The Office of the National Coordinator for Health IT, in collaboration with the Centers for Medicare and Medicaid Services, launched a new Clinical Quality Framework (CQF) initiative on March 21 to harmonize standards for clinical decision support (CDS) and electronic clinical quality measurement (eCQM).

One of the primary goals of the CQF initiative is to relieve the implementation burden on vendors and providers who are adhering to different standards and find it difficult to share logic between eCQMs and CDS rules.

CDS and eCQM are closely related and share many common requirements, such as the ability to identify a cohort of patients based on logical combinations of patient data. However, the standards used for the electronic representation of CDS and eCQM were not developed in concert with each other and use different approaches to patient data and computable expression logic. ONC notes that that much of the standards harmonization work is already underway in Health Level Seven work groups.

"This is a really important partnership particularly as we look at the importance of being able to measure and improve quality going forward within the healthcare system and as part of healthcare reform and payment reform," said Doug Fridsma, ONC's Chief Science Officer and Director of the Office of Science and Technology, in a webex meeting to launch the CQF initiative.

CDS guides a physician to follow a standard plan of care, while CQM measures adherence to a standard plan of care. The two come together in the electronic health records meaningful use program, which requires implementation of CDS rules to improve the outcomes of certain eCQMs. An EHR system that supports both CDS and eCQM will need to map its native data format to two different data standards and to implement computation capabilities for two different logic expression standards. The current aim of the CQF initiative is to complete much of its work in time for meaningful use Stage 3.

"We have all learned a lot since Stage 1 of meaningful use,” said Kate Goodrich, Director of the Quality Measurement and Health Assessment Group at CMS. “We've learned what works and we have also learned what doesn't work so well about the draft standards, electronic quality measures, their development and implementation, certification, and alignment with our other programs,"

Fridsma emphasized, however, that the new CQF initiative is a "community" effort with weekly meetings starting April 3. "We do not see our job to be sort of the ones who develop those standards within the government. But, rather, our role is for government to serve as a platform for other people to succeed in terms of being able to create those conditions of interoperability," said Fridsma.

ONC's Standards & Interoperability Framework is an example of “government as a platform,” he said. The new CQF initiative builds on the work of the public-private Health eDecision (HeD) project created in June 2012 to enable interoperable CDS with the aim of developing and validating standards to be made available for potential inclusion in future EHR certification requirements. The CQF initiative will leverage the work of the HeD project, which is coming to a close in March.

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