The College of Healthcare Information Management Executives (CHIME) is pleading for clear "next steps" for putting health IT to work on what the organization calls "one of the most daunting challenges providers face today" – a mix of competing ways to measure clinical quality.
CHIME, which represents more than 1,450 chief information officers (CIOs) and other top information technology executives, made its comments in a letter to Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality, responding to a request for information on quality measures.
“Given the current reality of quality measurement, we believe AHRQ should focus its research on defining clear 'next steps' for providers to use health IT in quality measurement,” CHIME requested, in a comment letter signed by Richard A. Correll, president and CEO CHIME and Drex DeFord, CHIME board chair and CIO at Boston-based Steward Health Care.
CHIME also encouraged AHRQ to help other agencies under the Department of Health and Human Services to “harmonize quality measure efforts as a way to standardize specifications for measures used in multiple reporting programs.”
“We are worried that the goal of 100 percent automation is an extremely long-term vision, given the state of natural language processing and the workflows of providers,” said CHIME officials.
“We recommend that AHRQ look to develop practical ways that both EHRs and other health IT systems can be used to aid current workflows and processes so that abstractors can more efficiently perform quality assurance and CQMs [clinical quality measures] can increasingly be more meaningful.”
“While complete automation is a laudable goal, we believe the more pressing need is to make incremental advancements and disseminate best practices in the near-term," the letter read. "One way to do this would be to focus on harmonization.”
Other key points in CHIME’s letter:
- “Through our experiences with meaningful use and other quality reporting programs, we found that although EHR products were able to automatically produce CQM reports, the data was inaccurate, inconsistent and largely incomparable across different providers.”
- “The RFI correctly characterized the environment of quality measurement as largely conducted via paper chart information capture, manual chart abstraction, and the analysis of administrative claims data.”
- “This process has enormous implications for provider workflows. In many instances, Quality Abstractors (additional FTEs) are required to complete quality measurement.”
- “We believe such harmonization must extend through (1) the specific CQM, (2) how the CQM is reported, and (3) to whom it is reported.”
CHIME highlighted the morass of reporting requirements as it already had in its comments on meaningful use, Stage 2, noting that "CQMs shared among different reporting programs use different specifications, diminishing gains made through harmonization."
CHIME said it supported the Office of the National Coordinator’s (ONC) proposed strategic approach to CQM data capture and export. “We encourage AHRQ to investigate more fully the National Quality Forum’s Quality Data Model (QDM) and Measure Authoring Tool (MAT) as a way to move towards more harmonization across programs,” CHIME told AHRQ.
The fate of AHRQ itself remains uncertain, since a House Appropriations subcommittee voted July 18 to go ahead with a controversial bill that would eliminate all funding for the agency.