Quality Measures in Electronic Health records

Jacob Reider, MDMedical Director, AllscriptsCo-ChairEHRA Acceleration Working Group

Quality Measures

• Goal: Improve the Quality of Care• “RESPECT what we INSPECT”

• Quality Measures / Performance Measureso Historically based on retrospective review of

paper chartso Try to capture evidence of providers’ ability to

follow guidelines – presumably based on best practices

Quality Measure Developers

• American Medical Association (AMA)• National Committee for Quality Assurance

(NCQA)• Centers for Medicaid and Medicare

Services (CMS)• Health Insurers • The Joint Commission• Provider Organizations

Quality Measure Consumers

• Care Delivery Organizations• Consumer groups• Health Insurers • Individual patients

Paper Medical Records

Paper Medical Records• Quality Measure:

o Did all diabetics get a foot exam?

Create audit tool A Human manually reviews records

Is this patient a diabetic? Is there evidence of a foot exam?

• Human abstracts the scribbles on paper and creates data

Electronic Health records

Electronic Health Record• May not represent “diabetes” consistently

• May not represent “foot exam” consistently

• May not represent “smoking cessation counseling for 10 minutes” consistently

• Requires “mapping” of concepts to the metrics of quality measures for retrospective review

Quality Measures• Are published in word processing documents

• May use ambiguous terms • “Diabetes”• “Smoking cessation counseling”• “Comfort Measures”

• May refer to data that isn’t captured in the EHR at all

• Include imprecise logical statements. Logic not enforced by Microsoft Word.

300+ Electronic Health Record Vendors in USA – How do we incorporate Quality Measures?

1. Pay Clinicians to Interpret Quality Measures

2. Pay analysts to create logical statements of business logic and functional requirements for quality measure management in our software

3. Pay developers to write code that expresses this business logic

4. Repeat 1- 3 for every measure, revision, etc

What if ? .. • The EHR “knows” what information the quality measure

will expect up front?• The Quality Measure is represented in a format that the

EHR can “consume” automatically• The Quality Measure definition is constrained to:

o A precise formato A precise set of logical statementso A precise set of terms and value sets

Nirvana

• Buddha described nirvana as the perfect peace of the state of mind that is free from craving, anger and other afflictive states (kilesa).

Improve Quality: Stakeholders

The Collaborative• Collaborative for Performance Measure Integration with

EHR Systems

o AMAo NCQAo EHRA

• The Collaborative is comprised of a group of stakeholders — who have a shared goal of facilitating the integration of performance measures with EHR systems.

Collaborative Tasks

• Technical definition of a standard expression syntax for performance measures definition

• Work with NQF to define criteria and an editorial process by which appropriate measures would be endorsed as “fit for EHRs”

• ARRA Alignment – educate government leadership on the importance of this initiative as a keystone to the improvement of care delivery

Technical Definition

• Health Quality Measures Format draft specification: Htpp://www.hqmf.org

• NQF sponsorship of activities to move HQMF through standards process, IHE profile , HITSP Value Case

Criteria and Editorial process

• April 30 meeting in Washington DC

• Collaboration with National Quality Forum

• Collaboration with ONC

ARRA Alignment

Summary• Quality care is a key component of ARRA

• Electronic Health records CAN improve the quality of care

• Quality Measures can define the essential components of quality care ..

So long as ..

• Quality measures are expressed in a standard way ...• Quality measures can be automatically consumed and

leveraged by EHRs ..