QUM WG RFC Summary

1. HIT Policy Committee/ Quality Measure Workgroup RFC Summary QUM WG RFC Summary February 2, 2011

2. Findings: Total Respondents • A total of 134 respondents – 112 organizations and 22 individuals not associated with an organization – responded to the RFC • 85 organizations and 5 individuals not associated with an organization submitted comments using the online tool • 27 organizations and 17 individuals not associated with an organization submitted comments via email and/or blog only

3. Organizations Abbott Nutrition Products Division, Abbott Agency for Healthcare Research and Quality Alliance for Nursing Informatics America’s Health Insurance Plans American Academy of HIV Medicine, Association of Asian Pacific Community Health Organizations, HIV Medicine Association, National Alliance of State & Territorial AIDS Directors, Partnership for Prevention, and Trust for America's Health American Academy of Hospice and Palliative Medicine American Academy of Ophthalmology American Academy of Pediatrics American College of Physicians American College of Preventive Medicine American College of Radiology IT & Informatics Committee/GR Subcommittee American College of Surgeons American Dietetic Association American Foundation for Suicide Prevention American Hospital Association American Medical Association American Nurses Association American Society of Clinical Oncology Arizona Health Care Cost Containment System Association for Professionals in Infection Control and Epidemiology Association of American Medical Colleges Baylor Health Care System Boston University School of Public Health; and Veterans Administration California Maternal Quality Care Collaborative California Primary Care Association Campaign for Better Health Care Continuum Alliance Case Western Reserve University Catholic Health East Catholic Healthcare Centers for Disease Control and Prevention, National Center for Injury Control and Prevention Certification Commission for Health Information Technology Charlotte Hungerford Hospital Cheboygan Memorial Hospital Childbirth Connection Clinical Inservices Solutions, LLC Consumer Partnership for eHealth Consumer-Purchaser Disclosure Project Dartmouth Institute Davis Family Physicians Delaware Health Net Disability advocacy groups (43 co-signers) Drs. Concannon & Vitale, LLC Duke Durham Regional Hospital Eastern Maine Healthcare Systems Epic GE Healthcare IT George Washington University Golden Living, LLC & LTPAC HIT Collaborative Gundersen Lutheran Health System Health Dialog Health Economics Group+A2 Health IT Now Coalition Health Resources and Services Administration

4. Organizations HealthInsight Regional Extension Center HealthPartners Research Foundation Healthwise HealthyCircles, LLC HMS Hospice and Palliative Care Coalition Hospital Executive Council Indian Health Service Intuit Health Kaiser Permanente Local Public Health Association of Minnesota Massachusetts General Hospital McKesson Provider Technologies MEDai / an Elsevier Company Memorial University Medical Center Minnesota Counties Computer Cooperative Minnesota Department of Health Missouri Hospital Association NASMHPD National Association of Community Health Centers National Center for Cognitive Informatics & Decision Making National Coalition for Cancer Survivorship National Committee for Quality Assurance National Health IT Collaborative for the Underserved National Partnership for Women & Families Nemours Neumann University New York Chapter, American College of Physicians New Yorkers for Accessible Health Coverage Newborn Coalition North Carolina Bio-Preparedness Collaborative Oregon Health & Science University Center for Ethics in Health Care Partners Healthcare Patient Privacy Rights Pediatrix Medical Group Pharmacy e-HIT Collaborative Philips PhRMA Planned Parenthood Federation of America Qualidigm REACH (MN-ND HIT Extension Center) Riverbend Medical Group Scots Pine Clinic, PLLC SHAPE HITECH, LLC Social & Scientific Systems Society for Participatory Medicine Society of Behavioral Medicine St. Joseph Health System Stanford University State of Oregon Health Information Technology Oversight Council Surescripts TeenScreen National Center for Mental Health Checkups at Columbia University Texas Department of State Health Services UnitedHealth Group University of Wisconsin School of Medicine and Public Health VersaForm Systems Corp Washington University School of Medicine

5. Criteria for Measure Selection • *National Quality Forum, 2013 eQM Report

6. Measure Domain Areas • Patient & Family Engagement • Clinical Appropriateness/Efficiency • Care Coordination • Patient Safety • Population & Public Health

7. Findings: Measure Recommendations

8. Additional 113 Retooled Measures by Specialty

9. Patient & Family Engagement Most Promising Measures • Patient experience of care & HIT connection with providers • Measurement of functional status & health risk • Patient activation and self-management skills Methodological Issues • Defining discrete measures from larger validated instruments • Data platform for patient-reported measures • Sampling versus census approach to data collection

10. Clinical Appropriateness/Efficiency Most Promising Measures • Lipid Control using Framingham risk score • Measure assessing the appropriate use of diagnostic imaging procedures, with measures for redundancy, cumulative exposure, and appropriateness • Measure assessing appropriate medication treatments, including overuse and/or underuse Methodological Issues • Readmissions measures currently are using claims and administrative data (incorporation of claims) • Measures using risk assessment scores and algorithms will need further work

11. Care Coordination Most Promising Measures • Measure assessing adherence to a comprehensive care plan • Measure of patient and family experience of care coordination across a care transition • Measure of an advance care plan as a product of shared decision making • Composite measure assessing receipt by both care team members and the patient/caregiver of a comprehensive clinical summary after a transition Methodological Issues • Acknowledging the current state of interoperability to permit adequate care coordination • Verifying that care coordination has occurred • Standardizing longitudinal record or action plan for patients • Defining specific elements of a comprehensive care plan

12. Patient Safety Most Promising Measures • Adverse Drug Events (ADEs) • Monitoring of patients on chronic medications • Health care associated infections (HAIs) outcome and bundled process measures • VTE outcomes • Falls risk assessment Methodological Issues • Meaningful measurement of ADEs • Capturing relatively rare events (HAIs, VTEs, ADEs) • Measures of falls and ADEs applicable in both hospital and ambulatory settings • Risk adjustment of measures

13. Population & Public Health Most Promising Measures • Measure assessing patients with undiagnosed hypertension using a calculated algorithm • Longitudinal assessment of blood pressure • Longitudinal assessment of blood glucose • Stratify quality measures by patient demographics information* Methodological Issues • Population health management presents challenges to traditional outcomes measurement • Standard data entry conventions need to be identified for some measures *Not a quality measure but a methodology for reporting

14. Gap Areas • Measures of decision quality • Comprehensive Clinical Summary • Closing the referral loop measure • Measures related to action plans for patients • Measures to meaningfully capture adverse drug events • Health equity measures (e.g. population-based interventions) • Readmission measures and medication adherence measures require multiple sources of data

15. Next Steps • A superset of measure concepts/measures to be recommended • Individual Tiger Team meetings for final recommendations • Further workgroup attention to: • Capturing patient-reported measures • Integration of multiple, longitudinal data sources • Framework for quality measures reporting (core/menu)

16. Next Steps • Recommendations from HIT PC/Quality Workgroup will inform ONC on priority measures/concepts for Stage 2 and Stage 3 • Consideration will be given to harmonization process, stage of readiness, and criteria as outlined (parsimony, HIT sensitivity, etc.) • Development, testing, validation of measures to be completed by Q4/2011 for Stage 2 and Q4/2013 for Stage 3