HIT Standards Committee

Report of the Clinical Quality Workgroup Janet Corrigan, Chair Floyd Eisenberg July 21, 2009

Clinical Quality Workgroup --Process

• CQ Workgroup conference calls – – June 22, 2009 July 15, 2009 • Consultation/Coordination with Policy Committee – – July 9, 2009 (Meaningful Use Workgroup) July 16, 2009 (Policy Committee)

CQ Workgroup Initial Tasks

• Identify potential set of existing standardized performance measures that correspond to the Policy Committee’s quality measure concepts • Identify the “data types” that must be captured to calculate the measures • Handoff to Clinical Operations Workgroup to identify HIT standards

Sources of Measures

• National Quality Forum (NQF) Database – – Over 500 endorsed measures Pipeline measures • Includes measures used by Centers for Medicare & Medicaid (CMS) (in PQRI and RHQDAPU), Hospital Quality Alliance, accrediting entities, and Physician Consortium for Performance Improvement

Identify Data Types

Health Information Technology Expert Panel (HITEP) – Convened by NQF; supported by Agency for Healthcare Research and Quality (AHRQ) – Identify a “Quality Data Set” – Types of data necessary to calculate and report on performance – Currently includes over 56 “data types”

Performance Measure Set for 2011

• Includes 27 performance measures (see handout) •

Provisional

– recommendations Detailed review of measures by CQ Workgroup not yet complete – CO Workgroup identification of HIT standards not yet complete • Significant measure “retooling” required – Efforts underway to ascertain feasibility • Seeking Standards Committee approval with understanding that there will need to be some changes

Performance Measures: Key Challenges

• Measure Gaps – E.g., % reportable lab results; % patients with access to educational resources – For 2011 attestation is likely method of data collection • Available measures developed assuming more limited availability of data – – Fail to take advantage of clinically-rich data in EHRs E.g., % patients at high risk for cardiac events on aspirin prophylaxis

Performance Measures: Key Challenges

• Some measures rely on data types that will be challenging to capture in 2011 – – E.g., BMI, vital signs May be necessary to have different measure specifications for 2011 and 2013 (e.g., ICD-9 for 2011 and SNOMED for 2013) • Some measures require data for which there is currently no standardized method of collecting – E.g., VTE (antithrombotic devices)

Performance Measures: Key Challenges

• Some measures require data that may be costly to collect – Lipid profile • Significant harmonization issues – Measures should be patient-centered – Current measures vary across settings (e.g., hospital, ambulatory, LTC) and age groups (e.g., BMI measure for children differs from BMI for adults)

Next Steps

• Detailed review of individual measures underway – – Identify any necessary changes in measures Provide guidance to measure stewards regarding “retooling” • Develop a 2-dimensinal framework for classifying measures – – Degree of readiness of a measure for 2011 implementation Level of performance expectations (i.e., threshold considerations)