NQF Webinar: Vendors, providers challenged by measuring health IT quality
 |
National Quality Forum (NQF), a Washington, D.C.-based nonprofit, invited Siemens Healthcare's CMIO of the health services unit, Marc Overhage, MD, and Tenet Healthcare's Vice President of Applied Clinical Informatics Elizabeth O. Johnson, RN-C, to discuss electronic measure (e-measure) implementation from a hospital’s and vendor’s perspective during a Dec. 8 webinar.
Vendors
Standardized formats for e-measure sets, particularly the Quality Data Model (QDM) developed by NQF, may help vendors incorporate measure sets into their health IT products, but Overhage indicated it will take time to determine whether vendors can use them successfully.
“Everyone is quite excited about the evolution of the QDM,” he said. “It’s clear that it should reduce the implementation burden by removing the ambiguity and the need for translation that exists today.”
However, “there is very little experience in the vendor community with using these formalisms and tools,” Overhage added, and a learning curve should be expected.
Although the QDM should make it easier for engineers to build measure sets into EHR systems, Overhage said that some vendors are concerned that the model will place restraints on their ability to build the systems that they conceptualized.
Even if measure sets are easily incorporated into vendors’ products, there are still concerns. Overhage suggested that providers may blame vendors for imposing unwanted or inaccurate measure sets on them when, in fact, it would be at the behest of measure set model developers.
“Part of this is a transference concern,” Overhage said, but “the vendor is just reflecting the realities of the measures that have been imposed on the provider and may feel like they don’t have a lot of flexibility to improve that.”
Overhage advised listeners to be aware of the “potential for unintended consequences” associated with a system for simple measurement set development, but also recognized the potential benefits of e-measures and indicated that additional developments, such as a measure authoring tool, could ease concerns.
“The development and evolution of the QDM has the potential to greatly improve the speed and agility with which measures can be created and integrated into vendor systems,” Overhage said.
“The biggest challenge is related to prioritizing data and thinking about consistency of data across measures,” he concluded. “As we bring more measure sets into practice, we’re going to have to look more diligently across systems to find common ways to fix problems.”
Hospitals
“How does this really affect our future and what should we be thinking about moving forward?” Johnson asked.
According to Johnson, Tenet Healthcare, an organization that operates hospitals in 11 states, chose quality improvement as the guiding principle behind its implementation of e-measures.
“First and foremost, e-measures should lead us to improvements in quality,” she said. “If we’re not using clinical data and clinical decision supports to influence decision-making at the bedside, then we’re not taking advantage of a tool that can improve quality of care.”
Tenet’s approach to creating e-measures, according to Johnson, was to determine e-measure requirements, identify content sources, consider workflows impacted, make design decisions and capture data.
Johnson said that Tenet’s biggest challenge was collecting data from various record-keeping systems, including paper, and formatting it into standardized codes. The manual extraction of data has been a difficult task, according to Johnson, but the process was necessary to prepare Tenet for the future.
As Tenet develops e-measures, it is working closely with vendors to ensure that they can be incorporated into health IT systems, accessed throughout the organization and eventually shared outside of the organization.
“We’re doing the part we need to do on the provider side, we’re very dependent on vendors of all types to be able to help us with the technology that’s required to do that,” Johnson said.
While Tenet is working to develop e-measures with the available guidelines, Johnson, like Overhage, suggested that data models needed to be further refined for e-measure optimization.
“We are waiting and working to get those standards further defined so that the discrete data is captured and can be exchanged,” she said, because “another piece of this is not just having the data to use inside a particular care setting, but being able to exchange that data across the United States, to wherever our patients need care.”
To those providers that may be discouraged by the laborious task of developing, learning or using e-measures, Johnson said that it will take time, but believes that those who stay the course will be rewarded in the future.