FOR IMMEDIATE RELEASE
Aug. 29, 2008

CONTACT: Stacy Fiedler, NQF
202 783 1300
sfiedler@qualityforum.org
PDF Version

 

NATIONAL QUALITY FORUM ENDORSES
NATIONAL CONSENSUS STANDARDS FOR
HEALTH INFORMATION TECHNOLOGY

Structural measures help create system of high-quality, patient-centered care
by sharing and managing information electronically

Washington, DC - To improve quality and efficiency and reduce errors and unnecessary treatments across the healthcare system, the National Quality Forum (NQF) has endorsed nine new national voluntary consensus standards for health information technology (HIT) in the areas of electronic prescribing, electronic health record (EHR) interoperability, care management, quality registries, and the medical home.  These HIT structural measures are intended to help providers assess the efficiency and standardization of current HIT systems and identify areas where additional HIT tools can be used. 

Adoption of HIT by clinicians has been shown to reduce medical errors by increasing access to information thereby improving response times to abnormal results, eliminating repetitive testing and providing clinical decision-support tools to facilitate evidence-based care.   

Evidence has shown a decrease in medication errors by up to 20 percent and a decrease in per admission costs by more than 12 percent when clinicians use HIT.

“If we hope to achieve high-quality, patient-centered care, we need interoperable HIT that can help us share information electronically and track patients throughout the delivery system – all of which can reduce errors and overuse and increase measurement across the continuum of care,” said NQF President and CEO Janet Corrigan.  “These newly endorsed measures can provide important information on effective use of health IT for both early adopters of HIT and those who are just beginning to implement HIT systems.” 

Blackford Middleton, MD, director of clinical informatics research and development at Partner HealthCare System in Massachusetts, and Joel Slackman, MS, managing director of the Blue Cross Blue Shield Association, co-chaired NQF’s steering committee on HIT structural measures.

“NQF-endorsed HIT structural measures will help the practice of medicine move forward with the adoption of information technology in healthcare,” said Middleton. “This allows us to better understand how widely healthcare information technology is being used in care delivery, and is a critical first step toward transforming healthcare.”

E-Prescribing
Electronic prescribing improves quality by reducing legibility errors, providing interactions and dosing alerts, and reducing costs by comparing equally effective alternative medications.  The two e-prescribing measures endorsed by NQF encourage the adoption of either a stand-alone e-prescribing tool for providers without EHR systems or the enhanced use of e-prescribing within an EHR for early adopters of HIT. 

Electronic prescribing measures endorsed by NQF were developed by Quality Insights of Pennsylvania (QIP) and the New York Department of Health and Mental Hygiene.

Interoperability of EHRs
The interoperability of electronic health records –EHRs that can share information between clinics, offices, and laboratories – improves quality by increasing timely, efficient, evidence-based care.  NQF endorsed two measures to increase adoption of interoperable EHRs: the first measures adoption of an EHR to manage clinical data within a practice, the second measures receipt of clinical data such as external laboratory results into an EHR.  NQF aligned these measures with Certification Commission for Health Care Information Technology (CCHIT) recommended EHR- certification criteria whenever possible.

Measures for the interoperability of EHRs endorsed by NQF were developed by the Centers for Medicare & Medicaid Services (CMS) and QIP.

Care Management
Electronic care management tools improve quality by improving patient-centered care that is coordinated and evidence-based.  Too often information about patients falls through cracks in the delivery system.

Both of the care management structural measures endorsed by NQF measure the use of HIT to identify specific patients in need of care, track their preferences and laboratory results, and assist the clinician in providing evidence-based care according to national guidelines using automated alerts and reminders. To measure care management across and between settings, the first measures HIT used during a patient- clinician visit and the second measures clinical results between visits.

These care management measures endorsed by NQF were developed by CMS and QIP.

Quality Registries
Sharing information through electronic quality registries allows for increased care coordination by tracking patients in need of care throughout the delivery system and giving feedback to providers.  Registries also assist in data collection on the safety and effectiveness of care to guide quality improvement efforts.  The two structural measures for quality registries endorsed by NQF assess clinician participation in quality registries at the local, statewide, and national levels.

These measures endorsed by NQF were developed by CMS.

Medical Home
The medical home is a broad model of primary care that aims to improve quality by providing coordinated, effective, continuous, patient-centered care.   Many of the measures endorsed by NQF in this set of HIT structural measures assess technology tools that are central for creating a medical home that is patient-centered and drives toward coordinated care.

NQF has endorsed a Medical Home System Survey that will allow clinicians to assess whether their practices are functioning as a medical home by providing ongoing, coordinated, and patient-centered care.  The survey specifically includes measurement of key HIT functionalities, such as the use of electronic-based charting tools to organize clinical information, the use of tracking tests and referrals, and the adoption and implementation of evidence-based guidelines. 

