Quality Measures in Electronic Health records
Jacob Reider, MDMedical Director, AllscriptsCo-ChairEHRA Acceleration Working Group
Quality Measures
• Goal: Improve the Quality of Care• “RESPECT what we INSPECT”
• Quality Measures / Performance Measureso Historically based on retrospective review of
paper chartso Try to capture evidence of providers’ ability to
follow guidelines – presumably based on best practices
Quality Measure Developers
• American Medical Association (AMA)• National Committee for Quality Assurance
(NCQA)• Centers for Medicaid and Medicare
Services (CMS)• Health Insurers • The Joint Commission• Provider Organizations
Quality Measure Consumers
• Care Delivery Organizations• Consumer groups• Health Insurers • Individual patients
Paper Medical Records
Paper Medical Records• Quality Measure:
o Did all diabetics get a foot exam?
Create audit tool A Human manually reviews records
Is this patient a diabetic? Is there evidence of a foot exam?
• Human abstracts the scribbles on paper and creates data
Electronic Health records
Electronic Health Record• May not represent “diabetes” consistently
• May not represent “foot exam” consistently
• May not represent “smoking cessation counseling for 10 minutes” consistently
• Requires “mapping” of concepts to the metrics of quality measures for retrospective review
Quality Measures• Are published in word processing documents
• May use ambiguous terms • “Diabetes”• “Smoking cessation counseling”• “Comfort Measures”
• May refer to data that isn’t captured in the EHR at all
• Include imprecise logical statements. Logic not enforced by Microsoft Word.
300+ Electronic Health Record Vendors in USA – How do we incorporate Quality Measures?
1. Pay Clinicians to Interpret Quality Measures
2. Pay analysts to create logical statements of business logic and functional requirements for quality measure management in our software
3. Pay developers to write code that expresses this business logic
4. Repeat 1- 3 for every measure, revision, etc
What if ? .. • The EHR “knows” what information the quality measure
will expect up front?• The Quality Measure is represented in a format that the
EHR can “consume” automatically• The Quality Measure definition is constrained to:
o A precise formato A precise set of logical statementso A precise set of terms and value sets
Nirvana
• Buddha described nirvana as the perfect peace of the state of mind that is free from craving, anger and other afflictive states (kilesa).
Improve Quality: Stakeholders
The Collaborative• Collaborative for Performance Measure Integration with
EHR Systems
o AMAo NCQAo EHRA
• The Collaborative is comprised of a group of stakeholders — who have a shared goal of facilitating the integration of performance measures with EHR systems.
Collaborative Tasks
• Technical definition of a standard expression syntax for performance measures definition
• Work with NQF to define criteria and an editorial process by which appropriate measures would be endorsed as “fit for EHRs”
• ARRA Alignment – educate government leadership on the importance of this initiative as a keystone to the improvement of care delivery
Technical Definition
• Health Quality Measures Format draft specification: Htpp://www.hqmf.org
• NQF sponsorship of activities to move HQMF through standards process, IHE profile , HITSP Value Case
Criteria and Editorial process
• April 30 meeting in Washington DC
• Collaboration with National Quality Forum
• Collaboration with ONC
ARRA Alignment
Summary• Quality care is a key component of ARRA
• Electronic Health records CAN improve the quality of care
• Quality Measures can define the essential components of quality care ..
So long as ..
• Quality measures are expressed in a standard way ...• Quality measures can be automatically consumed and
leveraged by EHRs ..