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The Quality Measurement “Ecosystem”: Keeping It “In Balance”

February 4, 2014
by Mark Hagland
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The organizers of a HIMSS14 pre-conference symposium have a lot to say about why cultural preparation is so important to outcomes measurement initiatives

Among the dozens of pre-conference symposia available to attendees at HIMSS14, the annual conference of the Chicago-based Healthcare Information and Management Systems Society (HIMSS), to be held Feb. 23-28 in Orlando, will be “Keeping the Delicate Quality Measurement Ecosystem in Balance.” That pre-conference symposium will be held Sunday, Feb. 23, 8:00 AM-4:00 PM, in Room 208C of the Orange County Convention Center. According to the symposium’s brochure, “Improving national health through timely and accurate clinical quality measure reporting is a key goal of the drive to automate the U.S. healthcare system. To succeed in this venture, a complex ecosystem of public and private players and initiatives must be kept in delicate and collaborative balance. This symposium will illustrate this ecosystem through the eyes of its players, and provide an understanding of the need to keep all components healthy and functional in cooperative symbiosis.”

Two of the organizers of that pre-conference symposium are Ferdinand Velasco, M.D., the chief health information officer at the 25-hospital, Arlington, Tex.-based Texas Health Resources, and Maggie Lohnes, R.N., who has worked as a critical care nurse, and in clinical informatics and healthcare administration, and who is now clinical care executive, enterprise intelligence, at McKesson Connected Care and Analytics, a division of the Alpharetta, Ga.-based McKesson Corporation.

“Data analytics and informatics will be the next big trend in health IT, and we’re collecting all this data,” says Velasco. “And there’s a lot of interest and need for leveraging that data for performance improvement and quality measurement. And historically, quality measurement has required laborious manual chart review or working through claims data. So this whole discussion will be around the convergence that’s coming about through the transition to the digital age. And Maggie and I and everyone, have been in the thick of all this. So we’ll be talking about navigating this landscape, and what to look out for, and a vendor perspective, a quality measurement perspective, and a provider perspective.”

Ferdinand Velasco, M.D.

Says Lohnes, “Quality measurement is a trend, but it’s also a trend in transition, and requires collaboration among all these different players. I’ve had the opportunity to work as a provider,” she explains, “as a clinician and as an administrator; as someone working in policy, and now on the vendor side. And I can see that if anything goes off balance, this transition is going to be rocky. So we’ve gathered, through the help of our planning committee, a perspective that will hopefully have our audience understanding all the pieces. If anything goes wrong in the reporting world, it’s no one individual person’s fault.”

Maggie Lohnes, R.N.

So what are the areas of potential breakdown? “There are obviously multiple failure points, “Lohnes stresses, “from a lack of collaboration within the provider organization—between the informatics side and the quality side—to “breakdowns between CMS [the federal Centers for Medicare & Medicaid Services] and providers; or between vendors and regulators; which can result in problems with the outputs in measurement.”

As a real-world example, Lohnes notes that, “In Stage 1 of the meaningful use process, there was a typographical error in one of the measures. In one of the measures, instead of neurology, it was entered as nephrology, or vice-versa. Nobody caught that error, and it was published in the measure specifications that then the vendors built into their systems, and it was discovered later. And the process of correcting that required vetting back through that whole continuum.” As a result, she notes, “Between Stage 1 and Stage 2, CMS published a brand-new tracking system, the Jira Issues Tracking System, allowing vendors or providers to enter questions. And CMS would evaluate the question, and assign that to the appropriate measure developers, so they could correct the issues.”

In other words, at a fundamental level, Velasco and Lohnes say, it is very important for clinical informatics leaders to strategize in order to successfully help lead their colleagues forward on comprehensive quality measurement work, both at the micro and macro levels.

“This [outcomes measurement] is a very important dimension of effective use of health IT; it’s one of the three pillars of meaningful use,” Velasco emphasizes. “And this is a very important topic, and organizations need to be focused on this, because it will expand and become increasingly important, in the later stages of MU; and as the federal government looks to align its other programs with the EHR [electronic health record] program. So people involved in quality improvement need to be familiar with these programs; and so this symposium will be very valuable,” he concludes.