NCQA MedAssurant NYC Department of Health Palo Alto Medical Foundation Brookings Institute Geisinger Kaiser Permanente Partners HIT POLICY COMMITTEE / QUALITY WORK GROUP: Federal Ex Officio Members − AHRQ -HRSA − SAMSHA -ASPE − ONC − IHS − AHRQ − CMS Confidential For Internal Use Only eQM Criteria STATE OF READINESS – state of measure development and pipeline/endorsement status HIT-SENSITIVE – evidence that measure can be built into EHRsystems PARSIMONY – applicable across multiple types of providers, care settings and conditions PREVENTABLE BURDEN – evidence that measurement can support potential improvements in population health and reduce burden of illness LONGITUDINAL MEASUREMENT – enables assessment of a longitudinal, conditionspecific, patient-focused episodes of care. *National Quality Forum, 2013 eQM Report Confidential For Internal Use Only Stage 2 Priority Measure Concepts PATIENT AND FAMILY ENGAGEMENT • Self-management/Activation • Honoring Patient Preferences and Shared Decision Making • Public Health Outcomes • Community Resources Coordination/Connection CLINICAL APPROPRIATENESS • Appropriate/Efficient Use of Facilities • Appropriate/Efficient Use of Diagnostic Tests • Appropriate/Efficient Treatment of Chronic Disease Across Multiple Sites of Care • Appropriate/Efficient Use of Medications CARE COORDINATION • Effective Care Planning • Care Transitions • Appropriate and Timely Follow-Up PATIENT SAFETY • Medication Safety • Hospital Associated Events POPULATION AND PUBLIC HEALTH • Health Lifestyle Behaviors • Effective Preventative Services • Health Equity Confidential For Internal Use Only Findings from Request for Comment • • • A total of 134 respondents – 112 organizations and 22 individuals not associated with an organization – responded to the RFC 85 organizations and 5 individuals not associated with an organization submitted comments using the online tool 27 organizations and 17 individuals not associated with an organization submitted comments via email and/or blog only Organizations Abbott Nutrition Products Division, Abbott Agency for Healthcare Research and Quality Alliance for Nursing Informatics America’s Health Insurance Plans American Academy of HIV Medicine, Association of Asian Pacific Community Health Organizations, HIV Medicine Association, National Alliance of State & Territorial AIDS Directors, Partnership for Prevention, and Trust for America's Health American Academy of Hospice and Palliative Medicine American Academy of Ophthalmology American Academy of Pediatrics American College of Physicians American College of Preventive Medicine American College of Radiology IT & Informatics Committee/GR Subcommittee American College of Surgeons American Dietetic Association American Foundation for Suicide Prevention American Hospital Association American Medical Association American Nurses Association American Society of Clinical Oncology Arizona Health Care Cost Containment System Association for Professionals in Infection Control and Epidemiology Association of American Medical Colleges Baylor Health Care System Boston University School of Public Health; and Veterans Administration California Maternal Quality Care Collaborative California Primary Care Association Campaign for Better Health Care Continuum Alliance Case Western Reserve University Catholic Health East Catholic Healthcare Centers for Disease Control and Prevention, National Center for Injury Control and Prevention Certification Commission for Health Information Technology Charlotte Hungerford Hospital Cheboygan Memorial Hospital Childbirth Connection Clinical Inservices Solutions, LLC Consumer Partnership for eHealth Consumer-Purchaser Disclosure Project Dartmouth Institute Davis Family Physicians Delaware Health Net Disability advocacy groups (43 co-signers) Drs. Concannon & Vitale, LLC Duke Durham Regional Hospital Eastern Maine Healthcare Systems Epic GE Healthcare IT George Washington University Golden Living, LLC & LTPAC HIT Collaborative Gundersen Lutheran Health System Health Dialog Health Economics Group+A2 Health IT Now Coalition Health Resources and Services Administration Organizations HealthInsight Regional Extension Center HealthPartners Research Foundation Healthwise HealthyCircles, LLC HMS Hospice and Palliative Care Coalition Hospital Executive Council Indian Health Service Intuit Health Kaiser Permanente Local Public Health Association of Minnesota Massachusetts General Hospital McKesson Provider Technologies MEDai / an Elsevier