A Big Week for Patient Quality Reporting in the USA.

There has been a lot of movement in definition of quality standards supported by health IT in the last week it seems.

First we have this.

Federal Register: August 29, 2008 (Volume 73, Number 169)

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality

Common Formats for Patient Safety Data Collection and Event  Reporting

AGENCY: Agency for Healthcare Research and Quality (AHRQ), DHHS.

ACTION: Notice of Availability--Common Formats for Safety Data  Collection and Event Reporting.

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SUMMARY: The Patient Safety and Quality Improvement Act of 2005  (Patient Safety Act) provides for the formation of Patient Safety  Organizations (PSOs), which would collect and analyze confidential  information reported by healthcare providers. The Patient Safety Act  (at 42 U.S.C. 299b-23) authorizes the collection of this information in  a standardized manner, as explained in the related Notice of Proposed  Rulemaking published in the Federal Register on February 12, 2008: 73  FR 8112-8183. 

As requested by the Secretary of DHHS, AHRQ has  coordinated the development of a set of common definitions and  reporting formats (Common Formats) which would facilitate the voluntary  collection of patient safety data and reporting of this information to  PSOs. The purpose of this notice is to announce the initial release of  the Common Formats, Version 0.1 Beta, and the process for development  of future versions.

DATES: Ongoing public input.

ADDRESSES: The Common Formats can be accessed electronically at the  following Web site of the Department of Health and Human Services: 

http://www.pso.ahrq.gov/index.html.

E-mail: psoc@ahrq.hhs.gov.

The full text is available here:

http://frwebgate3.access.gpo.gov/cgi-bin/waisgate.cgi?WAISdocID=15395113822+2+0+0&WAISaction=retrieve

and then there is this:

NATIONAL QUALITY FORUM ENDORSES NATIONAL CONSENSUS STANDARDS FOR HEALTH INFORMATION TECHNOLOGY

Structural measures help create system of high-quality, patient-centered care by sharing and managing information electronically

Washington, DC - To improve quality and efficiency and reduce errors and unnecessary treatments across the healthcare system, the National Quality Forum (NQF) has endorsed nine new national voluntary consensus standards for health information technology (HIT) in the areas of electronic prescribing, electronic health record (EHR) interoperability, care management, quality registries, and the medical home. These HIT structural measures are intended to help providers assess the efficiency and standardization of current HIT systems and identify areas where additional HIT tools can be used.

Adoption of HIT by clinicians has been shown to reduce medical errors by increasing access to information thereby improving response times to abnormal results, eliminating repetitive testing and providing clinical decision-support tools to facilitate evidence-based care.

Evidence has shown a decrease in medication errors by up to 20 percent and a decrease in per admission costs by more than 12 percent when clinicians use HIT.

“If we hope to achieve high-quality, patient-centered care, we need interoperable HIT that can help us share information electronically and track patients throughout the delivery system – all of which can reduce errors and overuse and increase measurement across the continuum of care,” said NQF President and CEO Janet Corrigan. “These newly endorsed measures can provide important information on effective use of health IT for both early adopters of HIT and those who are just beginning to implement HIT systems.”

Blackford Middleton, MD, director of clinical informatics research and development at Partner HealthCare System in Massachusetts, and Joel Slackman, MS, managing director of the Blue Cross Blue Shield Association, co-chaired NQF’s steering committee on HIT structural measures.

“NQF-endorsed HIT structural measures will help the practice of medicine move forward with the adoption of information technology in healthcare,” said Middleton. “This allows us to better understand how widely healthcare information technology is being used in care delivery, and is a critical first step toward transforming healthcare.”

E-Prescribing

Electronic prescribing improves quality by reducing legibility errors, providing interactions and dosing alerts, and reducing costs by comparing equally effective alternative medications. The two e-prescribing measures endorsed by NQF encourage the adoption of either a stand-alone e-prescribing tool for providers without EHR systems or the enhanced use of e-prescribing within an EHR for early adopters of HIT.

Electronic prescribing measures endorsed by NQF were developed by Quality Insights of Pennsylvania (QIP) and the New York Department of Health and Mental Hygiene.

Interoperability of EHRs

The interoperability of electronic health records –EHRs that can share information between clinics, offices, and laboratories – improves quality by increasing timely, efficient, evidence-based care. NQF endorsed two measures to increase adoption of interoperable EHRs: the first measures adoption of an EHR to manage clinical data within a practice, the second measures receipt of clinical data such as external laboratory results into an EHR. NQF aligned these measures with Certification Commission for Health Care Information Technology (CCHIT) recommended EHR- certification criteria whenever possible.

Measures for the interoperability of EHRs endorsed by NQF were developed by the Centers for Medicare & Medicaid Services (CMS) and QIP.

Care Management

Electronic care management tools improve quality by improving patient-centered care that is coordinated and evidence-based. Too often information about patients falls through cracks in the delivery system.

Both of the care management structural measures endorsed by NQF measure the use of HIT to identify specific patients in need of care, track their preferences and laboratory results, and assist the clinician in providing evidence-based care according to national guidelines using automated alerts and reminders. To measure care management across and between settings, the first measures HIT used during a patient- clinician visit and the second measures clinical results between visits.

These care management measures endorsed by NQF were developed by CMS and QIP.

Quality Registries

Sharing information through electronic quality registries allows for increased care coordination by tracking patients in need of care throughout the delivery system and giving feedback to providers. Registries also assist in data collection on the safety and effectiveness of care to guide quality improvement efforts. The two structural measures for quality registries endorsed by NQF assess clinician participation in quality registries at the local, statewide, and national levels.

These measures endorsed by NQF were developed by CMS.

Medical Home

The medical home is a broad model of primary care that aims to improve quality by providing coordinated, effective, continuous, patient-centered care. Many of the measures endorsed by NQF in this set of HIT structural measures assess technology tools that are central for creating a medical home that is patient-centered and drives toward coordinated care.

NQF has endorsed a Medical Home System Survey that will allow clinicians to assess whether their practices are functioning as a medical home by providing ongoing, coordinated, and patient-centered care. The survey specifically includes measurement of key HIT functionalities, such as the use of electronic-based charting tools to organize clinical information, the use of tracking tests and referrals, and the adoption and implementation of evidence-based guidelines.

The Medical Home System Survey endorsed by NQF was developed by the National Committee for Quality Assurance (NCQA).

The full release and details of the requirements are here:

http://www.qualityforum.org/news/releases/082908-endorses-health-it.asp

I see this activity as the next step beyond the basic standards setting processes. What is happening here is the definition of how information that is being collected can be used to guide operational improvement and safety – which is, after all, what we are all working towards.

It will be an important activity of whatever flows from the National E-Health Strategy that these issues are addressed as soon as basic e-Health capabilities are developed.

David.