Health IT experts brainstorm with ONC on clinical quality measures

New quality e-measures could include records tracking "pre-diabetic progressing to diabetes"
By Anthony Brino
10:16 AM
Informaticists joined clinical quality experts in a brain storming session this week with new ONC chief Karen DeSalvo, exchanging ideas on developing the "next generation" of quality measures. 
Charged with developing new e-clinical quality measures that can work in tandem with accountable care measures, the HIT Policy Committee’s Quality Measures Workgroup offered recommendations to Karen DeSalvo at her first policy meeting.
The Workgroup’s co-chairs, National Quality Forum VP Helen Burstin, MD, and Veterans Health Administration informatics director Terry Cullen, MD, developed recommendations for measure domains, criteria and implementation, some of which seems to have drawn resistance from a few health IT companies.
In the area of patient safety, the ONC and CMS should develop measures addressing falls, hospital-acquired infections and EHR safety, the Workgroup recommended. Providers could track their rates for avoidable readmissions, drug-drug interactions, falls and infections, all of which could help “proactively notify clinicians of high risk patients," Burstin and Cullen wrote.
For population health and equity, new e-measures could include records tracking "pre-diabetic progressing to diabetes," along with other screenings such as mammograms and colonoscopies, and comparing the rates across patient demographics.
To improve patient engagement, the workgroup is suggesting, the ONC and CMS could develop measurements for patient outcomes, experiences, self-management, preferences and shared-decision making.
Burstin and Cullen are also suggesting developing measures that address "appropriateness of care and efficient use of facilities." Those e-measures could be based on clinical, claims and pharmacy data, and gauge the total cost of care based on a per member per month average, or the number of duplicate tests or the rate of avoidable emergency department visits.
For all of those ideas and for all of e-clinical quality measures, Burstin and Cullen reiterated a principle that CMS leaders say they’re looking to adopt to reduce provider administrative burden: a "preference for reporting once across programs that aggregate data."
Burstin and Cullen also recommended "innovation pathways" for implementing the measures. One "conservative approach" could use "certified development organizations" to "develop, release and report proprietary CQMs" for meaningful use.
An alternative approach "might open the process to any (eligible provider or eligible hosptial) but constrain allowable eCQMs via measure design software."
In either case, the HIT Policy Committee’s Tiger Team argues that a pathway with data validation would be costly to develop and maintain, and that it shouldn’t be considered as part the next meaningful use certification.
And regardless of whether or not those proposed measures are included in certification, Burstin and Cullen noted that they have significant data and infrastructure needs: comprehensive claims data and interoperable systems across care settings. 
This story first appeared in Government Health IT here.
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