The national shift toward interoperable electronic health records (EHRs) enables the calculation and reporting of innovative performance measures that address critical performance and measurement gaps. The electronic ability to clearly and consistently identify patients with specific conditions or interventions, in a given population or setting, is especially important for patient-centered, longitudinal and meaningful healthcare improvement. However, to meet this promise, measure development needs electronic clinical data standards and reusable “building blocks” of code vocabularies to ensure measures can be consistently and accurately implemented across disparate systems. These coded vocabulary groups, known as “value sets,” provide definitions of the data elements necessary to calculate Clinical Quality Measures (CQMs). A value set consists of unique codes and descriptions, drawn from standard vocabularies such as SNOMED CT® and ICD-10-CM, which are used to define clinical concepts (e.g., patients with diabetes, clinical visit). In current programs using EHR data, concepts such as medications, diagnoses, and procedures are addressed, in part, as Data Elements (DE) – the pieces of information to be collected as part of a measure. A Common Data Element (CDE) is a data element that is found in multiple data sets across different measures. Value Sets are the list of possible values for a DE or CDE.
In 2012, the National Library of Medicine (NLM), in collaboration with the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS), launched the Value Set Authority Center (VSAC). Through the VSAC, the NLM is charged with value set “curation,” which includes ensuring that value set codes are not incorrect or malformed, do not contain code system or code mismatches, and do not contain code and description mismatches.1 The VSAC also updates value sets based on the current, valid transition and standard vocabularies approved by ONC’s Health Information Technology Standards Committee (HITSC). The VSAC provides downloadable access to all official versions of vocabulary value sets contained in the Meaningful Use Stage 2 (MU2) eMeasure specifications, also called the 2014 Clinical Quality Measures (eCQMs). The value sets in the VSAC describe the specific populations and clinical actions included and excluded in order to properly calculate each of the 64 eCQMs for eligible professionals (EPs) and the 29 eCQMs for eligible hospitals (EHs) for the 2014 MU2 eCQMs.
Many stakeholders in the Health IT community have recognized the need for such a repository of value sets, and the VSAC is a remarkable achievement. But to enable value sets to be used efficiently to build and maintain effective eCQMs, curation alone is not enough. There is also a need to validate the clinical meaning of codes given the intent of the measures and to assess multiple competing value sets addressing the same intended purpose in order to harmonize them.
About the Project
This project, which launched in January 2015, will develop and pilot test a value set harmonization and approval process to promote consistency and accuracy in eCQM value sets. NQF defines value set harmonization as the process by which unnecessary or unjustifiable variance will be eliminated from common value sets in eCQMs by the reconciliation and integration of competing and/or overlapping value sets. In addition, harmonized value sets will provide basis of gap analysis and for examination of face validity of value sets. Harmonized value sets will be remanded to the NLM for modification in the VSAC. The project will also offer guidance on how approved value set status should be integrated into the eCQM endorsement process.
This project will be guided by a multi-stakeholder Value Set Committee (VSC), as well as subject-specific technical expert panels (TEPs). The VSC will comprise multi-stakeholder experts with broad expertise in health IT policy, measure development, clinical information systems, coding, and interoperability. The subject-specific TEPs will consist of clinical coding experts, measure developers and methodologists, EHR vendors, and specialists in clinical process and structure (e.g., defining encounters).
The VSC will help NQF to determine the overall approach to the harmonization and approval of value sets, including development of evaluation criteria; evaluating the results of the harmonization process; and providing broader recommendations on how harmonized and approved value sets should be integrated into the measurement endorsement process. Working under the guidance of the VSC, the TEPs will then use the process developed by the VSC to conduct the actual technical analysis and harmonization of the value-sets related to each measure.
This project is funded under NQF’s contract with the Department of Health and Human Services, “National Strategy and Priorities for Healthcare Performance Measurement.”
Related NQF Work
For more information, please contact Kathryn Streeter at 202-783-1300 or via email at email@example.com
1Cragin M, Heidorn PB, Palmer CL, et al. An Educational Program on Data Curation. ALA Science & Technology Section Conference. Available at https://www.ideals.illinois.edu/handle/2142/3493. Last accessed October 2014