Qual-IT - October 2006 | Archived

The American Health Information Community (AHIC) formed its new Quality Workgroup this past August with the goal of determining how health information technology can be used to develop quality measures to improve patient care and assist the health care industry. It is co-chaired by Carolyn Clancy, MD, director of the Agency for Health Care Research and Quality, and Rick Stephens of the Boeing Corporation.   The workgroup will make recommendations to AHIC to ensure that HIT can provide the necessary data, automate measurement and reporting for a comprehensive set of quality measures, both currently and in the future, and accelerate the use of clinical decision support that can improve performance on those measures.   The group is also charged with determining how performance measures should align with the capabilities and limitations of current HIT systems.

As we reported in the last issue of Qual-IT, in August President Bush issued an executive order requiring federal health care programs to procure only HIT systems that meet interoperability standards recognized by the Department of Health and Human Services (HHS), and to utilize quality measures developed by HHS-recognized organizations.   One such organization, the Certification Commission for HIT (CCHIT), has already established interoperability standards for electronic health records (EHRs) in ambulatory care settings; standards for inpatient EHRs will follow in 2007.   CCHIT-approved interoperability and functional requirements also address quality reporting and improvement.   The interoperability requirement references the technical standards adopted by the Centers for Medicare & Medicaid Services (CMS) for the DOQ-IT program, which requires reporting of quality measurement data from physician EHRs to the CMS data warehouse.   CCHIT's functional requirements include many EHR features essential to supporting health care quality and safety, such as medication management, adherence to protocols, and decision support for chronic care management and preventive services.

When the National Quality Forum published its Safe Practices for Better Health Care consensus report in 2003, it did not include any specific HIT standards in its recommendations.   This month, Forum members voted to adopt an update of that document.   While the final version has not yet been posted, the draft report made available for public comment did include, for the first time, specific references to HIT.   The draft described a new “safe objective” – promoting “the safe use of medications, tests and procedures through the successful implementation of integrated clinical information technologies that reduce preventable harm to patients.”  Toward that end, the Forum proposed implementation of a computerized prescription order entry system as a new “safe practices” standard.   The approved update should spur further adoption of computerized prescription order entry, as many public and private purchasers use Forum standards in their health plan and provider contracts.

In September, the Institute of Medicine released the third in a series of reports commissioned by CMS on quality improvement in the Medicare program.   The report, Rewarding Provider Performance: Aligning Incentives in Medicare, reinforces and expands on current Medicare policy on quality measurement and improvement, addressing HIT in its discussion of implementation.   Although the Institute does not recommend requiring HIT adoption as a pay-for-performance condition, it does clearly acknowledge the important role that HIT plays in improving health care quality and easing the process of reporting on Medicare quality measures, and specifically recommends that HHS explore a variety of approaches to assist providers with HIT implementation.

American Health Information Community.   Information about the Quality Workgroup, including meeting materials, is available online at http://www.hhs.gov/healthit/ahic/quality_main.html

Certification Commission on HIT.   Information on the CCHIT standards for electronic health records is available online at www.cchit.org

Institute of Medicine.   2006.  Rewarding provider performance: Aligning incentives in Medicare.   Executive summary can be downloaded without charge, and the full report purchased, at http://www.nap.edu/catalog/11723.html

National Quality Forum.   Information on the “safe practices” initiative is available online at http://www.qualityforum.org

The White House.   2006.   Executive Order: Promoting quality and efficient health care in federal government administered and sponsored programs.    Available online at http://www.whitehouse.gov/news/releases/2006/08/20060822-2.html