Feds to weight value in more flexible approach to quality measures

The feds have taken several steps—not all forward ones—on a new path toward greater flexibility in their approach to using clinical quality measures as meaningful-use criteria, according to Dr. Jacob Reider, deputy national coordinator for health information technology at HHS. And it sounds like those steps will continue, signaling a changing mindset when it comes to EHR quality measurement by weighting the value of a measure.

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Office of the National Coordinator for Information Technology will seek to find a balance between the relative ease or difficulty in gathering data to perform a quality measure and the value that measure will provide in quality improvement.

“The value of a certain data element defines its priority,” Reider said in an interview following his presentation Wednesday at the annual Physician-Computer Connection Symposium in Ojai, Calif.

“As we look at successful care delivery organizations that are improving quality, every single one has a way of measuring that quality,” Reider said.

Organizations may not use a specific quality measure endorsed by the National Quality Forum, but they've come up with clinical quality measures, or combinations of outcomes and process measures, that work for them, he said.

“We're trying to step back and say, what's really important here,” Reider said. An NQF endorsement means the science behind a measure is solid, but “it has never addressed the question whether the measure was appropriate for EHR technology,” Reider said. “Nobody had done anything wrong here,” he said, but “we've learned a lot here as technology has approved.”

One step, already taken, is toward aligning measures used by CMS in its quality reporting program and those used in the electronic health-record incentive payment program under the American Recovery and Reinvestment Act.

Another series of steps, still being contemplated, is to respond to pleadings by many providers and members of the federally chartered Health IT Policy Committee for flexibility in the use of clinical quality measures in the EHR incentive payment program. The idea is to move away from a big list of measures that are hard-wired by federal rules as requirements that providers must meet to achieve meaningful use, receive payment and avoid future Medicare reimbursement cuts as penalties for noncompliance.

“We see a future that's more flexible,” Reider said, with ONC focusing on how measurement might be facilitated rather than on prescriptive measures. For example, “Can we focus on the availability of data to do measurements? You can't report on it if you never caught the data.” On the other hand, “I can ask a set of questions from a data set as long as I know what that data set is,” Reider said.

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