# Presentation: 178681

## Sources of Data for Quality Measures

- October 11, 2006

**Sources of Data for Quality Measures**

- Presented to:
- AHIC Quality Workgroup

## Outline

- Discuss AQA HIT subgroup work on defining administrative data
- Outline Thomson Medstat efforts to create a framework for accessing and using clinical data
-                Both efforts just beginning and a work in progress

## Question Posed to AQA HIT Subcommittee

- Provide a definition of administrative data
- Purpose – to compare data collected in the AQA pilots

## Definition of Administrative Data: An Approach

- Current state of understanding administrative data
- Situation has evolved and will continue to do so
- Have clinical elements; ICD-9, CPT-4, drug data
- Increasingly becoming available electronically
- “Readily available electronic data” can only take us so far
- Approach decided
- Describe and define (include if codable) the various data elements
- Describe the data flow from collection at the point of care to storage; include manual or electronically handled
- Map these two dimensions (see hand outs)

## An Approach to Accessing and Using Clinical Data

- Context – need clinical data for multiple purposes (see appendix)
- A definition
- Uses (see appendix)
- Types of clinical data (see appendix)
- Criteria for a focused effort to access and use

## Definition of “Administrative” Versus “Clinical” Data

- Administrative data, generally:
- Support payment
- Include limited clinical detail
- Clinical data: Is *all* information:
- About the patient (history)
- What is done to the patient (diagnosis and treatment)
- What happens to the patient (process and outcome)
- There is a blurring between administrative and clinical data

## Types of Clinical Data Described (see appendix)

## Spectrum of Use/Quality Measures (e.g. Diabetes)

## Mapping Exercises for the Uses of Clinical Data

- Five mapping exercises: (*quality measures*)
- To organizations that develop, adopt and implement
- To diseases and conditions
- Six IOM aims (steep)
- Four FACCT patient perspectives
- To clinical data sources and dimensions of the data sources

## Mapped Clinical Data to Diseases/Conditions to Support CPMs and DM

- Example Only

## Mapped Clinical Data to Diseases/Conditions to Support CPMs and DM (cont’d)

- Example Only

## Criteria for Obtaining Clinical Data

- Support known and valued uses
- Reside in known locations and databases
- Are available in digital formats, with classification systems
- Are not prohibitively costly to collect and transmit
- Produce value for the end user

- These criteria can be assessed quantitatively and qualitatively, as well as mapped data source.

## Options for Enhancing “Administrative” Data and Accessing “Clinical” Data to Support Quality Measurement Sets

- Enhance “administrative” data
- Access drug, laboratory, etc. data from “silos”
- Add admission diagnosis for hospitalized patients
- Expand CPT-4 coding to capture measurement specifications
- Improve ICD-9 Coding (ICD-10 etc)

## Options for Enhancing “Administrative” Data and Accessing “Clinical” Data to Support Quality Measurement Sets (cont’d)

- Directly access “clinical” data
- Extract from EMR/EHR
- Embed measurement specifications into EMR/EHR
- Collect from “clinical” data silos and merge
- Use data collection tools – stand alone or integrated into workflow

## Short-Term Approaches to Identifying and Obtaining Clinical Data

- Identify key data elements with a systematic approach
- Link claims to other existing patient-level data systems:
- Chemistry lab results
- Pharmacy records
- Hospital charge masters
- Explore other currently ‘silo” stored data
- Continue exploratory research on uses of the emerging electronic medical record, so that key data elements can be extracted uniformly and efficiently

## Contact Information

- Louis H. Diamond
- VP & Medical Director
- Thomson Medstat
- 4301 Connecticut Avenue, NW
- Suite 330
- Washington, DC 20008
- 202-719-7833
- 301-468-0666
- 202-719-7866 – fax
- _[Louis.diamond@thomson.com](mailto:Louis.diamond@thomson.com)__  _

## Appendix

## Uses of Clinical Data

- Diagnosis and treatment of the patient
- Evidence-based practice
- Quality measurement and improvement
- Management of health care facilities
- Public reporting on performance
- Provider accountability

## Uses of Clinical Data (cont’d)

- Payment for performance
- Management of populations (e.g., disease management, predictive modeling)
- Public health surveillance
- Research and development
- Risk stratification and risk adjustment – cross cutting

## Types of Clinical Data

- Patient history:
- Patient self-report (e.g., history, symptoms, medications, functional state, etc.)
- Patient physical examination (e.g., vital signs)
- Diagnostic test results:
- Chemistry – kidney function, cholesterol, blood glucose, blood coagulation, pregnancy related tests, etc.
- Other test – hematology, drug blood levels, serology, microbiology, etc.
- Others diagnostics – imaging, pulmonary function, EKG, angiography, etc.

## Types of Clinical Data (cont’d)

- Patient management:
- Education / information sharing
- Medications prescribed
- Surgery / radiation
- Physiotherapy
- Counseling
- Patient outcomes:
- Health status (symptom relief, defect repair, etc.)
- Functioning
- Quality of life
- Satisfaction with care

## Types of Lab Tests

- Anatomic pathology
- Chemistry
- Coagulation
- Cytopathology
- Hematology
- Immunology and Serology
- Microbiology  (see virology)

- Specimen Collection
- Drug Monitoring/Toxicology
- Trace Elements
- Transfusion
- Urinalysis
- Virology

## Mapped Clinical Data to Diseases/Conditions to Support CPMs and DM (cont’d)

- Example Only

## Mapped Clinical Data to Diseases/Conditions to Support CPMs and DM (cont’d)

- Example Only