Like most providers, the Virginia Commonwealth University Health System (VCUHS) in Richmond, Va., experienced a lot of pressure and uncertainty in preparing for its first mandatory Electronic Clinical Quality Measure (eCQM) submissions. Unlike most, VCUHS also felt frustration due to two previous unsuccessful attempts at eCQM implementations.
VCUHS was an early adopter of electronic health records (EHR) and first attempted eCQM implementation in 2012 with help from its quality reporting vendor, using the vendor's reporting software. In that project, the health system and vendor together were unable to extract the data necessary for eCQMs from VCUHS' systems. In an attempt to solve that problem, VCUHS contracted with its EHR provider. While strides were made in data abstraction, this effort was not a full success due to lack of flexibility and data source interoperability. VCUHS met the submission criteria because it could attest that it could run a report. However, the actual data in the report was incomplete and largely inaccurate. VCUHS was not satisfied with the result. Because VCUHS is on a journey to become America's safest and most caring health system, with a strong commitment to quality, its goal was to produce meaningful data that could be used to evaluate and improve the quality of care and services.
“Capturing the required data elements for accurate eCQMs is a very different world from what everyone is used to,” says Jill Bradford Shuemaker, a clinical informaticist who specializes in quality measures at VCUHS. She notes that providers, solution specialists, and even the regulators that developed the program and make the rules are struggling with the complexities and technical immaturity surrounding eCQM abstraction and submission. “It seemed logical for existing manual reporting vendors and EHR solution providers to come into the space, but it isn't natural for either of them. Many of the first vendors to come into the market are no longer eCQM vendors.”
Here is one example of why eCQM quality reporting can be so challenging. VCUHS is an early adopter of electronic health records and implemented with a strategy to gain 100 percent user acceptance. To meet that goal it has made many modifications to its EHR system over the years. VCUHS uses multiple modules of the EHR, and they are not all interoperable. Data nomenclature is not standard or consistent across the different modules and system versions. For example, instead of creating one field for blood pressure that could be utilized in multiple applications, VCUHS has multiple fields for documenting blood pressure based on clinical needs; therefore, instead of being straightforward, extracting blood pressure data to report is complex and challenging.
“Lots of vendors can get to data, but knowing if the data is appropriate for a specific measure is critical,” says Wendy Sale, VCUHS's eCQM project manager. “You need someone who understands the specifications and complexities of each eCQM, and who understands your organization and its systems. Due to all the complexities, we approach eCQMs as a quality endeavor that relies heavily on collaboration with our information technology (IT) partners; both quality and IT expertise are essential for success.”
Although VCUHS was uncertain if it could find a qualified vendor partner to help it with eCQMs, the organization was determined to produce accurate, meaningful, actionable eCQM data. Therefore, it renewed its electronic submission efforts in 2015 by beginning a comprehensive new vendor assessment process. Among many goals of the project, VCUHS desired to submit the required four eCQMs by early December 2016. The goal was three months before the deadline, which would leave VCUHS time to try again if something went wrong.
“We were much better prepared this time because we learned a lot from our previous projects,” says Bradford Shuemaker. “We vetted our potential vendors very thoroughly, which we were able to do because we were educated about our own systems and their limitations, we knew what we wanted in a vendor, and we knew what questions to ask.”
VCUHS's Performance Improvement/Quality office and Enterprise Analytics partnered to define vendor requirements, including:
- Working knowledge of the current eCQM requirements and most recent revisions;
- Experience in the measures VCUHS selected so the vendor could advise on appropriate data and submission formats;
- The expertise and flexibility to extract data from multiple, inconsistent systems without requiring a lot of programming or maintenance support from VCUHS's IT staff;
- A convenient user interface for the eCQM solution;
- Drill down capabilities that facilitated data problem solving and pinpointing improvement opportunities.
“We wanted an organization that was at the forefront of the field. We're ahead of most organizations in eCQM experience, and we wanted to work with someone that was at our level or above,” says Sale. “We also have high functional requirements. For example, we wanted to be able to drill down to the code level to see why we didn't meet a quality measure for any individual patient. The vendors we had worked with were not able to do that. We also needed a vendor who could support both Eligible Hospital (EH) and Eligible Physician (EP) eCQMs, as we have an integrated EHR and manage quality measure programs centrally.”