Webinar: Quality measurements require more national uniformity, health IT

Describing the current state of healthcare performance measurements and the transition to EHRs as “a cacophony of well-meaning but uncoordinated signals,” Helen Burstin, MD, senior vice president for performance measures of the National Quality Forum (NQF), explained during a HIMSS quality measurement webinar on April 21 that by setting national priorities, the strategies and efforts of multiple groups in the U.S. can be aligned towards improvement.

Currently, the NQF is in the midst of reviewing quality measures, as well as evaluating the submission criteria for quality measures following the passage of the American Recovery and Reinvestment Act and the proposed rule of meaningful use for health IT. Burstin said that in addition to setting uniform priorities, endorsing national consensus standards for measuring and publicly reporting performance and promoting education and outreach programs to improve the quality of U.S. healthcare is part of the NQF mission for quality measurement and reporting.

In establishing national priorities, the NQF must first identify measure gaps and then develop these measures, noted Burstin. Next, the endorsement of these measures, including safe practices and serious reportable events (SRE) measures, as well as the building and supporting of data platforms can take place.  After that, the public reporting of these events can begin, in which Burstin said: “We are new to this part, it’s a work in progress.”

Following the endorsement and reporting of the measures, the alignment of payments and other incentives and performance improvement can be evaluated, she said.

In terms of priority selection criteria, Burstin noted that they must eliminate harm, reduce disease burden, remove waste and eradicate disparities. Noting that there has been various “drivers of change” in regard to measurement selection, the NQF has expanded its set of endorsed measures. 

“Measurements are clearly needed for pay-for-performance programs, as well as measures that are disparity-sensitive, and those that deal with patient experience in multiple settings,” she said. “As we look forward to what the NQF portfolio is going to need to move toward, and the measurement agenda for the nation, few or none to date are completed based on what is possible in the context of EHRs."

For the evolution of quality measurement, Burstin noted that the NQF is pushing towards higher performance and shifting toward composite measures to give a more comprehensive view of care, while measuring disparities along the way. Ultimately, she noted that the harmonization of measures across all sites and providers is a main goal.  “It’s so important from a health IT perspective to be able to think of how you could look at the quality of care across the full continuum.”

In addition to the harmonization of measures, the NQF is also looking to promoted shared accountability and measurement across patient-centered episodes of care, including outcome and appropriateness, as well as cost and resource use measures, Burnstin noted.

The evaluation criteria of measures by NQF has been updated, said Burnstin, keeping in mind the scientific acceptability of the measurement properties, including its reliability and validity; the importance, or level of evidence of the measures and the usability and feasibility that the measure would have, without burden to the EHR environment.

“The specific focus of what is measured should be considered important enough to expend resources for measurement and reporting, not only that it is related to an important broad topic area,” Burnstin said.

Another “big-picture” question proposed by Burnstin is deciding what the key data elements or critical functions within the electronic system are shared. “What is the sweet spot between clinical guidelines that we know we want to adhere to, the performance measures we want to capture, and the decision support that we want to be able to provide to clinicians?” she asked.

Offering the linkage of health IT and measurement as an answer, Burnstin noting that with the capture of the right data, the ability to calculate the performance measure, as well as being able to provide real time information to the clinician with decision support, “quality measures can be returned to the clinicians much more rapidly.”

Burnstin presented examples of current measure classifications and broke them down into code sets and lists, illustrating that the NQF wants to ensure that each quality data element has an associated data flow that allows a user to know where to locate that key quality data element, as well as the likely source of that data.

During this interim period, Burnstin explained that the NQF has been working with measure developers in the retooling of the measures. “We are looking towards a more robust tool in the future that will allow us to look at a measure authoring tool that will allow people to develop or retool their measures for EHRs.”

Presenting a prototype of how the NQF envisions the use of quality data sets, Burnstin said, “We can begin to see how if we had the electronic quality measures using the quality data sets and health IT standards, we can begin to ensure that we can capture the data across various sites of care.”