September 27, 2012
In response to a recent Request for Information on Quality Measurement Enabled by Health IT (RFI) from the Agency for Healthcare Research and Quality (AHRQ), the American Hospital Association (AHA) commented that accurate quality measures cannot be achieved without reconfiguring the e-measures currently used to achieve Stage 1 meaningful use (Stage 1) for electronic health records (EHRs) under the Health Information Technology for Economic and Clinical Health Act (HITECH). The AHA agreed that automated quality measurements have the potential to be crucial tools for improving the quality of care in the healthcare system. However, the AHA pointed out, clinical quality measures (CQMs) used in Stage 1 contained “known errors and were not properly field tested.” The AHA called for all future CQMs for hospitals to be endorsed through the National Quality Forum (NQF).
The AHA also called for more provider involvement in the design and testing of EHRs. Currently, there may not be much incentive for provider involvement because the data collection is burdensome and the real-time feedback desired by providers is unavailable. Furthermore, as was noted in a complementary AHRQ report to the RFI, there are more than 80 different programs by a variety of actors, both government and private, seeking to improve quality measurement enabled by health IT. The AHA noted that the multitude of initiatives creates confusion and sometimes contrasting requirements.
Overall, AHRQ plans to use the RFI responses to create a summary report for the summer of 2013. Additionally, the Centers for Medicare and Medicaid Services (CMS) announced the Final Rule for Stage 2 meaningful use on Aug. 23, 2012. The Final Rule will be implemented in 2014. The rule amends the reporting requirements for CQMs and adds more CQM choices for hospitals. Finally, CQMs used in Stage 2 have “either undergone feasibility testing in EHR systems and clinical settings or were finalized in Stage 1 final rule … and have been updated based on experiences with reporting those CQMs.” As of Sept. 26, 2012, a complete list of the new CQMs is still pending.
For more information on achieving meaningful use with electronic health records or reporting CQMs, please contact the authors.