Clinical Quality Workgroup Update Jim Walker MD, Chair

1. Clinical Quality WorkgroupUpdate • Jim Walker MD, Chair July 25, 2012 Office of the National Coordinator for Health Information Technology

2. Agenda 1:00 p.m.Call to Order/Roll Call – MacKenzie Robertson, Office of the National Coordinator 1:05 p.m. Review of Agenda – Jim Walker, CQWG Chair 1:10 p.m. Characteristics of Optimal Clinical Quality Measures Update– Karen Kmetik, Tiger Team Chair & Co-Chair, CQWG 1:15 p.m. Actionable Steps from the June 7 Clinical Quality Public Hearing – Jim Walker, CQWG Chair 1:25 p.m. Value Set Discussion & Planning • Value Set Authority Center Update • Discussion of Value Set Governance Principles • Value Set Versioning – Jim Walker, CQWG Chair 1:45 p.m. Clinical Decision Support as Real-Time Quality Measurement – Jacob Reider, Office of the National Coordinator 1:55 p.m. Public Comment 2:00 p.m. Adjourn Office of the National Coordinator for Health Information Technology

3. Characteristics of Optimal Clinical Quality Measures Update This Tiger Team met multiple times in April – May, 2012 to identify characteristics of optimal clinical quality measures for Health IT • Optimal characteristics include: • Usability • Feasibility • Accuracy • Standard terminology • Specific recommendations are not put forward at this time Office of the National Coordinator for Health Information Technology

4. Actionable Steps from the June 7 Clinical Quality Public Hearing • Develop methodologies for identification of focus areas with greatest opportunity for improvement. Example: Resource intensive procedures with high variation • Shift focus from reporting to implementation of tools that are usable in the flow of care to proactively monitor and improve performance Examples: Clinical decision support is real-time measurement Reports that assess variation from standard work in real time Office of the National Coordinator for Health Information Technology

5. Actionable Steps, cont. • Focus on operational improvement as a core competency of a data driven adaptive learning organization. • Focus on strategies that enable workflow measurement (time stamping, etc.) to improve organizations’ ability to evaluate and change work flows. • Develop visual displays that show real-time in addition to retrospective performance, and predict outcomes based on current performance. • Provide statistical reports that make visible an organizations’ status toward leverage of real-time quality data. Are improvement strategies being followed? Who is doing well, and not? Why? • Create cultural change tools to help shift away from the RVU mindset and implement compensation methodologies that consistent with care improvement goals Office of the National Coordinator for Health Information Technology

6. MU2 Value Set Update The May, 2012 Essential Components Tiger Team value set recommendations are actively being executed by NLM & ONC. Ongoing activity: • Initial NLM quality assurance check for MU2 value sets is complete • ONC is coordinating “clean up” work by value set authors • NLM will become the authoritative source for MU value sets after posting of the MU2 final rule Office of the National Coordinator for Health Information Technology

7. API NLM Value Set Repository • Integration with Authoring Tool(s) to support value set authorship • Free-standing, web-based value set authoring tool(s) • API Phase 2 Phase 1 (Meaningful Use 2) Authorship Curation Delivery Consumption • Web page population for human consumption Controlled Value Set Repository & Validation Engine • Web download / web services for machine consumption Value Set / Measure Authors Consensus Organization(s) NLM ONC NLM Vendors Providers Public Health Orgs Office of the National Coordinator for Health Information Technology

8. Value Set Planning May 2012 scope: Value set infrastructure to support MU2 value set delivery and consumption. We now have the opportunity to address: • Value set governance • Longer term infrastructure needs: • Value set authorship & versioning • Value set reuse • Semantic validity Office of the National Coordinator for Health Information Technology

9. Draft Governance Principles Draft Value Set Governance Principles: Well-defined roles and role expectations establish clear governance structure and responsibilities. Defined mechanisms for shared decision-making, oversight, and resolution of disagreement facilitate timely & responsive governance. Governance will span all related activities, including mission, strategy, architecture, products/services, and data. Well-defined criteria for value set authorship, reuse, and maintenance over time facilitate effective value set creation and use. Clarification and resolution of intellectual property concerns where necessary. Office of the National Coordinator for Health Information Technology

10. CDS as Real-Time Quality Improvement Moving the bar on quality: • Retrospective reporting offers no opportunity to influence care in the moment • Identification of actions to be taken in real-time offers greatest opportunity for proactive care improvement • Clinical decision support can be conceptualized as real-time quality measurement • Increasing efforts around real-time quality measurement is consistent with testimony from the June 7, 2012 quality hearing. Office of the National Coordinator for Health Information Technology

11. Discussion Office of the National Coordinator for Health Information Technology