Quality Measures Vendor Tiger Team

1. Quality Measures Vendor Tiger Team December 13, 2013

2. Agenda • Review and provide feedback on the Quality Measure Recommendations to HITPC for Meaningful Use Stage 3 • Review topics for future VTT discussion Office of the National Coordinator for Health Information Technology

3. Measure Gap Priority Areas The Quality Measure WG recommends that ONC and CMS consider development of quality measures for MU Stage 3 in the following priority areas and subareas: • Population and Public Health • Health equity • Patient Safety • Falls prevention • Hospital associated conditions • EHR safety • Patient and Family Engagement • Patient health outcomes, experiences, and self-management/activation • Honoring patient preferences and shared decision making • Clinical Effectiveness • Efficient use of facilities • Effective Use of Resources • Appropriateness of care • Post-Procedure Functional Status and Recovery Times Office of the National Coordinator for Health Information Technology

4. Measure Gap Priority Areas • Where are the good measures? • Need vendor input on how to leverage knowledge and get good measures in the pipeline Office of the National Coordinator for Health Information Technology

5. Evaluation Criteria for Quality Measures The Quality Measure WG recommends that ONC and CMS consider the following criteria to evaluate appropriateness of quality measures for MU Stage 3: • Preference for eCQMs or measures that leverage data from HIT systems (e.g., clinical decision support) • Includes “HIT sensitivity” – EHR systems that help improve quality of care (e.g., CDS, CPOE for accuracy and content of order, structured referral documentation) • Enables patient-focused and patient-centered view of longitudinal care • Across EPs or EHs • Across groups of providers • With non-eligible providers (e.g. behavioral health) • Supports health risk status assessment and outcomes • Supports assessment of patient health risks that can be used for risk adjusting other measures and assessing change in outcomes to drive improvement • Preference for reporting once across programs that aggregate data reporting • (e.g., PCMH, MSSP, HRRP, CAHPS) • Applicable to populations • Broadest possible experience of the patient/population is reflected in measurement (e.g. require interoperable systems) • Benefit outweighs burden • Benefits of measuring & improving population health outweighs the burden of organizational data collection and implementation • Promotes shared responsibility • Measure as designed requires collaboration and/or interoperability across settings and providers • Interoperability – systems need to be able to communicate to receive longitudinal care • New criterion? Promotes efficiency • Reduces high cost and overuse, and promotes proper utilization • New criterion? Measures can be used for population health reporting • Use existing measures or build measures where the denominator can be adjusted for population health reporting • Supports group reporting options (e.g., in CMS reporting programs) Office of the National Coordinator for Health Information Technology

6. Innovation Pathway The Quality Measure WG recommends that ONC and CMS consider an “innovation pathway” whereby MU participants would be able to waive one or more objectives by demonstrating that they are collecting data for measures used for internal quality improvement or by integrating with a clinical data registry. The Quality Measure WG recommends that ONC and CMS specify the gaps that an innovation pathway should help close, including identifying measure gaps for specialty providers. The Quality Measure WG has considered two approaches to provider-initiated eCQMs: • A conservative approach might allow “Certified Development Organizations”, to develop, release and report proprietary CQMs for MU. • An alternate approach might open the process to any EP/EH but constrain allowable eCQMsvia measure design software (e.g., Measure Authoring Tool). Office of the National Coordinator for Health Information Technology

7. Innovation Pathway -How do we let provider organizationsget credit for measures? Roles and Recommendations for Data Intermediaries made by the Data Intermediaries Tiger Team Calculate Meaningful e-Clinical Quality Measures from EHR Data that Providers Use for MU Credit Short Term: Providers will only receive credit for measures that are part of the EHR Incentive Program. Long Term: There will be a minimal set of standardized quality measures that approximate the core measures for the EHR Incentive Program that all DIs will be certified to import data elements for, calculate and report to HHS via QRDA cat III (or appropriate data standard). Long Term: Intermediaries will be encouraged to develop proprietary measures and providers will receive credit for reporting on intermediary-developed measures via standard reporting document (e.g. QRDA cat III). Long Term: Require some review of proprietary/innovative measures that is less extensive than current requirements for national endorsement. Long Term: Limit innovative measures to those that conform to the criteria below: • Specification expressed in unambiguous logic that conforms to Quality Data Model or future standard for eCQM and uses standardized value sets/logic consistent with others measures in EHR Incentive Program • Measures are outcomes focused, or if a process measure is developed and tested, it must be submitted as part of a “suite” of measures which includes process measures that have close proximity to a desired outcome measure. • Address one or more NQS domains that are high priority or have gaps in EHR Incentive program (e.g. care coordination, patient engagement, etc). • Innovative measures should use multi-source data (claims, patient reported outcomes, financial, etc). • Providers that participate in MU and use core and innovative measures will receive credit for quality reporting across multiple programs as appropriate (PQRS, MU, VBM, etc). Office of the National Coordinator for Health Information Technology

8. Flexible Platform HITPC continues to prioritize a flexible platform for Quality Measurement What does flexible platform functionally mean? • Need to articulate definition • Need recommendations on what MU3 could contain to move us toward a flexible platform Discussion Topics • Avoidance of hard coded measures • Constraints around automated consumption of HQMF • Data Model considerations; e.g. QDM versus DEC • Ad hoc query for vendor certification (not same as HQMF) • Can measures be constrained to measures that are captured Office of the National Coordinator for Health Information Technology

9. Patient Reported Outcomes The Quality Measure WG recommends that ONC and CMS include patient-reported outcomes as MU objectives in Stage 3. Discussion Topics • PROMIS Framework • Patient reported outcomes as a MU objective requirement Office of the National Coordinator for Health Information Technology

10. Preliminary Recommendations for ACO Measures(Awaiting further deliberation from the ACQM Subgroup at their12/13/13 call ) Office of the National Coordinator for Health Information Technology

11. Future Topics for the VTT Subgroup • Clinical Decision Support • Certification for ECQMs • Data Element Catalog • Reporting Requirements Expectations • Population Health Tools • QRDA Category II • Risk stratification and attribution Office of the National Coordinator for Health Information Technology