Digital Quality Measurement Blueprint Modernizing CMSs Quality Measurement
Digital Quality Measurement Blueprint Modernizing CMS’s Quality Measurement Enterprise Joel Andress, Ph. D 12/17/2021 © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.
Evolution of quality measures © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 2
CMS has set the ambitious and critical goal of transitioning to digital quality measurement by 2025 © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 3
To achieve this vision, CMS needs a coordinated strategy that builds on recent and current activities • Recent rules require provider and health plan FHIR APIs that will make data more accessible for interoperability • Meaningful Measures 2. 0 identifies priority areas and focuses on digital quality measures • CCSQ QMVIG Strategy Project is building tools for specifying and testing electronic clinical quality measures (e. CQMs) in FHIR, and ISG is building a FHIR server for data storage • Health Level Seven (HL 7®) FHIR Accelerator multi-stakeholder private and public-private groups are advancing FHIR standards for use cases © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 4
Goals • Quality measurement system that is fully based on digital measures, which reduces burden of reporting, can provide many dimensions of data in a timely fashion, enable rapid feedback and transparent reporting • Digital measures leveraged for advanced analytics to define, measure and predict key quality issues • Quality measures are a secondary product from routine data generation of normal workflow (less burden) • This new quality measurement paradigm can only be accomplished through digital measures combined with interoperability, ideally through FHIR API technology © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 5
Digital quality measures (d. QMs) defined • d. QMs are quality measures that use one or more sources of health information that are captured and can be transmitted electronically via interoperable systems • Potential data sources for d. QMs include, but are not limited to: – EHRs – Administrative systems – Case management systems – Instruments (e. g. , medical devices, wearable devices) – Patient portals or applications (e. g. , for collection of patient-generated health data) – Data from health information exchanges (HIEs) or registries – Data from post-acute assessments • d. QMs will leverage advances in technology (e. g. , FHIR APIs ) to access and electronically transmit interoperable data for d. QMs will reinforce the aggregation of data across multiple data sources, rapidcycle feedback, and alignment of programmatic requirements © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 6
CMS is developing a strategy for advancing d. QM centered around four key domains © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 7
Reduce collection burden with structured, standard data © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 8
Leverage FHIR APIs to implement a low-burden measurement approach that facilitates learning © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 9
Providers have to implement FHIR APIs that perform transformation functions for data interoperability © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 10
Modular Measure Calculation Tools can bridge the gap between interoperable EHR data and d. QM requests © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 11
Progress on other lanes facilitates alignment © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 12
Goals of the CMS Quality Measurement Action Plan © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 13
CMS’s active engagement with a broad set of stakeholders is critical to the success of forming, operationalizing, and maintaining the d. QM Blueprint • Both the federal government and the private sector play key roles in accessing health data to improve care – For example, private sector develops technologies and measures • Alignment opportunities – Cross-agency – Federal/states – Federal/private sector © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 14
CMS recently requested comments on plans to modernize its quality measurement enterprise • Requested feedback in the Fiscal Year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) Rates Proposed Rule (CMS-1752 -P) • Areas for comment – Definition of digital quality measures – Using the Fast Healthcare Interoperability Resources (FHIR®) standard for e. CQMs – Standardizing data required for quality measures for collection via Application Programming Interfaces (APIs) – Leveraging technological opportunities to facilitate digital quality measurement – Supporting data aggregation – Developing a common portfolio of measures for potential alignment © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 15
Additional Considerations • Systems, vendors and users need to adapt to new digital healthcare environment (Digital transition – Improves American Healthcare Infrastructure) • Need for public/private partnerships to accelerate improvement • Adequacy of workforce • Standardization of data elements; improvement of quality measurement • Certification requirements • Timing of transition, industry readiness © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 16
STANDARDS ENABLING DIGITAL QUALITY MEASUREMENT © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 17
Components of an e. CQM Data Model: What data to look for in the patient’s medical record Expression Logic: How to calculate the result, evaluate the “right” care was provided Structure: Metadata, numerator, denominator, exclusions, and exceptions © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 18
Example Measure: Controlling High Blood Pressure Measure concept: Patients whose most recent blood pressure is adequately controlled during the measurement period Patients 18 -85 years of age who had a visit and diagnosis of essential hypertension before and continuing into, or starting during the first six months of the measurement period Exclusions: - Patients in hospice, patients >65 in long term care for >90 days, patients with an indication of frailty, and patients receiving palliative care © 2019 Health Level Seven ® Internatio 6 al. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 19
Computable Measure Representation • What we’re looking for: – Qualifying systolic blood pressure reading • Computable Representation: © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 20
QI-Core, CQL, and terminology in use Observation, profiled in QI-Core “and exists, ” CQL "Systolic blood pressure, " LOINC Code 8480 -6 © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 21
e. CQMs: Present and Future e. CQM Specifications QDM Data Model CQL Logic HQMF e. CQM Reporting QDM Data Model QRDA III e. CQM Specifications QI-Core Profiles CQL Logic Quality Measure IG e. CQM Reporting QI-Core Profiles DEQM Individual Summary Measure Report 22 © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.
Standards for Digital Measurement – QI-Core • – CQL • – Conceptual/logical expression language designed to automate sharing of executable clinical knowledge FHIR Quality Measure • – Model IG using profiles based on US Core and base FHIR resources used for e. CQMs, Quality Reporting, and clinical decision support (CDS) Specification IG detailing how e. CQMs are structured based on FHIR Measure Resource Data Exchange for Quality Measures • Defines exchange operations for measure data 23
HL 7® Standards and IGs for Quality Measurement CQL – Clinical Quality Language DEQM - Data Exchange for Quality Measures FHIR – Fast Healthcare Interoperability Resources IG – Implementation Guide QI – Quality Improvement Retrieved from: http: //hl 7. org/fhir/us/davinci-deqm/index. html#quality-measurement-standards-landscape © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 24
IG Overviews - http: //hl 7. org/fhir/us/qicore/ - https: //cql. hl 7. org/ - http: //hl 7. org/fhir/us/cqfmeasures/ - http: //hl 7. org/fhir/us/davinci-deqm/ © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 25
Connectathon Tracks • Day 2: Quality Measures – The focus will be to calculate measure outcomes and create measure reports for a measure or measures of interest. • Day 3: Quality Reporting – Test the use of the Data Exchange for Quality Measures (DEQM) IG for quality measure and gaps in care reporting use cases using FHIR-based e. CQMs © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 26
QUESTIONS? © 2019 Health Level Seven ® International. Licensed under Creative Commons Attribution 4. 0 International HL 7, Health Level Seven, FHIR and the FHIR flame logo are registered trademarks of Health Level Seven International. Reg. U. S. TM Office. 27
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