1. HIT Standards Committee Clinical Quality Workgroup: Progress Report Janet Corrigan Floyd Eisenberg National Quality Forum August 20, 2009

2. 2 Process 1.Identify appropriate standardized performance measures that correspond to HIT Policy Committee’s 2011 Measures 2.Review performance measures and develop guidance for measure retooling 3.Identify underlying data types and elements that must be captured in EHRs and PHRs to produce the performance measures 4.Handoff to Clinical Operations to identify IT standards

3. 3 Measure Set Recommended Set of 30 Performance Measures NQF-endorsed measures (23) –can be retooled for EHR (18) –attestation (5) Other measures (7) –E.g., public health surveillance data; % patients access to educational resources; % orders entered through CPOE

4. 4 Staging of Measures Consider Staging of Measures to reflect evolving HIT capacity: e.g., BMI 2011 - documentation of BMI 2013 – BMI percentile plus counseling e.g., asthma medications 2011 – appropriate meds for asthma 2013 – appropriate meds by stage e.g., readmissions 2011 – own facility 2013 – more than one facility 2015 – community-wide

5. 5 Guidance for Measure Retooling: Diagnoses/Problem Lists Use National Library of Medicine (NLM) SNOMED CT core subset for problem lists –Ongoing development and maintenance will be needed Multiple versions of measures to provide options  2011 – ICD 9 or SNOMED CT  2013 – ICD10 or SNOMED CT  2015 – SNOMED CT Can use internal codes using SNOMED CT expertise to map to SNOMED CT EHR certification should require problem list

6. 6 Guidance for Measure Retooling: Exclusions Phase in  2011 – Attestation (e.g., CPT 2 code to indicate medical reason, personal reason, or system reason)  2013 – All exclusions from EHR elements Focus on exclusions related to contraindications  Eliminate “decimal dust”  Thresholds will influence decisions about need for various types of exclusions

7. 7 Guidance for Measure Retooling: Patient-centered Measures Harmonization of measures, data types, and data elements across settings  Include long-term care (LTC) Develop denominators that apply to:  Multiple settings: ambulatory, hospital, long-term care (LTC)  All age groups

8. 8 Planning Ahead for 2013 and 2015 Begin developing measures of patient engagement now Understanding of treatment options “comfort care” measure: need methods of capturing DNR/DNI