# Presentation: 001888

## AHIC Quality Workgroup Meeting

**AHIC Quality Workgroup Meeting**
**May 9, 2008**
***Discussion of Vision Roadmap Component: ***
***Measure Set Evolution***
***Planning for Future Activities of the Quality Workgroup***

## Broad charge: What are we trying to accomplish?

- 	Make recommendations to the American Health Information Community so that health IT can provide the data needed for the development of quality measures that are useful to patients and others in the health care industry, automate the measurement and reporting of a comprehensive current and future set of quality measures, and accelerate the use of clinical decision support that can improve performance on those quality measures. Also, make recommendations for how performance measures should align with the capabilities and limitations of health IT.

## Discussion of 

**Discussion of **
**Vision Roadmap Component:**
**Measure Set Evolution**** **

## Slide 4

## Key themes from the Vision Roadmap

**Patient-centric quality measurement**
**	**The patient-centric emphasis in the broad charge indicates a need for longitudinal quality measurement and improvement, where data is collected and used to inform quality improvement across care settings and over time, thereby putting the patient at the focal point of any improvement efforts.
**Payment reform as an accelerator**
**	**Payment reform is required to create incentives for both better-coordinated, high-quality health care and the development of a health IT infrastructure to enable the exchange of health information across care settings.
**Importance of data exchange and aggregation**
**	**Patient-centered care requires data exchange between providers and across care settings.  Data aggregation is needed to create population-level metrics for the purpose of longitudinal quality measurement and improvement. Policy decisions and industry consensus must be established in order to further develop existing strategies and technological solutions, which include, but are not limited to: interoperable IT systems; protocols for physician and provider matching; and rules related to privacy and security.

## Key themes from the Vision Roadmap (cont.)

**Alignment around national priorities**
**	**A national priority setting process will focus the development of measures, the needed enhancements to medical coding, and the development of IT specifications and standards related to interoperability, data export and storage that are necessary to allow efficient assessment of the nation’s progress towards quality goals.
**Proactive consideration of health IT needs to support quality**
**	**The links between quality measurement and improvement and health IT need to be addressed proactively to achieve the future state of the vision.  A common set of data elements, i.e., a quality data set, can be used across quality measure development, health IT standards development and harmonization, guideline development, and clinical decision support to facilitate better coordination.
**Support for a hybrid data strategy**
**	**Much of the work toward the future state vision can begin now; there is no need to wait for full electronic health record (EHR) adoption.  A hybrid data strategy can make use of existing sources of data (paper-based and electronic, administrative and clinical) for quality measurement while also integrating increasing amounts of clinical data from EHRs as it becomes available.

## Measure Set Evolution

**Current State (2007)**
- Setting-specific measures are in use (HQA, AQA, etc.).
- NQF is establishing a coordinated process for reaching consensus on national priorities and goals for measure development.
- NQF is establishing a longitudinal measurement framework for 3 key conditions: AMI, back pain, and diabetes.
**Mid State **
- By 2009, the consensus-based patient-centric longitudinal quality metrics (including efficiency measures) are field-tested for select high priority conditions based on national goals.
**End State (2011)**
- A single set of patient-centric longitudinal quality metrics for key conditions based on national goals for public reporting and payment is in use across the nation.

**Key Players to Enable Movement Towards Vision**
- Measure Developers	• Vendors
- National Quality Forum	• Payers
- Purchasers		• Consumers

## Measure Set Evolution Component: Accomplishments

- In March 2007, the Quality Workgroup made recommendations to the AHIC about:
- Automating data capture and reporting for a core set of AQA/HQA measures (Recommendations 1.1-1.3).
- Aligning quality measurement with the capabilities and limitations of health IT (Recommendations 4.1-4.2).
- As a direct result, the National Quality Forum’s Health Information Expert Panel (HITEP) was formed.

## Measure Set Evolution Component: Critical Gaps

**Critical Gap:**  Further research and information is needed to develop frameworks for episodic measurement, including the interoperability and privacy standards that will allow the exchange of information to collect and use episodic measures for quality improvement.