Company Memorial University Medical Center Minnesota Counties Computer Cooperative Minnesota Department of Health Missouri Hospital Association NASMHPD National Association of Community Health Centers National Center for Cognitive Informatics & Decision Making National Coalition for Cancer Survivorship National Committee for Quality Assurance National Health IT Collaborative for the Underserved National Partnership for Women & Families Nemours Neumann University New York Chapter, American College of Physicians New Yorkers for Accessible Health Coverage Newborn Coalition North Carolina Bio-Preparedness Collaborative Oregon Health & Science University Center for Ethics in Health Care Partners Healthcare Patient Privacy Rights Pediatrix Medical Group Pharmacy e-HIT Collaborative Philips PhRMA Planned Parenthood Federation of America Qualidigm REACH (MN-ND HIT Extension Center) Riverbend Medical Group Scots Pine Clinic, PLLC SHAPE HITECH, LLC Social & Scientific Systems Society for Participatory Medicine Society of Behavioral Medicine St. Joseph Health System Stanford University State of Oregon Health Information Technology Oversight Council Surescripts TeenScreen National Center for Mental Health Checkups at Columbia University Texas Department of State Health Services UnitedHealth Group University of Wisconsin School of Medicine and Public Health VersaForm Systems Corp Washington University School of Medicine Criteria for Measure Selection STATE OF READINESS – state of measure development and pipeline/endorsement status HIT-SENSITIVE – evidence that measure can be built into EHR-systems PARSIMONY – applicable across multiple types of providers, care settings and conditions PREVENTABLE BURDEN – evidence that measurement can support potential improvements in population health and reduce burden of illness HEALTH RISK STATUS – supports assessment of patient health risks that can be used for risk adjusting other measures and assessing change in outcomes AND OUTCOMES MEASUREMENT LONGITUDINAL – enables assessment of a longitudinal, condition-specific, patientMEASUREMENT focused episode of care. *National Quality Forum, 2010 Gretsky Group Report Measure Domain Areas • • • • • Patient & Family Engagement Clinical Appropriateness/Efficiency Care Coordination Patient Safety Population & Public Health Findings: Measure Recommendations 1100 recommended measures 491 unique measures recommended draft superset of Stage 2 and 3 measures overlap of 79 retooled measures 113 already retooled measures Patient & Family Engagement Most Promising Measures • Patient experience of care & HIT connection with providers • Measurement of functional status & health risk • Patient activation and self-management skills Methodological Issues • Defining discrete measures from larger validated instruments • Data platform for patient-reported measures • Sampling versus census approach to data collection Clinical Appropriateness/Efficiency Most Promising Measures • Lipid Control using Framingham risk score • Measure assessing the appropriate use of diagnostic imaging procedures, with measures for redundancy, cumulative exposure, and appropriateness • Measure assessing appropriate medication treatments, including overuse and/or underuse Methodological Issues • Readmissions measures currently are using claims and administrative data (incorporation of claims) • Measures using risk assessment scores and algorithms will need further work Next Steps • A superset of measure concepts/measures to be recommended • Individual Tiger Team meetings for final recommendations • Further workgroup attention to: • Capturing patient-reported measures • Integration of multiple, longitudinal data sources • Framework for quality measures reporting (core/menu) *NQF 2010 Preferences PHR Social / Cultural Clinicians Healthcare Organization s EHR Behavioral Environment Electronic Quality Measures using the QDS Individual Family Social Context Resources Quality Data Set (QDS) element Clinical Care Enabling Quality Through Measurement and Interoperability Communities registry Public Health Universal Interoperable Health IT Standards using the QDS Issues for HIT Standards • Recommendation and feedback of data elements for future e-measures (using the QDS model developed by NQF, funded by HHS) • Guidance and recommendation needed on evolution of QDS • Guidance on vocabulary sets for e-measures • Recommendations on methodologic issues related to eQMs (e.g.-patient self reported measures, delta measures)