Like it or not, healthcare is now a team sport. That’s obvious for clinicians participating in Accountable Care Organizations (ACO) and Clinically Integrated Networks (CIN), but thanks to MACRA and MIPS, it’s now true even for a single doctor in a private practice. Why? Because of Quality. And more specifically for today’s discussion, Quality Measures.

Why Quality Measures?

If you’re still reading this, then chances are you know the drill. Healthcare costs are out of control and threaten to bankrupt our country. At the same time, many people are skeptical that we’re getting commensurate value (although there’s a bit of a creeping narrative there). Either way, CMS has explicitly signaled the move to value-based care and the commercial market has followed suit. And if we’re only going to pay for value, then we need to define it, measure it and report it. And that’s why we need quality measures. This should be easy, right!?

Wrong! Quality Measures are Very, Very Hard

What is value? Who gets to decide? (Note: I talked about this with NCQA’s Andy Reynolds on Episode 22).

Should we measure processes (i.e. I asked the patient if they smoked) or outcomes (i.e. we added 3 quality years to the patient’s life)?

How can we effectively measure and report it?

Should we use claims data or clinical data?

Who do we hold accountable and how do we do it? Should doctor’s be held accountable for their patients’ choices?

These questions don’t even scratch the surface, but they should begin to demonstrate the problems that we face.

Kicking off our Quality Measure Series

On this episode, we talk with John D’Amore. John is Founder, President and Chief Strategy Officer at Diameter Health and has been working on Quality Measures in healthcare since the early 2000s. Yup, pre-EMR quality measures!

John takes us on a fascinating journey from paper based quality measurement (see RHQDAPU… at least we’ve streamlined our acronyms!) to the dawn of electronic measurement. via the Electronic Medical Record (EMR).  He explains why the single-EMR approach made sense in the hospital, but how the industry was hurt when it decided to apply that approach in the ambulatory setting.  Finally, John describes the future state where quality measures are calculated from a longitudinal patient record that encompasses all the care a patient has received. This, of course, calls for a trusted central authority to do the aggregation, data remediation and reporting. Perhaps, an HIE?

It’s a complex story and John delivers it well. We dig through all that and so much more, including:

  • What are Quality Measures and why do we need them? (1:23)
  • John D’Amore’s background and the founding of Diameter Health (5:30)
  • What has been the historic approach to quality measurement in healthcare? (8:00)
  • Should we limit quality measures in the short-term to only those that can be understood by patients? (13:00)
  • How do we pick the measures? What do we care about? (17:30)
  • What might a quality program look-like in a “digital-native” world? (21:10)
  • How can we move from a retrospective, tell me what happened world, to one where clinicians and administrators get the data when there’s still time to impact outcomes? (25:48)
  • We talk about the difference between clinical and claims data, and explore why the clinical data is not flowing. (30:30)
  • John gives an example of an HIE that’s achieved great success in Quality Reporting (Indian Health Information Exchange) and we explore why they’ve been successful (33:00)
  • Will providers start to realize that a robust HIE can help them improve quality scores and potentially increase revenue? (36:15)
  • Why is Data Quality such a linchpin issue when it comes to quality measures? (38:15)
  • How does data fidelity, or fitness for purpose, differ when looking at a single chart vs. longitudinal data sources from many systems? (42:50)
  • John and Shahid are both speaking at the Digital Quality Summit. We discuss their talks and goals for the event. (45:45)

We’ll be continuing the Quality Measurement series over the next month or two. I hope you enjoy the setup episode as much as I did!

~ Don Lee

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About John D’Amore and Diameter Health

John D’Amore, MS has over a decade of experience providing informatics and strategic insight to healthcare organizations. He is Founder of Diameter Health and is dedicated to improving healthcare quality and efficiency through the intelligent use of data.

Previously, John was Vice President at Eclipsys (now Allscripts) overseeing enterprise performance management solutions. Before then, John worked at the largest health system in Texas overseeing clinical informatics, decision support and business intelligence. During his tenure, Memorial Hermann won accolades for its financial performance as well as the National Quality Forum Award for exceptional clinical care.

John has published on best practices in population health and presented at national forums on how information technology can improve medical outcomes. He is a technical advisor to the National Committee for Quality Assurance and a primary editor of HL7’s standard for care summaries, the Consolidated Clinical Document Architecture. He holds a biochemistry degree from Harvard University and a graduate degree in clinical informatics from the University of Texas, School of Biomedical Informatics.

Twitter: @jddamore

Diameter Health enables clinical insight through the normalization, cleansing, de-duplication and enrichment of medical data from across the care continuum. This creates a single, unified source of longitudinal structured patient information for improved care and actionable analytics. The Diameter Health platform empowers organizations that depend on multi-source data streams, such as Health Information Exchanges (HIEs), Accountable Care Organizations (ACOs), health systems and health plans, to realize greater value from their data.

For more information, visit the website or email us at

Twitter: @DiameterHealth

Checkout John’s whitepaper on Semantic Interoperability:

Semantic Interoperability

Mentioned on the Show

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

Description from the site: HL7 and NCQA are partnering 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.

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