Identify value proposition for successful eCQMs

CHICAGO—Providers will support electronic clinical quality measures (eCQMs) if there is a value proposition, said Michael Zaroukian, MD, PhD, vice president and PhD, CMIO of Sparrow Health System, speaking at the Quality Symposium at the 2014 HIMSS Annual Conference & Exhibition.

Zaroukian said measures need to be clear, simple, consistent, stable; matter to my patients and me; are fairly attributed to me; fit into efficient EHR workflows; yield reports I agree with and can act on; are easy to calculate and submit; and can be implemented at reasonable cost.

He discussed three “buckets” involved in quality measures: developers who need to keep it simple and make sure the measures are feasible and will work in the real world; vendors who need to bake measures into EHRs; and providers who need to align workflows and EHR functionalities.

There is much disdain for quality measures among clinicians, Zaroukian said, because of the staff resources needed to manage reporting and the added work required to prove a measure was met.

He offered several strategies to engage with vendors. Commit to a mutual purpose and shared success. Study vendor quality reporting documents, project management, terminology mapping and crosswalks. Promote synergy not defensiveness. “In our case, our vendor has really robust document on how to do this. Making people highly familiar can help us help our doctors.”

Standards testing looks at feasibility, validity and reliability, said Sharon Giarrizzo-Wilson, MS, RN-BC, CNOR, president and CEO of SymQuality Consulting. “It’s a rigorous process” that involves alpha or internal testing and beta or field testing. Without a national testbed, testing only occurs in silos across programs. “A testbed would offer consistency on how these measures can be integrated into systems and how end-users will be able to report.”

Giarrizzo-Wilson discussed the Cypress project, the Meaningful Use Stage 2 testing and certification tool. “We produce the measures and then hand them over to Cypress and they try to break the measure. We really want to make sure the measures can work in the cert tools. Prior to passing measures over to testing tools, we were very inconsistent. We didn’t know whether measures would work properly in HER and Cypress testing environment.”

The maintenance process begins as soon as a measure is posted publicly. “We start looking at what needs to change,” she said. “The goal is harmonization with all of the measures.”

The tools are more efficient than when they started, she said, but “we still have inefficiencies.” After much discussion about alignment the measures for eligible professionals and eligible hospitals, “we’re finally starting to do it.”

Among the challenges for standards testing are tool limitations. “We are unable to test the full range of use cases and scenarios. The value sets are updated annually. Those terminologies update multiple times throughout the year so we need to make sure we have consistent alignment for the value set we’re using in our measures. When end-users start to report, we want to make sure we have the correct information in their measures, they are reporting for the right year for the right measures with the right value sets.”

Zaroukian said top priorities for progress with quality measures include collaboration, participation of subject matter experts, and keeping the focus on whether data collection and reporting will result in better health, better care and lower costs. “We need to align rewards and accountability around who benefits and who pays. For physicians, that’s a gap that needs to be addressed.”

Physicians will care about performance that’s relevant, he said. “We need to give them enough oxygen in the room for them to take the time to get better. We’re doing this to have a healthcare system that’s not broken.”