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HIT Standards CommitteeHIT Standards Committee
Report of the Clinical Quality WorkgroupReport of the Clinical Quality Workgroup
Janet Corrigan, Chair
Floyd Eisenberg
July 21, 2009
Clinical Quality Workgroup --Process
• CQ Workgroup conference calls – June 22, 2009– July 15, 2009
• Consultation/Coordination with Policy Committee– July 9, 2009 (Meaningful Use Workgroup)– July 16, 2009 (Policy Committee)
CQ Workgroup Initial Tasks
• Identify potential set of existing standardized performance measures that correspond to the Policy Committee’s quality measure concepts
• Identify the “data types” that must be captured to calculate the measures
• Handoff to Clinical Operations Workgroup to identify HIT standards
Sources of Measures
• National Quality Forum (NQF) Database – Over 500 endorsed measures– Pipeline measures
• Includes measures used by Centers for Medicare & Medicaid (CMS) (in PQRI and RHQDAPU), Hospital Quality Alliance, accrediting entities, and Physician Consortium for Performance Improvement
Identify Data Types
Health Information Technology Expert Panel (HITEP)
– Convened by NQF; supported by Agency for Healthcare Research and Quality (AHRQ)
– Identify a “Quality Data Set”
– Types of data necessary to calculate and report on performance
– Currently includes over 56 “data types”
Performance Measure Set for 2011
• Includes 27 performance measures (see handout)
• Provisional recommendations– Detailed review of measures by CQ Workgroup not yet
complete– CO Workgroup identification of HIT standards not yet complete
• Significant measure “retooling” required– Efforts underway to ascertain feasibility
• Seeking Standards Committee approval with understanding that there will need to be some changes
Performance Measures: Key Challenges
• Measure Gaps – E.g., % reportable lab results; % patients with access to
educational resources– For 2011 attestation is likely method of data collection
• Available measures developed assuming more limited availability of data– Fail to take advantage of clinically-rich data in EHRs– E.g., % patients at high risk for cardiac events on aspirin
prophylaxis
Performance Measures: Key Challenges
• Some measures rely on data types that will be challenging to capture in 2011 – E.g., BMI, vital signs– May be necessary to have different measure specifications for
2011 and 2013 (e.g., ICD-9 for 2011 and SNOMED for 2013)
• Some measures require data for which there is currently no standardized method of collecting– E.g., VTE (antithrombotic devices)
Performance Measures: Key Challenges
• Some measures require data that may be costly to collect– Lipid profile
• Significant harmonization issues– Measures should be patient-centered– Current measures vary across settings (e.g.,
hospital, ambulatory, LTC) and age groups (e.g., BMI measure for children differs from BMI for adults)
Next Steps
• Detailed review of individual measures underway– Identify any necessary changes in measures – Provide guidance to measure stewards regarding “retooling”
• Develop a 2-dimensinal framework for classifying measures– Degree of readiness of a measure for 2011 implementation– Level of performance expectations (i.e., threshold
considerations)
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