ONC kicks off quality framework initiative

The Office of the National Coordinator for Health IT (ONC) has launched a new initiative focused on "harmonizing the standards for clinical decision support (CDS) and electronic clinical quality measurement (eCQM)," according to Doug Fridsma, MD, PhD, director of ONC’s Office of Science and Technology.

The launch of the Clinical Quality Framework comes as the public-private Health eDecision project established in June 2012 comes to a close. The project’s work will be furthered through this new initiative that focuses on clinical decision support (CDS) and electronic clinical quality measures (eCQMs), Fridsma said during a kickoff webcast.

“We have all learned a lot since Stage 1 of Meaningful Use,” said Kate Goodrich, MD, director of the CMS quality measurement and health assessment group. “It’s important going forward that CMS and ONC collaborate to share these learnings” to develop a strategic plan that will help the healthcare industry reach a future state.

The framework represents “a new endeavor in quality improvement,” said Amy Helwig, ONC’s acting chief medical officer. Both CDS and eCQMs are needed to improve care, she said. “Doing one or the other alone doesn’t always lead to improvement. We’re working to link quality measures to CDS so providers can measure performance and work to improve.”

Fridsma cited the Standards & Interoperability Framework, which included work done around accelerating the process of developing and harmonizing standards. “We don’t see our job as being the ones who develop these standards. Our role is to serve as a platform for other people to succeed to create those conditions of interoperability.”

Fridsma said there will never be a one-size-fits-all solution. From rural practitioners to academic institutions to large urban medical centers, all need “the ability to measure quality and improve it.” Sharing information and including a degree of flexibility are important, he said, as well as identifying commonalities between clinical improvement and measuring quality. The new initiative aims to “identify those things that should be in common and find a common language to describe things that are the same and different, thereby providing the mechanisms by which some of that variability can be captured.”

Building incrementally also is essential, Fridsma said. The goal is to focus on different building blocks and then “have each block mature and grow and become more standardized at different paces.”

The framework provides an opportunity to work with the federal advisory committees that provide official guidance to ONC about standards and their readiness.

The effort also served as a call for participation. Once assembled, the team will discuss how they will define success. “What gets adopted is something the community votes on and they will feel they have a stake in the game.”

The team will focus activities primarily around use cases, he added, which will drive home the goal of exchange and use of information. “As we define that use case, we will try to ensure harmonization.” Tools will be developed and adopted, information will go before federal advisory committees and the team will ensure that appropriate elements are balloted through standardization organizations.

Kensaku Kawamoto, MD, PhD, director of the University of Utah Health Care’s Knowledge Management and Mobilization Initiative, is serving as a co-coordinator of the initiative. He said the difficulty of sharing logic between eCQMs and CDS rules imposes an additional burden on vendors and providers. “We would like to be able to reuse resources but that’s difficult to do since they utilize different standards.”

A CDS rule author cannot easily reuse the work of an eCQM developer and vice versa, he said, so an EHR system that supports both CDS and eCQM needs to map its native data format to two different data standards.

A lot of harmonization work already is under way so the CQM framework will promote wide visibility and engagement and provide more real-world implementation-based feedback to develop more robust specifications around metadata and expression logic, Kawamoto said. “We don’t want to develop standards that are divorced from the real world.”

Co-coordinator Marc Hadley, DPhil, senior software systems engineer at MITRE, said the initiative’s timeline is open to revision but the schedule is fairly tight. That’s because “we’re trying to get much of this work done in time for Meaningful Use Stage 3 timelines. A delay in one item may have significant impact on the downstream scope.”

The initiative currently is in prediscovery and moving into discovery. A May 14 use case kickoff will launch an effort of implementing specifications, creating feedback and revising the standards as a result of that feedback. “Towards the end of the year, we’ll be evaluating what we’ve developed,” Hadley said. “We must prioritize our activities” and the consensus process will allow for the community to decide what kinds of pilots to run.”

The initiative team will hold its first meeting on April 3 and will meet weekly. All information about the initiative will be posted on the Standards & Interoperability wiki.