CMS: EHRs not mature enough to report eCQMs correctly

computer keyboard with stethoscope

Hospitals are still struggling to use their electronic health records to accurately report electronic clinical quality measures (eCQMs), according to a recent summary of findings published by the Centers for Medicare & Medicaid Services from a 2015 validation pilot.

CMS conducted a hospital inpatient quality reporting (IQR) validation pilot project to better understand how EHRs vary for supporting eCQM reporting. The pilot, conducted in the spring and summer of 2015 with 29 hospitals, evaluated strategies to validate eCQMs for the hospital IQR program.  The objectives of the pilot were, among other things, to access the accuracy and completeness of eCQM data, evaluate hospital and CMS readiness to support CMS' eCQM reporting and validation requirements, and plan future validation requirements.

The pilot assessed hospital readiness to submit eCQM medical record information in two ways, using both a CMS contractor to extract eCQMs by remotely viewing the EHRs, and by examining hospital reported eCQMs as Quality Reporting Document Architecture Category I (QRDA 1) files of patient level data.

CMS found that while EHRs were capable of enabling the contractor to collect the data remotely with hospital staff support, many EHR processing procedures “had not yet matured” to permit creation of complete and accurate QRDA I files based on the 2014 eCQM specifications. Many hospitals had challenges with creating complete files, which prevented a meaningful comparison of the QRDA data to that obtained via remote viewing.

The measures match rate was low, anywhere from 12 to 49 percent. Primary problems stemmed from the data mapping and workflow issues. For instance, much information was in free text, notes or scanned documents, not discrete data fields, so the data could not be extracted to create the data elements in the QRDA files.

The hospitals recommended that CMS provide more outreach and education regarding eCQMs, reduce the burden of eCQM adoption and provide tools and guidance for implementation.

"This study provided insight into the mapping prerequisites, resource requirements for eCQM reporting and the transition process for moving from attesting measures in Meaningful Use to eCQM reporting," CMS said. "CMS will continue to invest in unscored validation pilots to assist hospitals and vendors with the transition to eCQM reporting, and ultimately to improve the accuracy of the data reported."

To learn more:
- here's the summary (.pdf)

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