1. HIT Standards Committee Report of the Clinical Quality Workgroup Janet Corrigan, Chair Floyd Eisenberg July 21, 2009

2. Clinical Quality Workgroup --Process CQ Workgroup conference calls –June 22, 2009 –July 15, 2009 Consultation/Coordination with Policy Committee –July 9, 2009 (Meaningful Use Workgroup) –July 16, 2009 (Policy Committee)

3. CQ Workgroup Initial Tasks Identify potential set of existing standardized performance measures that correspond to the Policy Committee’s quality measure concepts Identify the “data types” that must be captured to calculate the measures Handoff to Clinical Operations Workgroup to identify HIT standards

4. Sources of Measures National Quality Forum (NQF) Database –Over 500 endorsed measures –Pipeline measures Includes measures used by Centers for Medicare & Medicaid (CMS) (in PQRI and RHQDAPU), Hospital Quality Alliance, accrediting entities, and Physician Consortium for Performance Improvement

5. Identify Data Types Health Information Technology Expert Panel (HITEP) –Convened by NQF; supported by Agency for Healthcare Research and Quality (AHRQ) –Identify a “Quality Data Set” –Types of data necessary to calculate and report on performance –Currently includes over 56 “data types”

6. Performance Measure Set for 2011 Includes 27 performance measures (see handout) Provisional recommendations –Detailed review of measures by CQ Workgroup not yet complete –CO Workgroup identification of HIT standards not yet complete Significant measure “retooling” required –Efforts underway to ascertain feasibility Seeking Standards Committee approval with understanding that there will need to be some changes

7. Performance Measures: Key Challenges Measure Gaps –E.g., % reportable lab results; % patients with access to educational resources –For 2011 attestation is likely method of data collection Available measures developed assuming more limited availability of data –Fail to take advantage of clinically-rich data in EHRs –E.g., % patients at high risk for cardiac events on aspirin prophylaxis

8. Performance Measures: Key Challenges Some measures rely on data types that will be challenging to capture in 2011 –E.g., BMI, vital signs –May be necessary to have different measure specifications for 2011 and 2013 (e.g., ICD-9 for 2011 and SNOMED for 2013) Some measures require data for which there is currently no standardized method of collecting –E.g., VTE (antithrombotic devices)

9. Performance Measures: Key Challenges Some measures require data that may be costly to collect –Lipid profile Significant harmonization issues –Measures should be patient-centered –Current measures vary across settings (e.g., hospital, ambulatory, LTC) and age groups (e.g., BMI measure for children differs from BMI for adults)

10. Next Steps Detailed review of individual measures underway –Identify any necessary changes in measures –Provide guidance to measure stewards regarding “retooling” Develop a 2-dimensinal framework for classifying measures –Degree of readiness of a measure for 2011 implementation –Level of performance expectations (i.e., threshold considerations)