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Enabling Quality Measurement

Enabling Quality Measurement. Daniel Rosenthal, MD MSc MPH Program Director, Health Information Technology National Quality Forum. Quality. HIT. +. *. promotion. content. structure. How do we get quality measurement into and out of EHRs?.

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Enabling Quality Measurement

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  1. Enabling Quality Measurement Daniel Rosenthal, MD MSc MPH Program Director, Health Information Technology National Quality Forum

  2. Quality HIT + * promotion content structure

  3. How do we get quality measurement into and out of EHRs?

  4. AHRQ Foundations NQF National Priority Partners NCQA The Joint Commission AMA PCPI Medical Societies Medical Specialty Boards CMS AHRQ Others** QIOs Regional Collaboratives Providers Oversight Organizations Employers Health Plans Fed/State Govt Health Plans Employers Consumers Providers NQF QASC Quality Alliances Joint Commission NCQA Medical Specialty Boards Regional Collaboratives Fed/State Govt. Health Plans Others QASC Regional Collaboratives RHIOs/HIEs CMS States Health Data Stewards Content » Participants evaluate health care national priorities NQF improve quality create measures 1. High Quality 2. Equitable 3. Affordable 4. Patient-Centered Consumer Outcomes incentive policies endorse measures public reports implementation strategies implement, test and aggregate results DRAFT - Quality Alliance Steering Committee

  5. Content NQF

  6. 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

  7. 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

  8. 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

  9. 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

  10. national priorities Content » NQF » National Priority Partners • establish national priorities and goals for performance measurement and public reporting • focus measurement and improvement efforts on achievement of these goals • multi-stakeholder Committee with representation from 27 leadership organizations

  11. 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

  12. Content » NQF » National Priority Partners 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 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 ACCREDITATION/CERTIFICATION • American Board of Medical Specialties • The Joint Commission • National Committee for Quality Assurance • Certification Commission for Healthcare Information Technology 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 OTHERS • America’s Health Insurance Plans • Institute for Healthcare Improvement • Institute of Medicine

  13. Provide Effective Care EliminateHarm EradicateDisparities RemoveWaste Content » NQF National Priority Partners

  14. Content » NQF » National Priority Partners • Patient and family engagement • Population health • Safety • Palliative care • Care coordination • Overuse • Management of patient-focused episodes High Impact Areas

  15. Content » NQF » NPP Framework

  16. national priorities create measures endorse measures Content » NQF » Measures

  17. Content » NQF » endorsed measures

  18. Content » NQF » Strategic Goals • high system performance • composite measurement • outcomes • disparities

  19. Content » NQF » Consensus Development Process • importance • scientific acceptability • usability • feasibility

  20. submit supporting information specs Content » NQF » CDP evaluate do not endorse endorse specs share

  21. Structure How do we get quality measurement into and out of EHRs?

  22. Structure Measure Specifications

  23. Clinical Guidelines Decision Support Quality Measures Structure

  24. Structure » Interoperable Measure A “well-defined quality measure” is composed of a set of common data elements, encoded using standard taxonomies, structured logically into a standardized expression that can be shared and applied to patient data and reported NQF HITEP HITSP AMA-NCQA Collaborative PQA QRDA

  25. Structure » HITEP » Goals • QASC charged NQF to establish a Health IT Expert panel for: • Establishment of a priority order for a subset of existing AQA and HQA measures; • Development of a generic prioritization framework that could be used across many clinical conditions; and • 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.

  26. Structure » HITEP » Priority Order AQA/HQA NQF-Endorsed™ measures related to IOM Priority Conditions defined by maximal impact, improvability, and inclusiveness: • 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

  27. Structure » HITEP » Priority Framework

  28. Structure » HITEP » Priority Framework

  29. Structure » HITEP » Priority Framework

  30. Structure » HITEP » Priority Framework

  31. Structure » HITEP » Priority Framework

  32. Structure » HITEP » Common Data Types

  33. Structure » HITEP » Common Data Types

  34. Numerators, Denominators, Exclusions Structure » HITEP » Pareto

  35. Structure » HITEP » Pareto

  36. Structure » HITEP » Pareto

  37. Exclusions only Structure » HITEP » Pareto

  38. Structure » HITEP » Measure Scores

  39. Structure » HITEP » Measure Scores

  40. Structure » HITEP » outcome • concepts  HITSP Quality Interoperability Specifications • measure quality ~ fx(data quality) • billing code  problem list • allergy != side effect • coded diagnostic summary

  41. Structure » HITEP » NQF limited medical record review clinically enriched administrative data EHR functional requirements

  42. 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

  43. Structure » Interoperable Measure A “well-defined quality measure” is composed of a set of common data elements, encoded using standard taxonomies, structured logically into a standardized expression that can be shared and applied to patient data and reported NQF HITEP HITSP AMA-NCQA Collaborative PQA QRDA

  44. NQF HITEP NQF HITEP HITSP HITSP AMA-NCQA Collaborative AMA-NCQA Collaborative PQA QRDA PQA QRDA Structure » Interoperable Measure

  45. Structure Where do we find quality measurement specifications for our EHR?

  46. Structure One-stop shopping for measures

  47. submit supporting information specs Structure » Measure consumption evaluate do not endorse endorse specs share

  48. specs specs specs specs NQMC ? QMIS NQF

  49. NQMC specs specs ? QMIS NQF specs specs

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