A Waste of Physicians’ Money and Vendors’ Time

A Waste of Physicians’ Money and Vendors’ TimeEHR vendors are facing the arduous task of programming as many as 125 clinical quality measures (CQMs)—in addition to the development challenges presented by all the other new meaningful use requirements for Stage 2—and to do this in a relatively short period of time. To compound matters, the calendar is rapidly advancing and the specifications for these quality measures are not even available yet.

Is there a better way to approach quality measure reporting? I think so—and it seems so obvious to me! EHRs should not be doing all of the analysis—they should simply collect and report the data, and CMS or its designate should provide the analytics. A centralized approach would be much more efficient and would produce more consistent and reliable data.

Think of the time and resources being wasted. Why should each of the 472 vendors offering certified EHRs have to program the same 125 clinical quality measures—that’s the programming of a total of 59,000 measures—when they should not have to program any at all? This unnecessary cost will ultimately be passed on to physicians. And what about the effect on standardization and comparability of the data produced? Despite the certification requirements for each of the quality measures, minor variances in calculations are inevitable, and this compromises the value of the data for comparative purposes. Centralization would also allow changes to be implemented in a nimble and timely manner. With a centralized registry, new measures could be introduced, and changes to measure specifications that result from new research could be programmed and released immediately, without having to wait what could be years for each of the 472 vendors to develop, upgrade, and deploy the changes to the hundreds of thousands of physician-EHR users.

A model already exists for such an approach, and the infrastructure for data exchange is in place using one or more of the standards that are accepted in the industry today. Registries are already analyzing clinical data and identifying areas for quality improvement. It is critical that we think outside of the box to find opportunities like the above that eliminate unnecessary duplication of effort and free vendors to focus on areas of keen interest—like EHR usability and physician productivity.

5 thoughts on “A Waste of Physicians’ Money and Vendors’ Time

  1. Evan:

    I couldn’t agree more – and you’re only describing half the battle. We’ve already had a number of interactions with RECs in different states whose interpretation of the “simple” CQM’s is both different from ours AND our certifying body’s. The definition of what goes into some of the denominators or numerators is (mis)interpreted on a state-by-state basis and the REC and/or state essentially holds the client hostage. Honestly, we get comments like, “…even though we cannot produce, in writing, our explanation of the rule, yours is wrong.” And, even after we produce written CMS guidelines supporting our position, they often refuse to budge. Each one of these discussions takes up ENORMOUS resources at our company as many people are involved in the analysis.

    What a waste.

  2. A failure of the lack of a requirement for a uniform software coding. If that were in place, then the government could write a standard quality control program and distribute it to all comers.

  3. There are, and have been for awhile, vendors who have developed support for CQMs, by using the Standard Arden Syntax rules. It seems appropriate that certification criteria for vendors of these tools be developed and implemented. Then the EHR vendors could link/embedded to the certified CQM products, as appropriate. This would take the onus off the EHR vendors and make CQM management a standardizd tool.

  4. This makes too much sense – the government won’t buy it. Really, there is too much momentum now in pushing the current plan for MU implementation. Mostashari is going to push his own agenda (the government’s agenda which he is charged with pushing) and you won’t budge him no matter how logical your reasoning is. You can make you most impact by contacting members of the ONC Advisory committee individually.

  5. ONC and MITRE have done some nice open source work around ambulatory quality measures. PopHealth and it’s successor product hQuery are worth evaluating. hQuery leverages Query Health standards including a modified HQMF (Health Quality Measure Format) standard that will be balloted by HL7 this fall. hQuery and the “new” HQMF enable dynamic queries, as opposed to statically built programs, for quality measures.

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