The Medical Home System Survey endorsed by NQF was developed by the National Committee for Quality Assurance (NCQA).

How to Appeal

NQF is a voluntary consensus standards-setting organization. Any party may request reconsideration of the recommendations, in whole or in part, by notifying NQF in writing via e-mail no later than September 27 (appeals@qualityforum.org). For an appeal to be considered, the notification e-mail must include information clearly demonstrating that the appellant has interests that are directly and materially affected by the NQF-endorsed recommendations and that the NQF decision has had (or will have) an adverse effect on those interests.

Funding

This work was conducted under a contract from CMS.

MEASURES ENDORSED BY NQF

The full specifications for these HIT structural measures and research recommendations are available in the voting report.

	Measure Title	Measure Description	IP Owner,   Developer
e-Prescribing	Adoption of Medication e-Prescribing	Documents whether provider has adopted a qualified e-Prescribing system and the extent of use in the ambulatory setting.	CMS QIP
	EHR with EDI prescribing used in encounters where a prescribing event occurred	Of all patient encounters within the past month that used an electronic health record (EHR) with electronic data interchange (EDI) where a prescribing event occurred, how many used EDI for the prescribing event.	NYCDHMH
Interoperable EHR	Adoption of Health Information Technology	Documents whether provider has adopted and is using health information technology. To qualify, the provider must have adopted and be using a certified/qualified electronic health record (EHR).	CMS QIP
	The Ability for Providers with HIT to Receive Laboratory Data Electronically Directly into their Qualified/Certified EHR System as Discrete Searchable Data Elements	Documents the extent to which a provider uses certified/qualified electronic health record (EHR) system that incorporates an electronic data interchange with one or more laboratories allowing for direct electronic transmission of laboratory data into the electronic medical record (EHR) as discrete searchable data elements.	CMS QIP
Care Management	The Ability to use Health Information Technology to Perform Care Management at the Point of Care	Documents the extent to which a provider uses a certified/qualified electronic health record (EHR) system capable of enhancing care management at the point of care. To qualify, the facility must have implemented processes within their EHR for disease management that incorporate the principles of care management at the point of care which include: The ability to identify specific patients by disease, diagnosis, or medication use The capacity to present alerts for disease management, preventive services and wellness The ability to provide support for standard care plans, guidelines, protocols.	CMS QIP
	Tracking of Clinical Results Between Visits	Documentation of the extent to which a provider uses a certified/qualified electronic health record (EHR) system to track pending laboratory tests, diagnostic studies (including common preventive screenings) or patient referrals. The Electronic Health Record includes provider reminders when clinical results are not received within a predefined timeframe.	CMS QIP
Quality Registry	Participation in a Practice-based or individual Quality Database Registry with a standard measure set	This Registry should be capable of generating population based reports relating to published guideline goals or benchmarking data providing comparisons to the practitioner  providing feedback that is related to guideline goals capturing data for one or more chronic disease conditions (i.e. diabetes) or preventive care  measures (i.e. USPTF recommendations).	CMS
	Participation by a physician or other clinician in systematic clinical database registry that includes consensus endorsed quality measures	Participation in a systematic qualified clinical database registry involves: Physician or other clinician submits standardized data elements to registry Data elements are applicable to consensus endorsed quality measures Registry measures include representative NQF consensus endorsed measures for registry's clinical topic(s) Registry provides calculated measures results, benchmarking, and quality improvement information to individual physicians and clinicians. Registry must receive data from more than 5 separate practices and may not be located (warehoused) at an individual group’s practice.  Participation in a national or state-wide registry is encouraged for this measure. Registry may provide feedback directly to the provider’s local registry if one exists.	CMS
Medical Home	Medical Home System Survey	The Medical Home System Survey assesses whether the practice is functioning as a patient-centered medical home by providing ongoing, coordinated patient care.  Meeting Medical Home System Survey standards demonstrates that practices have physician-led teams that provide patients with: Improved access and communication Care management using evidence-based guidelines Patient tracking and registry functions Support for patient self-management Test and referral tracking Practice performance and improvement functions.	NCQA

[1] Intellectual Property owner and copyright holder. ALL RIGHTS RESERVED. For the most current specifications and supporting information please refer to the IP owner.
CMS – Centers for Medicare & Medicaid Services
NCQA – National Committee for Quality Assurance
NYCDHMH – New York City Department of Health and Mental Hygiene
QIP – Quality Insights of Pennsylvania

The mission of the National Quality Forum is to improve the quality of American healthcare by setting national priorities and goals for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance, and promoting the attainment of national goals through education and outreach programs. NQF, a non-profit organization (qualityforum.org) with diverse stakeholders across the public and private health sectors, was established in 1999 and is based in Washington, DC.