One of the promises of modern Electronic Health Records (EHR) technologies is to provide the tools that clinicians need in order to improve the quality of the health care that they deliver. One of the central elements of EHR Certification, and of demonstrating Meaningful Use of EHRs, is the tracking and reporting of Clinical Quality Measures (CQM).
The first stage of Meaningful Use has already defined the specific CQM elements to be measured. They involve 3 core measures (or 3 alternate-core measures, depending on the nature of the practice), and 3 of 38 other “menu” items.
This is just the first step. Yesterday, the HIT Policy Committee’s Quality Measures Workgroup announced the start of the process for defining CQM for Stage 2 and Stage 3 Meaningful Use, and are soliciting comments about exactly what these should be.
At present, the future CQM criteria are simply “Clinical Quality Measures Concepts,” which are organized around the domains of (1) patient and family engagement, (2) clinical appropriateness/efficiency, (3) care coordination, (4) patient safety, and (5) population and public health. As a starting point for discussion, the CQM Concepts are listed under the 5 domain headings in a document that the workgroup has published.
The kinds of CQM criteria that are under consideration need to fit the criteria of (1) being HIT-sensitive, (2) being parsimonious, (3) demonstrating preventable burden, (4) assessing health risk status and outcomes, and (4) being longitudinal.
Given that it is early in the process, it is not clear what the relationship of these future CQM elements will be to the ones specified in the current Stage 1 definitions. Will they supplement the current measures, so that stage 2 and 3 Meaningful Use will have a much larger set to demonstrate? Will they modify or supplant the current criteria?
The CQM criteria are emerging as the standard to which all other programs that measure health care quality are converging – Medicare’s PQRI program intends to merge its criteria with Meaningful Use criteria, and commercial HEDIS criteria have voice similar convergence also.
So, taking a step back and recognizing that CQM criteria represent the evolving standard of care in this country, it is worth looking at what this process means. It is easy to get wrapped up in the details, With a broader view, the question before us is: will this direction (outcomes measurement in order to facilitate a system/structure that rewards measured quality) help us achieve the kind of healthcare delivery system we need?
The direction for healthcare implied in the Clinical Quality Measures at-hand shows that the future of healthcare will need to be more patient-centered, more engaged, more efficient, and more coherent, with diagnostics and therapeutics being the ones that work (and not anything that is ineffective). A tall order, but that is the shape of the future.
The evolution of CQM is a part of that transformation. It creates incentives. More fundamental change in structure, healthcare organization and payment is, of course, also necessary. But looking at the details from the macro perspective is important in order that the specific recommendations, now being solicited by the federal advisory committees, are helpful, and truly move the discussion forward.
Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR
