A federal work group looking to marry quality improvement efforts with healthcare information technology foresees a shift over the next three to five years from quality programs predominately using administrative claims data to programs that electronically obtain clinical data for long-term analysis.
The vision statement also sees a transition of pay-for-performance and value-based payment efforts from their mere "existence" today to those mandated by legislative reforms. It predicts legislation incorporating quality-based payment schemes will pass by 2009 with those programs being implemented by 2011.
The road map, in the form of a page of bar charts, was presented Wednesday at the meeting of the quality work group of the federally chartered American Health Information Community. AHIC was created by HHS Secretary Mike Leavitt in 2005 to advise him on healthcare IT policy. The quality panel, which first met in late September 2006, is the newest of eight AHIC work groups.
"We're going to have performance measures imposed on healthcare providers, whether we like it or not," said work group member Janet Corrigan, the president and chief executive officer of the National Quality Forum, a not-for-profit organization that vets and seeks consensus support for healthcare quality measures. Corrigan was recently listed as No. 32 on the Modern Healthcare list of the 100 Most Powerful.
Corrigan said it would be better if it is a short list of required measures at first, but noted the NQF itself has endorsed between 150 and 200 quality measures, adding, "I don't see those going away. I think we're going to see a sizable number of new measures coming online, at a faster rate."
But several work-group members expressed concern about the proposed pace and scope of change.
During a discussion on what recommendations it should make to the AHIC regarding a process to identify data standards that could be used by electronic health-record systems to communicate quality metrics for performance improvement, work-group member Charlene Underwood expressed frustration. She referenced the lack of coordination between the various government and private-sector groups that are already working on the problem.
"Right now (there) is a waste of effort in the industry trying to get people to hold hands," said Underwood, who serves as director of government and industry affairs for IT developer Siemens Medical Solutions and is a recent past chairman of the Electronic Health Record Vendors Association, an affiliate of the Healthcare Information and Management Systems Society. "What are the standards that need to be deployed to support quality measurement? The right hand yet does not know what the left hand is doing."
In a telephone interview after the meeting, Underwood said members of the vendors' group have been working with an NQF Health Information Technology Expert Panel and have made progress on standards that will not only address quality but also technical issues required by software developers. She said eventually these recording, reporting and transmission functions will wind up in criteria to be used to test vendors' products by the federally supported Certification Commission for Healthcare Information Technology.
"From the vendors' perspective, we want to make sure whatever measures we have to come up with are computable and we can be certified against," she said.
"I am excited as anyone about envisioning the future," said work-group member Reed Tuckson, executive vice president and chief of medical affairs for payer UnitedHealth Group, who is a former Modern Healthcare Up & Comer. "You still have an extraordinary amount of data priorities that physicians will have to meet and other organizations will have to meet beyond the national, focused set. I don't quite understand how the system is going to be able to respond to these priorities and every other coalition's priorities. I hope that we are able to be very clear in our reporting back to AHIC the relationship between an ideal future and the immediate right now."
The AHIC quality work group is chaired by physician Carolyn Clancy, the director of the Agency for Healthcare Research and Quality at HHS, who responded to several members who made similar comments about moving too far too fast.
"To not acknowledge those issues would be a big mistake," Clancy said. Another key problem is being able to identify and match patient records over time without a uniform national patient identifier, which would help, but which Clancy conceded is a political nonstarter. One of several proposed alternative matching strategies will have to be chosen, she said.
In the future, work-group members will have to get their arms around the available technologies, how they would work in EHR systems and health information exchanges and develop some guiding principles or best practices that provide an acceptable level of accuracy and also support quality measurement, reporting and improvement programs.
Clancy pointed out that hospitals this summer had their 30-day mortality rates posted in a joint effort with the CMS and the Hospital Quality Alliance.
The CMS announced last month that it plans to have quality measures on physicians publicly reported next summer. Both require record matching strategies and techniques. Some use algorithms to calculate the probabilities of records having identical or similar demographic data in specific data fields being from the same person.
"This is not a theoretical problem," Clancy said. "Any algorithm is going to be less than perfect."
For all the consternation, Clancy said, the quality panel is making progress.
"I think we're almost on the verge of figuring out what our critical path is," she said.
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