Getting patient quality data into EHR systems in a measurable, apples-to-apples comparable form is a tall order. The National Quality Forum (NQF) aims to tackle that task with a proposed update to its Quality Data Model (QDM) and an accompanying "style guide" for stakeholders who develop quality measures.
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NQF said it plans to publicly release both documents in June, according to speakers in a webinar sponsored by the U.S. Department of Health and Human Services (HHS), which contracted the NQF to create quality measures for CMS programs.
The measurement tools will eventually help providers, payers and even individuals to make sense of their health data. The hope, said Shannon Sims, M.D., clinical informatics director at Rush University Medical Center, is that the Quality Data Model will help people who create those tools to identify and categorize patient data better than is done now through insurance claims CPT codes and patient chart reviews.
"In order to accomplish this goal, we really need a health IT infrastructure," said Patrice Holtz, RN, nurse consultant for the CMS's office of Clinical Quality and Standards. "The QDM is a common language that can be used to represent the [quality of care] measure. The QDM is a grammar that defines and describes clinical concepts in a standardized format across all quality measures."
Present health care data collection a "wild west"
Right now, Sims said, data elements that a particular quality measure might require can be scattered throughout a provider's computer network, in various administrative and clinical applications from billing systems to lab information databases to EHRs. The data also can be housed in e-prescribing modules and external health information exchanges. In some cases, the data is unstructured and difficult to find. It all adds up to a "wild west" for quality-minded clinicians, Sims said.
The QDM aims to help tame all that data, by making it more accessible, in the electronic health record. The style book also can help designers of clinical quality measures understand what data is most feasible to acquire for a particular measure.
The QDM is a grammar that defines and describes clinical concepts in a standardized format across all quality measures.
Patrice Holtz, RN
Floyd Eisenberg, M.D., NQF senior vice president of HIT, said the new QDM style guide lays out the data elements for quality measures development by sorting them into different categories. That will include what's present as structured data in ONC-certified EHR systems; data elements written in to proposed 2014 EHR certification criteria; and those that are not part of certification criteria but which are feasible for doctors to collect during the course of care with small workflow changes.
Also under consideration are new definitions of patient care procedures -- physical acts like administering medications or observing the patient vs. interventions such as education. NQF is considering as well how to categorize participants in a patient's care beyond the main doctor, such as assisting physicians or other patient caregivers, in a standard fashion.
Quality Data Model, meet meaningful use
For the eMeasures that are part of the meaningful use program, the update to the Quality Data Model could be timely. Eisenberg said the quality forum is taking the timing of the stage 2 final rule release, slated for late summer, "under consideration" as it plans the publication of its update.
If it works out, the updated QDM would come in time for software developers trying to meet stage 2 requirements to build in the latest eMeasure versions, without having to do a secondary update later in the year. But all of that is up in the air. Eisenberg said they don't currently have a date when the authoring tool will be updated to reflect the new QDM style. In addition, the timing of stage 2 is still tentative.
"That's a difficult question for me to answer," Eisenberg said in response to a question about the timing during the webcast, because HHS personnel can't comment publicly about pending rules, leaving him to speak in generalities and not necessarily about meaningful use stage 2. "What I say in general is: Any measures chosen for the final rule, my understanding is, they will be in eMeasure format and made available for vendors and others to review and work with. I think that is as much as I know."
When the new QDM is live, he concluded, crosswalks from old to new QDM will be provided to the 18 measure developers with which NQF is contracted -- which in theory will make updating quality measures straightforward.