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EHRs and Quality Measures

April 23, 2010
by David Raths
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At the World Health Care Congress, industry leaders discussed the importance of using EHR data for clinical quality measures.

As the final meaningful use rules under the federal HITECH Act are being worked out, many hospital CIOs are paying attention to how much quality reporting they will be required to do. So the relationship between quality reporting and electronic health records (EHRs) was a timely focus of last week’s World Health Care Congress meeting held in Washington, D.C.

Two well-attended presentations explained why the use of EHRs is key to quality measurement, and described the progress that is being made on developing measures and identifying the data elements necessary to calculate those measures.

In the first talk, Paul Tang, M.D., chief medical information officer at the Palo Alto Medical Foundation and vice-chair of the federal Health IT Policy Committee, stressed that previous attempts to use claims data for clinical quality measures in pay-for-performance programs have been less than ideal. There are problems with accuracy and there is a considerable lag time between patient encounters and reports, as much as 18 months. Plus, doctors don’t tend to buy into their use, he said.

Tang, who was recently ranked No. 11 on the list of the 50 most powerful physician executives in healthcare by the readers of Modern Healthcare, stressed that clinical quality measures must come out of EHRs instead of claims. Timely, localized clinical data will lead to behavioral changes, he said. Using his own Palo Alto Medical Foundation as an example, he said quarterly reports from EHRs about how physicians are doing compared to peers in their department on measures like percentage of A1c tests for diabetic patients have led to quarter-by-quarter improvements. He said the quality measures also create a feedback loop into clinical decision support to remind those physicians that certain tests are in order.

Although the current generation of EHRs was not developed with quality reporting features, the goal of CMS is to spur demand for those product innovations. As CMS finalizes the meaningful use rules and determines the level of quality reporting required, the nonprofit, Washington-based National Quality Forum (NQF) continues its work on what it calls eMeasures. In his presentation, Daniel Rosenthal, M.D., NQF’s senior advisor for health information technology, described how NQF is working on content standards. “We recognize that although the use of EHRs is on the rise, pulling data for quality reporting can be cumbersome and still involves a lot of chart extraction,” he said. The goal, he added, is to define quality measures and then determine where you would capture that data element in the EHR.

Last year, NQF released a Quality Data Set, a framework that Rosenthal said provides a standardized set of data that should be captured in patients’ electronic health records to calculate the measures. The hope is that this common language to describe the information within quality measures will enable measurement from a variety of electronic sources, including EHRs, registries and health information exchanges.

NQF is working with health IT standards organizations and EHR vendors on identifying how those data elements can best be captured. The goal, Rosenthal said, is to make it easier to capture the right data, calculate the performance measure, provide decision support to clinicians and promote secondary uses such as public health reporting and comparative effectiveness research.