HITPC approves eCQM recommendations

The Health IT Policy Committee formally endorsed Quality Measure Workgroup recommendations governing the development of electronic clinical quality measures (eCQMs) at its Jan. 14 meeting. These measures include those that are patient and population centered, longitudinal and that cross settings of care, according to chair Helen Burstin, senior vice president, performance measures, National Quality Forum.

Unveiling a framework that incorporates issues like population health, disparity, outcomes and expenditures, the workgroup identified current measures and gap work where further development is needed. The need for interoperable systems across care settings was “the mantra we heard over and over again,” Burstin emphasized. 

The workgroup recommended the following areas of prioritization, along with sub-recommendations for accountable care organizations (ACOs):

• Development of measures that address fall prevention, healthcare-associated infections and EHR safety; an ACO sub-recommendation is developing measures that combine claims, EHR and ADT (admission, discharge, transfer) data that focus on reducing medical errors. Examples of measures include avoidable hospital readmission rates, drug/drug interaction rates and fall rates. Technology necessary to achieve these measures include EHR decision tools to prevent errors, interoperable systems across settings and data across claims-based settings.

• Development of measures that address population health and health equity; ACO sub-recommendation is developing measures combining EHR and patient-reported data. Example measures include prevention of pre-diabetic progressing to diabetes, mammograms, colorectal cancer screening, influenza vaccination and reduction of disparities. Health IT infrastructure needs include access to race, ethnicity and language data for stratification.

• Development of measures that address appropriateness of care and efficient use of facilities using claims, EHR and pharmacy data. Example measures include total cost of care, duplicate testing and avoidable emergency department visits per 1,000 patients. Health IT needs include medical expense data, interoperable systems across settings of care, data across electronic and claims-based systems.

• Development of measures that address patient health outcomes, experiences and self-management/activation; ACO sub-recommendation is developing measures combining EHR and patient-reported data that focus on medical decision-making and patient involvement in their care. Example measures include number of patients with personal goals aligned with clinical goals, patients with longitudinal care plan and patient experience. Health IT needs include electronic shared care plan, patient portals, mobile devices and other ways of capturing patient-generated health data. Measures involving functional status and well-being; the ACO sub-recommendation is developing measures combining EHR and patient-reported data that focus on optimizing wellness and functional status of patients and communities. An example measure is number of healthy days. Health IT needs include patient portals, mobile devices and other ways of capturing patient-generated health data.

• Development of measures that improve longitudinal care coordination and care transitions after acute hospital discharge from EHR, claims and ADT data. Example measures include percentage of patients with contact with outpatient services within seven days of discharge and percentage of patients with medication reconciliation within seven days of discharge. A health IT requirement is a case management registry for all discharged patients including discharge diagnosis and disposition.

In addition, the workgroup recommended the development of measures using the following set of evaluation criteria:

1. Preference for measures that leverage data from health IT systems

2. Enables patient-focused and patient-centered view of longitudinal care

3. Supports health risk status assessment and outcomes

4. Preference for reporting once across programs that aggregate data reporting

5. Benefit outweighs burden

6. Promotes shared responsibility

7. Promotes efficiency

8. Measures can be used for population health reporting

The workgroup also recommended the consideration of an optional “innovation pathway” in which Meaningful Use participants can waive one or more objectives by demonstrating they are collecting data for internal quality improvement.

The Office of the National Coordinator for Health IT and the Centers for Medicare & Medicaid Services should specify gaps that the innovation pathway would close, Burstin said. “We really want to use it as a way to drive innovation and help narrow the measure gaps we have.”

Per the request of the committee, the workgroup also vowed to look into measures involving “usability/meaningfulness” of measures on the consumer side.