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Helping CMS improve data quality measurement and interoperability

Supporting standards and harmonization of electronic clinical quality measures for Å·²©ÓéÀÖ Centers for Medicare & Medicaid Services (CMS).

Centers for Medicare & Medicaid Services

For Å·²©ÓéÀÖ , clinical quality measurement is an essential tool supporting Å·²©ÓéÀÖ transition from fee-for-service payment to reimbursement for care based on quality.

Challenge

The Health Information Technology for Economic and Clinical Health (HITECH) Act established Å·²©ÓéÀÖ availability of incentive payments to eligible professionals and hospitals to promote Å·²©ÓéÀÖ adoption and meaningful use of interoperable HIT. CMS is charged with developing Å·²©ÓéÀÖ Medicare and Medicaid Electronic Health Record (EHR) Incentive Program and determining Å·²©ÓéÀÖ clinical quality measures (CQMs) for reporting that meet one of Å·²©ÓéÀÖ criteria for meaningful use.

As clinical quality measurement is rapidly shifting from manually intensive and claims-based measures to electronic clinical quality measures (eCQMs), CMS required an agile, scalable, and cost-effective approach for developing and distributing eCQMs and clinical decision support interventions. These interventions will facilitate improved quality of care and produce accurate and reliable measurement across provider/hospital organizations and EHR platforms.

Solution highlights
  • Scaled Agile
  • Human-centered design
  • Data harmonization

Solution

We provide harmonization support to standardize quality measurement across Å·²©ÓéÀÖ healthcare IT landscape. The team helped CMS incorporate into its reporting programs and wrote implementation guides on how stakeholders need to structure EHR and file formats to be submitted to Å·²©ÓéÀÖ CMS receiving system in order to get Medicare reimbursement.

In Å·²©ÓéÀÖ development phase, Å·²©ÓéÀÖ team worked with many different stakeholders to ensure that Å·²©ÓéÀÖ standards meet Å·²©ÓéÀÖ needs of a wide variety of users including measure developers, tool developers, implementers, and those who manage receiving systems. They also lead education and outreach efforts on Å·²©ÓéÀÖ standards, coordinating with subject matter experts to ensure alignment and determine if testing efforts need to be executed.

The team continues to provide expertise on Å·²©ÓéÀÖ eCQM Standards for Å·²©ÓéÀÖ CMS Quality Reporting Programs, Quality Physician Payment (QPP) Program, and Hospital Inpatient Quality Reporting (HIQR) and Hospital Outpatient Quality Reporting (HOQR) Programs. They also manage Å·²©ÓéÀÖ , Å·²©ÓéÀÖ one-stop shop for information on eCQMs.

Where we are now

eCQM Standards are updated annually and communicated via educational webinars and Å·²©ÓéÀÖ eCQI Resource Center website to Å·²©ÓéÀÖ eCQI ecosystem. The team produces a ""—clinical quality language—educational series. While intended to help health IT vendors and implementers understand Å·²©ÓéÀÖ differences between Å·²©ÓéÀÖ previous standard and CQL, it evolved into a useful tool to troubleshoot specific challenges facing Å·²©ÓéÀÖ eCQM community. The ongoing webinar series helps educate members and provides advice on fixing problems in Å·²©ÓéÀÖir code.

As Å·²©ÓéÀÖ industry standard shifts to Fast Healthcare Interoperability Resources (FHIR), Å·²©ÓéÀÖ team is guiding CMS on Å·²©ÓéÀÖ transition to FHIR for quality measurement to be used in quality reporting programs. Additionally, Å·²©ÓéÀÖ team provides guidance to measure developers for eCQM Measure Conversion and chairing Å·²©ÓéÀÖ HL7 Clinical Reasoning Track for Connectathons and HL7 Working Groups.

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