EHRs Still Have a Ways to Go to Automatically Capture All Quality Data, Quality Experts Say

Vendors lack funds for dedicated staff to build quality measures into their software, NQF vice president says.

The National Quality Forum (NQF) in December released a set of best practices for increased scientific acceptability in electronic health record (EHR) data quality. Produced by an expert panel, it identified the causes, nature, and extent of EHR data quality issues.

The final set of recommendations addresses development and adoption of healthcare performance measures that use EHR data, and a set of practices to mitigate concerns about such measures.

Recently, Sheri Winsper, RN, MSN, MHA, senior vice president, quality measurement at the National Quality Forum, spoke with HealthLeaders about the increasing practice of health systems relying upon EHR data to report quality measures.

HealthLeaders: To what degree can information already contained in EHRs automate or take the place of separately reported quality measures required by the federal government today?

Sheri Winsper: Commonly used structured data are readily available in most electronic health record (EHR) systems which enables automated extraction of data. For example, the United States Core Data for Interoperability (USCDI) is an Office of the National Coordinator for Health Information Technology (ONC) effort to standardized commonly exchanged data.

NQF has identified the ability of EHR systems to connect and exchange data as an important aspect of quality healthcare. Although much progress has been made, EHR systems generally do not yet consistently capture all data needed to enable fully automated data extraction for reporting quality measures. In November 2019, under a contract with Centers for Medicare & Medicaid Services (CMS), NQF convened a multistakeholder Technical Expert Panel (TEP) over a series of Web meetings to better understand the potential of improving quality measurement with the use of EHR data for clinical quality measures. This multistep effort was aimed at identifying challenges and a set of strategies for addressing issues hindering EHR data quality and also focused on how well EHR data can be used to support automated clinical quality measurement. Several opportunities are recommended by the TEP in our final report, including broadening the availability and access to electronic data, as well as more cross-agency interactions and potential federal initiatives around national testing collaborative and test bed efforts. TEP recommendations also address challenges during the NQF measure endorsement process and call for support to help vendors hire dedicated staff members to incorporate electronic clinical quality measures (eCQMs) and EHR-sourced measures into their products.

HL: What impact has the EHR had on the kind of healthcare performance measures in use today?

Winsper: Using EHRs as a source of data, eCQMs were designed to enable automated reporting of measures using structured data. With the use of structured data, eCQMs have the potential to provide timely and accurate information pertinent to clinical decision support and facilitate timely and regular monitoring of service utilization and health outcomes. Today, NQF has endorsed nearly 540 healthcare performance measures with only 34 of these being eCQMs. Although the number of endorsed eCQMs is relatively low, several measures in NQF’s portfolio are quality measures that rely on data stemming from an EHR, which NQF refers to as EHR-sourced measures. Measures that can be captured without undue burden by relying on data elements available in EHRs or other electronic sources have the potential to be more feasible in terms of implementation for performance measurement.

HL: What role do measures that align across multiple settings of care have in building impactful use cases to further enhance healthcare quality?

Winsper: With respect to EHRs, measures that align across multiple settings of care highlight gaps in structured data needed to measure as patients move through different settings and different stages of measured conditions. Measure alignment across multiple settings promotes continuity of care, communication between providers regarding a patient’s care, and a comprehensive patient record that includes all aspects of care.

HL: What are NQF’s plans to develop specific guidance for EHR-sourced measures?

Winsper: NQF is committed to establishing and communicating reasonable expectations to all stakeholders for EHR-sourced measures. In a new CMS-funded project, NQF will convene a multistakeholder committee to identify best practices to leverage EHR-sourced measures to improve care communication and coordination of quality measurement in an all-payer, cross-setting, fully electronic manner. Scientific acceptability is a critical and complex component of NQF’s measure evaluation criteria and the nuances of EHR-sourced measures are significant enough to warrant its own targeted guidance. Utilizing input from experts in EHR-sourced measures, NQF plans to revisit the need for guidance on how the measure evaluation criteria should be applied to EHR-sourced measures.

HL: What benefit would it bring for CMS to consider grants to fund resources at health IT vendors to understand and incorporate quality measurement into their products, in ways not provided by the meaningful use program?

Winsper: Increased funding, in general, can be a great asset in ensuring compatibility across vendors and healthcare providers. Grants could indeed provide additional incentives that would help bring the patients at the center of focus by reducing the burden of implementing EHR-sourced measures, which in turn could open the door for more providers to participate in federal programs that involve measure reporting. Ultimately, it would also increase the use of EHR- sourced measures in various care settings.

In its final report the TEP offers guidance and recommendations. Examples mentioned by the TEP include: grants that fund experts dedicated to providing support to specialty providers and vendors for implementing and incorporating EHR-sourced measures into EHR systems, or grants to fund dedicated full-time equivalents to provide support for vendors in understanding and incorporating measurement into their products in the post-acute care setting that were not supported under American Recovery and Reinvestment Act /Meaningful Use program funding.