Feds Off Target On Healthcare Quality Reporting, CHIME Says

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The Agency for Healthcare Research and Quality (AHRQ), in its request for information (RFI) about health IT-enabled quality reporting, asked questions focused on research into automating healthcare quality reporting. For example, AHRQ wants to know for what kinds of measures should a combination of natural language processing and structured data be considered. But hospital CIOs are more interested in improving the process they use now to comply with Meaningful Use (MU) criteria and other government regulatory requirements.

This divergence in goals surfaced in a recent letter to AHRQ from the College of Healthcare Information Management Executives (CHIME), which represents CIOs. Instead of replying directly to the 15 questions in the RFI, CHIME expressed its general views on some of the problems that providers encounter in reporting on clinical quality measures (CQMs).

"The accurate reporting of electronic quality measures is one of the most daunting challenges faced by providers today," the letter said. "Through our experiences with Meaningful Use and other quality reporting programs, we found that although EHR products were able to automatically produce CQM reports, the data was inaccurate, inconsistent, and largely incomparable across different providers."

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Partly because of these shortcomings, CHIME said, many healthcare organizations must hire abstractors to complete quality measurement manually. In addition, work related to quality reporting takes staff members away from their regular duties.

Consequently, CHIME wants AHRQ to focus its research on ways to make it easier for providers to use health IT in quality measurement. In addition, the association would like AHRQ to work with other agencies to harmonize quality measurement efforts and standardize specifications for measures used in multiple reporting programs.

The letter points out that "the goal of 100% automation is an extremely long-term vision, given the state of natural language processing and the workflow of providers." Although the RFI doesn't refer to total automation, Jeffery Smith, assistant director for CHIME, told InformationWeek Healthcare that the association was "reading between the lines" of the RFI.

"When you look at the future state of CQMs, there's a belief that someday it can be done 100% automatically, without manual abstraction. But there's a long way to go from here to there."

Besides the problems in generating the necessary data for CQMs, some electronic health records (EHRs) do not include the capability to generate all of the CQMs providers can choose among to meet the MU stage 1 requirements, noted Smith in an interview with iHealthBeat. In his view, this happened because of the brief amount of time allotted to reprogram EHRs between the date when the final rule was issued and the beginning of stage 1. Also, he noted, vendors didn't want to rewrite software for CQMs they didn't think their customers would use.

The MU stage 1 rule did include e-specifications for the CQMs--although a spokeswoman for the EHR Association told iHealthBeat that those contained many inaccuracies. The final rule for MU stage 2 does not include e-specs, which means vendors are still waiting to begin rewriting their software for that stage, which begins in 2014. According to Smith, officials of the Centers for Medicare and Medicaid Services (CMS) were expected to discuss the topic with vendor executives this week.

The EHR companies say they need at least 18 months to imbed CQMs into their software. While there's less time than that before Jan. 1, 2014, the MU stage 2 rule allows a 90-day reporting period for attestation, rather than the full calendar year that had been anticipated. So even if EHRs don't include all of the specified CQMs until mid 2014, providers will still have time to use them for quality reporting.

AHRQ has no regulatory authority to force EHR vendors to improve the consistency and accuracy of the quality data their products produce, Smith noted in the InformationWeek Healthcare interview. But its findings, based on the RFI and other research, can "inform" the rulemaking of other agencies, he said. Also, AHRQ is forming a group of stakeholders to look at electronic quality reporting and plans to issue a report next summer.

"We're hoping the AHRQ research will come up with a roadmap for harmonization [of CQMs]," he said.

Meanwhile, AHRQ has extended the comment period for replying to its RFI to Sept. 21.

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