The path to Digital Quality Measures 2.0 starts with the National Committee for Quality Assurance (NCQA). Their Healthcare Effectiveness Data and Information Set, better known as HEDIS, is the basis for many of the measures used in value-based payment programs across the country.

Note: This is part 2 in a series. Checkout the rest of the Quality Measures series here.

Designed to measure the performance of health plans on an apples-to-apples basis, HEDIS originally went where the data was available – claims. And of course, when you’re talking claims data then you’re typically talking process measures. That is, are the “right things” being done?

As health information technology matured, NCQA, HL7, and others began to design standards such as the Healthcare Quality Measures Format (HQMF) to enable electronic clinical quality measures (eCQM). This meant we could begin to measure clinical outcomes from data in the suddenly ubiquitous EHRs. It was a great start, but the whole industry was moving very quickly and with draft standards. Nearly 10 years later we still have vendors who are unable to support the format.

Digital Quality Measures 2.0

On this episode, Rick Moore, CIO at NCQA, joins us for a discussion about what’s next for digital quality measurement. Rick likes to call this Digital Quality Measures 2.0 and you can see it coming to life in NCQA’s eMeasure Certification (eMC) program.  The program aims to take burden away from health plans and auditors by establishing a process for generating standard supplemental data for HEDIS measures. This will enable software vendors, providers, HIEs and others to more effectively and efficiently provide needed clinical data without all the manual chart pulls (you can see the certified vendors here).

Additionally, the eMeasure test process is now approved as the only alternative to the Project Cypress toolset in the ONC Health IT Certification Program.

Rick sees great opportunity ahead for a few reasons:

  1. The community is more engaged (vendors, providers, payers)
  2. The government has backed off (a bit) on mandating specifically how things will be done
  3. There are more options available to providers

These factors, coupled with the rise of promising new specifications like Clinical Quality Language (CQL) and FHIR, might put us in a position to move away from performance-based measures of providers and towards holistic, patient-centered measures; away from manual data entry and toward clinical data that is automatically collected as a by-product of the physician workflow. At the same time, he is realistic and offers several cautions:

  1. We can’t wait for CQL and FHIR. Let’s move forward with what we’ve got now and upgrade along the way.
  2. We can’t just toss out process measures and go strictly outcomes measures. We need both.
  3. We can’t mandate interoperabillity as the basis for all measures right away

We address these issues and so much more, including:

  • What is the National Committee for Quality Assurance or NCQA? (0:55)
  • What’s NCQA’s role in monitoring quality in healthcare? (2:08)
  • What’s the difference between process measures and outcomes measures? What about Patient Reported Outcomes Measures (PROMs) vs. institutionally focused outcomes measures? (4:35)
  • How does NCQA decide what’s worth measuring especially when you consider the high levels of administrative burden and burnout on the physicians? (10:00)
  • The unintended consequences of value-based payment (13:00)
  • What if we decided that from this point forward we would only have measures that could be collected digitally? (15:30)
  • Structured vs. unstructured data (20:00)
  • Manually entered and properly coded vs. automatically captured data points (23:45)
  • What if we decided that from this point forward we won’t collect measures unless we have interoperabillity? Would we get interoperabillity more quickly? (25:30)
  • Why aren’t we using all the digital info that is already available? Think manual chart pulls instead of data extracts or queries against Health Information Exchanges (HIE)? 27:30
  • Do you agree with the following statement? Some health systems will make the investment needed to satisfy quality measure requirements without a major burden on providers and that will give them a competitive advantage because doctors will choose to work there (33:00)
  • What is the Electronic Measure Certification (eMC) program? (39:00)
  • Does the eMC program serve as a vehicle for HIEs and other community aggregators to get in the HEDIS measurement flow by providing standard supplemental data to the health plans? (49:00)
  • What advice would you give doctors who want to have more of a say in the quality measure specifications going forward? (51:25)
  • Where can listeners learn more about you, NCQA and the eMC program? (51:25)

There’s a lot here. I hope you enjoy it!

~ Don Lee

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Mentioned on the podcast

Re-imagining Quality Measurement by Shahid Shah (presented at The Digital Quality Summit)

The Digital Quality Summit | Held November 1-2, 2017, Washington, DC

HL7 and NCQA partnered to host the Digital Quality Summit – gathering the best and brightest in health care and technology to demonstrate methods for eliminating measurement burdens and bridging the digital gap.

Health Impact Mid West | Held November 16, 2017, Chicago, IL

The 5th Annual HealthIMPACT Mdiwest, developed in partnership with NODE Health where the brightest minds in clinical health technology move beyond the digital medicine hype and forge a path from innovation to implementation to digital transformation using evidence as our guide.


About Rick Moore, PhD

As NCQA’s Chief Information Officer, Rick Moore is responsible for the vision and strategic direction of the Information Services, Information Technology and Information Products. He also works closely with NCQA’s stakeholder partners and represents NCQA on leading several national health information technology initiatives and panels including the Office of National Coordinator Standards and Interoperability Workgroup, and the Health Information Management and Systems Society (HIMSS) Quality and Patient Safety Committee.

Prior to joining NCQA in 2008, he was the Director of Health Informatics at the National Association of Children’s Hospitals where he led the development of information services and products for over 200 member hospitals. He has also served the Office of the Secretary of Health Affairs at the Department of Defense where he led the development of Electronic Health Record (EHR) systems and was awarded the Information Technology Officer of the Year of the Joint Medical Information Systems Office in 2004.

From 2001 to 2003, he was competitively selected by the U.S. Air Force Medical Service to attend the University of Alabama at Birmingham where he studied Health Informatics. In 2002, he was selected as a recipient of the HIMSS Foundation Richard P. Covert National Scholarship Award. Previously, he has served as the Director of Medical Readiness at Langley Hospital and was recognized as the Medical Readiness Officer of the Year for the command. He has also served as the Director of Managed Care for Moody Community Hospital and was selected in 1996 as the Air Force Medical Service’s Managed Care/Patient Administrator of the Year.He holds a Doctorate degree in Health Related Sciences from Virginia Commonwealth University, a graduate degree in Health Informatics from the University of Alabama at Birmingham, as well as a graduate degree in Management from Troy State University, and a Bachelor Degree in Industrial Technology from Southern Illinois University. He is a certified health care executive and Fellow in the American College of Healthcare Executives (FACHE), a Fellow of the Health Information Management and Systems Society (FHIMSS), a certified Professional in Health Information and Management Systems (CPHIMS), a Certified Information Security Manager (CISM), and a certified

Project Management Professional (PMP)
Email: moore@ncqa.org

Twitter: @Moore4Health 


About NCQA

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s Web site (ncqa.org) contains information to help consumers, employers and others make more informed health care choices.

Twitter: @NCQA


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