Core Measurement Needs for Better Care, Better Health, and Lower Costs Counting What Counts: Workshop Summary (2013) / Chapter Skim
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7 Building the Infrastructure
7 Building the Infrastructure
Pages 65-76
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From page 65... ...
7 Building the Infrastructure KEY SPEAKER THEMES Larsen • The Office of the National Coordinator for Health Information Technology, working with federal and non-federal partners, is developing a strategy focused on real-time measurement, as op posed to retrospective measurement, that is linked to decision support and patient dashboards. • Achieving the full benefits of digitally enabled measurement requires additional actions beyond adopting new technologies, in order to achieve the goal of a culture of care that uses health information technology to enhance care.
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From page 66... ...
INFORMATION TECHNOLOGY–ENABLED QUALITY MEASUREMENT Kevin Larsen explained that the goal of ONC is to improve the performance of the overall health and health care system, not simply to expand the use of digital tools. Operationalizing this goal means providing tools that providers, organizations, and public health systems can use to drive improvement.
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From page 67... ...
As part of this work, ONC has been building common definitions, which are housed in the Value Set Authority Center at the National Library of Medicine and can be downloaded easily. ONC, CMS, and the National Library of Medicine are also moving measures to new standards of representation, Larsen explained, using rich, standardized clinical languages such as SNOMED.
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From page 68... ...
He credited initiatives such as the Robert Wood Johnson Foundation's Aligning Forces For Quality program, the high-value health care initiative promoted by former HHS Secretary Michael Leavitt, and ONC's current Beacon Community Programs for the key roles that they have played in catalyzing the development of these multi-stakeholder, largely not-for-profit, and largely private-sector regional health improvement organizations. Given that context, Queram described WCHQ, which was founded in 2003, as a completely voluntary operation that worked to maintain a
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From page 69... ...
Several years ago, WCHQ made the explicit decision to align its work around the three-part aim, anticipating the prominence that the three-part aim would take as the centerpiece of the National Quality Strategy. WCHQ's core competencies revolve around four activities: developing and prioritizing performance measures for assessing the quality and cost of ambulatory care in Wisconsin; collecting, validating, and analyzing both administrative and clinical data; publicly reporting comparative performance results for health care providers, purchasers, and consumers; and sharing the best practices of health care organizations that demonstrate high quality.
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From page 70... ...
UW Health has used these data to improve colorectal cancer screening rates across all of its clinics, from 61 percent in 2005 to 79 percent in 2011, which was better than the 61 percent to 73 percent improvement seen across the entire WCHQ population. WCHQ makes its reports available through its webpage, and Queram noted that most of the visits to the website are by provider organizations that use the reports as benchmarks for their own organizations' performances.
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From page 71... ...
It was also important to spend time with diverse groups to develop buy-in and to build the social capital needed to develop and grow. Furthermore, WCHQ has developed and published an evidence base, finding a correlation between public reporting and improvement (Smith et al., 2012)
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From page 72... ...
"For all of the good intentions and emphasis of these national level activities, it's crowding out the human and financial capital that's critical to support local activities." He implored the workshop attendees to help redress this trend and create a balance that will enable important community-level work to continue. BUILDING THE DATA INFRASTRUCTURE IN A HEALTH CARE ENVIRONMENT Bruce Ferguson began the workshop's final presentation with a brief comment about the concept of a global outcome score -- the proportion of potentially preventable adverse events that are actually prevented with the current level of care -- as an actionable metric that can be used to assess the potential effectiveness of different interventions in a real-world setting.
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. Commenting on the universal patient identifier, Ferguson said that the cost to implement the universal patient identifier ranges from $1.5 billion to $11 billion but that the return on investment from having this identifier in combination with electronic health records would be $10 billion to $20 billion annually as a result of decreasing the inefficiency that now occurs in exchanging health information.
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From page 74... ...
It will be important, though, to evaluate the realities of the clinical environment in which national core metrics will operate and to evaluate how well the core metrics can be effectively executed in these clinical environments. DISCUSSION During the ensuing discussion, a comment was made that it is important to start thinking now about how to pull clinical data out of registries and combine it with information-rich population data in a unified data stream.
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From page 75... ...
2012. Public reporting helped drive quality improvement in outpatient diabetes care among Wisconsin physician groups.
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