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Quality Measures Update

HIT Standards Committee - Clinical Quality Measure Update. Quality Measures Update. Thomas Tsang, MD, MPH ONC February 16, 2011. Background.

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Quality Measures Update

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  1. HIT Standards Committee -Clinical Quality Measure Update Quality Measures Update Thomas Tsang, MD, MPH ONC February 16, 2011

  2. 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

  3. Clinical Quality Measures Testing/Validation of e-Specifications Establish National Priorities Identify Measures Harmonize and Coordinate Identify Measure Gaps Measure Development Retooling Process Interagency Input and Public Comment Public Comment Incorporate into Final Rule Vocabulary Sets required for Certified EHRs Confidential For Internal Use Only

  4. 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

  5. Partners HIT Policy Committee / Quality Work Group: • Federal Ex Officio Members • AHRQ -HRSA • SAMSHA -ASPE • ONC • IHS • AHRQ • CMS Confidential For Internal Use Only

  6. eQM Criteria • *National Quality Forum, 2013 eQM Report Confidential For Internal Use Only

  7. Stage 2 Priority Measure Concepts Confidential For Internal Use Only

  8. 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

  9. 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

  10. 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

  11. Criteria for Measure Selection • *National Quality Forum, 2010 Gretsky Group Report

  12. Measure Domain Areas • Patient & Family Engagement • Clinical Appropriateness/Efficiency • Care Coordination • Patient Safety • Population & Public Health

  13. Findings: Measure Recommendations

  14. 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

  15. 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

  16. 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)

  17. Enabling Quality Through Measurement and Interoperability Enabling Quality Through Measurement and Interoperability Clinical Care Individual Family Social Context Preferences PHR EHR Quality Data Set (QDS) element Social / Cultural Resources Clinicians Healthcare Organizations Environment Behavioral Electronic Quality Measures using the QDS registry Communities Public Health Universal Interoperable Health IT Standards using the QDS *NQF 2010

  18. 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)

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