Article Figures & Data
Tables
Health System Number Enrolled Control 125 Kaiser Permanente Washington 90 Kaiser Permanente Colorado 66 OCHIN 94 Southeast Texas Medical Associates 6 Total 256 OCHIN = a nonprofit health care innovation center focused on the needs of community health centers, small practices and critical access hospitals; TRADEMaRQ = Trial of Aggregate Data Exchange for Maintenance of certification and Raising Quality.
CMS eMeasure ID NQF # Measure Title KPWA KPCO OCHIN SETMA CMS165v2 18 Controlling High Blood Pressure X X X X CMS138v2 28 Smoking Cessation Counseling X X CMS125v2 31 Breast Cancer Screening X X X X CMS124v2 32 Cervical Cancer Screening X X X X CMS130v2 34 Colorectal Cancer Screening X X X X CMS147v2 41 Preventive Care and Screening: Influenza Immunization X X CMS127v2 43 Pneumonia Vaccination Status for Older Adults X X CMS131v2 55 Diabetes: Eye Exam X X X X CMS123v2 56 Diabetes: Foot Exam X X X CMS122v2 59 Diabetes: Hemoglobin A1c Poor Control X X X CMS134v2 62 Diabetes: Urine Protein Screening X X X CMS163v2 64 Diabetes: Low Density Lipoprotein (LDL) Management X X CMS164v2 68 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic X X CMS145v2 70 Coronary Artery Disease (CAD): Beta-Blocker Therapy—Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) X X CMS182v3 75 Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control X X CMS135v2 81 Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) X X X CMS144v2 83 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) X CMS2v3 418 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan X CMS68v3 419 Documentation of Current Medications in the Medical Record X X CMS = Center for Medicare & Medicaid Services; NQF = National Quality Forum; KPWA = Kaiser Permanente Washington; KPCO = Kaiser Permanente Colorado; SETMA = Southeast Texas Medical Associates; OCHIN = OCHIN is a nonprofit health care innovation center focused on the needs of community health centers, small practices and critical access hospitals.
Error Types Examples Fix Measure miscalculation Incorrect numerator or denominator
Measures calculated incorrectly sent from inception, noticed 11 months after system launch
Incorrect data period (measurement period required 12 months, but 11 months used)
Incorrect denominator inclusion criteria used for greater than 1 year
Numerator >denominator error
Patient panel (erroneously) reduced to 0
Physician moved clinics and changed panels so that measures could not be reconciled; removed from the study
Significant change in scores for 5 measuresCorrected data sent and uploaded manually after manual removal of incorrect data
Revised measure calculations
Error caught internally and repaired; delayed transmission
Fixed reporting period compression errorData delivery error Delay in data delivery
Blank file sent
Incorrect NQF number attached to fileCorrected, resent, manual data replacement Non-enrolled physician data sent Physician data sent before they were enrolled/randomized
Ineligible physician data sentPhysician enrolled and randomized or excluded Data reporting interrupted Physician data reported for one period but not another
Internal system change caused a measure to not get reported
Source database moved and transmission credentials not configured
Critical subsystem source failure, 6-week delayUpdated files sent and manually uploaded Host receiving server not running System update interruption Server brought back online Third party errors Two years into study, learned that a third-party company was doing measure management and transmitting incorrectly
Third-party processes caused several month delays in file transmission around turn of calendar yearWorked directly with vendor to correct calculation or transmission errors
Files caught up once data sent by third partyNQF = National Quality Forum; TRADEMaRQ = Trial of Aggregate Data Exchange for Maintenance of certification and Raising Quality.
Additional Files
The Article in Brief
Clinical Quality Measure Exchange Is Not Easy
Robert L. Phillips, Jr , and colleagues
Background Family physicians provide nearly 20% of all clinical outpatient visits, translating to 200 million visits in the U.S. annually, according to the Centers for Disease Control and Prevention. Frontline clinicians continue to report failures of certified electronic health records (EHRs) to meet federal certification requirements and electronic reporting needs.
What This Study Found Researchers created the Trial of Aggregate Data Exchange for Maintenance of certification and Raising Quality, a randomized controlled trial, to assess whether quality measure reporting could be made a byproduct of clinical care and quality improvement. They recruited family physicians from four health systems. A total of 256 family physicians participated. Of 19 measures negotiated for use, five were used by all systems. The researchers identified 15 types of errors, including breaks in data delivery; changes in measures; and nonsensical measure results. Only one system had no identified errors.
The study concluded that the secure transfer of standardized, physician-level quality measures from the four health systems, despite their having mature processes in place, proved difficult. There were many errors that required human intervention and manual repair, which precluded full automation.Implications
- The study reconfirms that despite widespread health information technology adoption
and federally meaningful use policies, health care remains far from reaching its goals
of making clinical quality reporting a reliable byproduct of care.
- The study reconfirms that despite widespread health information technology adoption
and federally meaningful use policies, health care remains far from reaching its goals
of making clinical quality reporting a reliable byproduct of care.
Supplemental data
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