Clinical Quality Measures
Quality health care is a high priority for President Obama, the U.S.
Department of Health and Human Services (HHS), the Centers for Medicare
∓ Medicaid Services (CMS), and the Office of the National
Coordinator of Health Information Technology (ONC). CMS uses clinical
quality measures (CQMs) in a variety of quality initiatives that include
quality improvement and public reporting. ONC certifies that electronic
health record (EHR) technologies are capable of accurately calculating
the CQM results for the meaningful use incentive program.
Meaningful Use Clinical Quality Measures for 2013
Eligible Professionals (EPs) will continue to report from the 44 measures finalized for Stage 1 and
Eligible Hospitals (EHs) and and Critical Access Hospitals (CAHs)
will continue to report from the 15 measures finalized for Stage 1.
In 2013, there are two reporting methods available for reporting the Stage 1 measures:
- Attestation
- eReporting Pilots: (Physician Quality Reporting System EHR Incentive Program Pilot for EPs eReporting Pilot for EHs and CAHs)
Meaningful Use Clinical Quality Measures for 2014 and Beyond
All providers are required to report on CQMs in order to demonstrate
meaningful use. Beginning in 2014, all providers regardless of their
stage of meaningful use will report on CQMs in the same way.
- EPs must report on 9 out of 64 total CQMs.
- EHs and CAHs must report on 16 out of 29 total CQMs.
In addition, all providers must select CQMs from at least 3 of the 6
key health care policy domains recommended by HHS's National Quality
Strategy:
- Patient and Family Engagement
- Patient Safety
- Care Coordination
- Population and Public Health
- Efficient Use of Healthcare Resources
- Clinical Processes/Effectiveness
A complete list of the 2014 CQMs, along with their
associated National Quality Strategy domains, usage guides, release
notes, fact sheets, etc. are available at: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html
Quality Measure Code Sets
The Clinical Quality Measures used by the HHS EHR incentive program
are comprised of definitions, measure logic, data elements, and value
sets. Four federal agencies: the Agency for Healthcare Research and
Quality (AHRQ), CMS, the National Library of Medicine (NLM), and ONC are
providing these components in various formats in order to be understood
by technical, non-technical, and clinical consumers. The Value Set
Authority Center will provide downloadable access to all official
versions of vocabulary Value Sets contained in CQMs that support
Meaningful Use Stage 2.
Data Elements Catalog (DEC) – A data element is a
representation of a clinical concept that represents a patient state or
attribute. This may be a diagnosis, lab value, gender, etc. that is
encoded using standardized terminologies. The DEC is maintained by NLM
and available through the Value Set Authority Center (VSAC).
Value Sets – Value sets define clinical concepts
unambiguously. They provide list of numerical values and the individual
descriptions from standard vocabularies used to define the clinical
concepts (e.g., diabetes, clinical visit) within the quality measures.
NLM maintains the value sets with the Value Set Authority Center.
USHIK – The United States Health Information Knowledgebase
(USHIK) is AHRQ's portal for Meaningful Use. The USHIK is intended as a
one-stop shop for publically accessing the components of meaningful use
quality measures, providing technical specifications including
definitions, measure computation logic, data elements, context, version
comparisons, and value (code) sets. Measures and value sets are
available in Excel, PDF, XML, and SVS.
Note: Viewing and/or downloading Meaningful Use
proprietary value sets, such as those including CPT codes or SNOMED CT
codes from NLM-VSAC or AHRQ-USHIK, requires a free Unified Medical Language System® Metathesaurus License (UMLS). Authentication via an UMLS ID and password is obtainable through the National Library of Medicine.
Certification
The ONC Certification Program provides a defined process to ensure
that EHR technologies meet the adopted standards and certification
criteria to help providers and hospitals achieve Meaningful Use
objectives and measures established by CMS. Eligible professionals and
eligible hospitals that seek to qualify for incentive payments under the
Medicare and Medicaid EHR Incentive Programs are required to
demonstrate meaningful use of certified EHR technology. For more
information on the ONC Certification Programs, please visit http://www.healthit.gov/policy-researchers-implementers/certification-programs-policy
Certification of EHR technologies under the ONC certification program
requires that EHR software products and EHR modules be tested, as
applicable, for the capability to accurately and appropriately calculate
the CQM results. ONC has commissioned the development of the Cypress certification tool.
The process for submitting the Cypress tool for official approval to be
used in the ONC Certification Program is currently under way. http://www.healthit.gov/cypress
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