Measure Harmonization: Getting in Tune
One in a series of reports from the NCQA Digital Quality Forum held in Boston July 16-18, 2019.
Chief Data Scientist
A trending topic in the clinical quality reporting industry is the misalignment of quality measures. Clinicians are likely reporting on multiple versions of measures trying to measure the same or very similar things. This adds to the clinician’s administrative burden, whose main job is to care for patients. It also leads to confusion when the same clinical practice is considered compliant (i.e. no care gaps) by one program but not by another (i.e. care gap exists). In addition to clinicians, these misalignments create significant challenges for other stakeholders such as measure developers and implementors.
Measure misalignment occurs because measure authors work for different organizations and under different sponsorships, most often in isolation from each other. As a result, they create different population definitions, value sets, and (or) terminologies. Misalignment on population definitions means the same data can be interpreted as compliant for one measure version but non-compliant or not applicable for another version. Misalignment on value sets or terminologies means the same code can mean compliance for one measure but not the other. As a result, the same set of data can be evaluated differently by different measures.
So, it was encouraging to learn that the NCQA is taking a leading role to harmonize these measures. For example, HEDIS has historically included only billing code systems such as CPT or ICD10-CM, but in the 2020 HEDIS volume 2 published this July, the measure value sets also started to include SNOMED, which is a prevalent terminology in clinical systems and documents. This way, when clinical data are used to supplement HEDIS measures, the SNOMED codes will be counted to reflect the care provided. Since the work involved is too large to fall on a single party, NCQA strongly recommends that the whole quality measurement community work together.
At Diameter Health, we are actively contributing and getting in tune with this developing community. As the first vendor certified by both the ONC Health IT and NCQA for e-clinical quality measurement we support both the eCQM (by calculating measure outcomes) and HEDIS use cases (by generating standard supplemental data). We have noticed multiple misalignments in the value sets between these two programs alone (e.g. cms125 and BCS for breast cancer screening). We evaluate these differences and work with the measure stewards as appropriate to map the codes so they can be counted properly to reflect the measure’s intention. In addition, we are actively working with our clients to make our product more tolerant to common data issues in the fields and still be able to use imperfect data to support accurate reporting. We have shared our approach and findings with improving the measure logic so it’s more harmonized with real-world data in a peer-reviewed journal.