## Measure Set Evolution Component: Further Action Needed

**Further action needed to continue driving QWG Recommendation 1.2 from March 2007 (not yet completed)**
- The Health Information Technology Standards Panel (HITSP) should use the work of the Quality Workgroup’s expert panel [NQF HITEP] recommended in 1.1 to identify the data standards to fill identified gaps for data elements required for automation of core sets of AQA and HQA quality measures.
**Further action needed to continue driving QWG Recommendation 1.3 from March 2007 (not yet completed)**
- The Certification Commission for Health Information Technology (CCHIT) should develop appropriate criteria necessary to support the reporting of core sets of AQA and HQA measures in the next round of criteria development.

## Measure Set Evolution Component: Further Action Needed

**Further action needed to continue driving QWG Recommendation 4.1 from March 2007 (not yet completed)**
- HHS, through the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ), along with major measure developers, should identify opportunities to enhance measure development by considering the data needs at the time a measure is developed, especially for measures targeted for public reporting.  This effort should also include clinical practice guideline developers and coordination of their role in developing performance measures.
**Further action needed to continue driving Recommendation 4.2 from March 2007 (not completed)**
- The National Quality Forum, through its endorsement process, should apply criteria that reinforce the use of standardized data elements in measures to allow quality measures to be embedded in EHRs.  The NQF may do so by incorporating such criteria into its endorsement criteria for new measures.

## Planning for Future Activities 

**Planning for Future Activities **
**of the Quality Workgroup**

## Proposed Future Activities of the Quality Workgroup

- Activity 1: Update and further develop Quality Workgroup Vision Roadmap
- Activity 2:  Develop additional recommendations as appropriate
- Activity 3:  Develop materials for AHIC 2.0 as needed
- Activity 4:  Provide input to other quality improvement efforts as appropriate
- Activity 5:  Complete work on past QWG (and CDS) recommendations

## Activity 1: Update and further develop Quality Workgroup Vision Roadmap

- Gather updates on current state for some components of Vision Roadmap.
- Determine if the Vision Roadmap should be further developed, especially for the mid-state.
- Identify potential gaps in the vision roadmap where additional testimony or interviews may be useful.
- Involve workgroup members through public meetings and small group meetings as appropriate.
- Update the Vision Roadmap as needed.
- If desirable, translate revised Vision Roadmap slides into narrative document with appropriate messaging for external organizations.
- Distribute the Vision Roadmap (slides and/or narrative) to external organizations.

## Activity 2:  Develop additional recommendations as appropriate

- Analyze results of testimony, interviews, and research for the vision roadmap development activity.
- Determine if there is an opportunity to develop additional recommendations to AHIC 1.0 to address outstanding issues that are actionable in the near future.
- If determined to be feasible and desirable, develop third recommendation letter for AHIC 1.0.

## Activity 3:  Develop materials for AHIC 2.0 as needed 

- Analyze past testimony and deliverables to help identify any gaps and to help guide the transition to AHIC 2.0 and other organizations as appropriate.
- Collect existing documentation to share with AHIC 2.0.
- Create summary documentation to share with AHIC 2.0.
- Consider creating a set of recommendations and lessons learned for AHIC 2.0 related to quality improvement.  This could take the form of a white paper.

## Activity 4:  Provide input to other quality improvement efforts as appropriate

- Communicate with Brookings Institution/QASC about the QASC effort to create a quality roadmap for data aggregation, and provide input based on the QWG’s efforts to date.
- Work with NCVHS on quality-related issues.
- Work with AHRQ to learn more about relevant grant activity, the outcomes of the supply chain meeting and upcoming plans for future supply chain meetings.
- Include a Medicaid representative at QWG meetings, if CMS chooses one.
- Investigate whether there are any initiatives at DoD or VA where the QWG could be of assistance.

## Activity 5:  Complete work on past QWG (and CDS) recommendations

- Interact with NQF HITEP as it conducts its work on clinical workflow and begins work on the quality data set.
- Refer to QWG Recommendations 2.1 of March 2007 and 2.1.1 of April 2008
- Participate in HHS forums on the measure development process.
- Refer to QWG Recommendation 1.1 of April 2008
- Help facilitate work between CMS, the Indian Health Service, VA and DoD on testing the quality data set.
- Refer to QWG Recommendation 2.1.2 of April 2008
- Support AHRQ, ONC, and NLM in their efforts to conduct an environmental scan, produce recommendations to HITSP, and develop an action agenda for data standards for structured clinical data.
- Refer to QWG Recommendations 3.1, 3.2, and 3.3 of April 2008
- Follow the work of the NHIN Test Implementations regarding the testing of the Quality Use Case.