Quality Reporting

Quality Reporting is one of the key components for Meaningful Use included in the ARRA portion of the economic stimulus package. A requirement for EMRs to report various quality measures is sure to be incorporated in the rule-making regulations now being refined for publication later this year. The standards and technology needed to facilitate interoperable electronic submission and reception of quality reports are evolving. Some are still being developed and tested. Others are relatively immature and have not been widely incorporated into EMRs. Meeting the timelines determined by ARRA will be a challenge for many of the involved stakeholders.

Models for quality reporting are CMS' Core Measures for hospital care and the Physician Quality Reporting Initiative (PQRI) for outpatient services. Quality measurement development organizations are too numerous to mention but include the Joint Commission, National Quality Forum (NQF), National Committee for Quality Assurance (NCQA), and Agency for Healthcare Research and Quality (AHRQ.) There are probably over 600 quality measures that have been developed. There are a number of problems with quality measurement and reporting. There are too many quality measures already. The organizations that develop quality measures rarely coordinate their efforts. Validation of the existing measures has not been extensive, thorough, or scientific in many cases. The number of organizations demanding quality reports is excessive, ever growing, and represents an increasing drain on precious health care resources. The mechanisms for collecting, aggregating, transmitting, and analyzing these reports are poorly defined, lack necessary standards and vocabulary, and, in many cases, the infrastructure for handling electronically do not exist.

The Meaningful Use (MU) regulations for quality reporting will not be published until late this year and early next. Discussions within the two health information technology FACA committees (HIT Policy Committee and HIT Standards Committee) that report to the Office of the National Coordinator for Health Information Technology seem to indicate that the requirements for 2011 will mostly be based on self-attestation, either paper-based or electronic, with entirely electronic reporting by 2015. The quality workgroup of the HIT Standards Committee has recommended 29 preliminary measures. Eventually decisions will need to be made about whether EMRs will be able to collect/calculate all of these measures internally or whether intermediaries will be needed. Also, government agencies tasked with collecting the reports and assessing MU will need to rapidly ramp up their capabilities to manage and promulgate this information electronically. For example, I have heard reports that CMS was not prepared to accept PQRI data from providers when that program was first initiated. Furthermore, transport mechanisms, to include privacy and security, need to be defined. Will the systems support just send/receive transactions or will query/respond transactions also be utilized (these will almost certainly be required.)

On the near horizon: HL7 and IHE have helped develop the QRDA (Quality Reporting Data Architecture) and the Performance Quality Report profile. QRDA provides a framework for reporting patient level quality data across disparate systems. Reports are published in XML to provide human and machine readable. It will be interesting to watch for standard vocabulary development and trial implementations.