Changing the way the nation’s providers report clinical quality measures will offer a chance to improve the process, derive better results and get more value out of the exercise.

In designing a strategy for electronic clinical quality measures (eCQMs), federal agencies must look ahead to the future of what healthcare will look like, and draw upon past experiences and testing to determine what works.

Organizations responding to a request for information on clinical quality measures and certification frequency for electronic health records provided that guidance to the Centers for Medicare and Medicaid Services (CMS).

In recent comments, the American Hospital Association and the American Medical Informatics Association primarily focused on the need to revamp approaches with quality measures. For years, healthcare providers have faced heavy burdens to report a variety of clinical indicators to government entities. Many within the industry have hoped that the move to EHRs would help facilitate the process, but progress toward eCQMs has been slow.

”Healthcare stands as one of the most measured industries in the U.S.,” says Thomas Payne, AMIA’s board chair and medical director of IT services at the University of Washington’s UW Medicine. “Yet, for all its measures, we understand very little about how patients fare as they travel through our healthcare system or how clinicians perform over time. Now is the time to leverage our national investment in health IT to better define quality on a longitudinal scale.”

AMIA President and CEO Douglas Fridsma, MD
AMIA President and CEO Douglas Fridsma, MD

An entire new approach is needed to get this kind of value out of clinical quality measures, and a major overhaul is in order, says Douglas Fridsma, MD, AMIA’s president and CEO. “We need a better process that constructs measures based on the capabilities of EHRs and other health IT, includes pilot testing to ensure those measures can be implemented and strives for simple measures that leverage high-quality electronic data.”

While some of this evidence is yet to be found, enough foundational information is available to enable informed analysis of eCQM, the AHA contends. CMS just hasn’t shared that information, and the AHA wants it to do so to allow the industry to see what past experience has been, particularly in recent demonstration and pilot projects.

“The requirement to report updated eCQMs must build on the provider experience to date with eCQM implementation,” the AHA said in a comment letter to CMS. “To support successful electronic eCQM submissions in 2016, the AHA recommends that CMS release the results of the previous eCQM demonstrations and pilots before the release of future rulemaking governing eCQM reporting.”

EHR certification and eCQMs are related, because it’s important that EHRs be able to gather and report required quality measures as a condition of being certified as an EHR system that providers can use to participate in the federal EHR Incentive Program, known as Meaningful Use. Alignment between eCQMs and certification needs to be strengthened, the organizations said.

The AHA urged CMS to expand eCQM education and outreach to support successful electronic reporting of the measures. The national hospital organization said it’s challenging for facilities to generate “accurate and reliable quality data from their certified EHR and use this data to improve care.”

Because the future of quality reporting lies in electronic reporting, the AHA recommends that “CMS clearly state its plans for the transition from chart-based reporting to electronic reporting across CMS programs” and that it tell how it plans to align its plans with requirements from other organizations, such as the Joint Commission, for electronic submission of quality measures.

Both the AHA and AMIA urged CMS to align eCQM reporting with the ongoing shift to new physician payment models and the overall trend toward value-based care. In particular, AMIA asked regulators to think critically about longitudinal measures and attribution, because the quality of care models introduced through the Medicare Access and CHIP Reauthorization Act of 2015 “will be best measured as trends, rather than thresholds.”

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