You can’t manage what you can’t measure. That’s why quality measurement is so important in healthcare.
Yet for many providers, quality measurement has become an onerous process involving people, paper, numerous vendors and a variety of electronic health record (EHR) software.
U.S. healthcare watched as various industries across the globe went through digital transformations for everything from customer service to personal finance to even ordering groceries. Some processes within healthcare itself have undergone magnificent digital transformations, as EHR use became de rigeur and imaging technologies evolved—at warp speed—from film to sharp, diagnostic-quality digital files that can be accessed online from any device.
Now, as more data modalities in the industry turn digital, it’s time for healthcare quality measurement to get its own digital transformation to enable unlocking real value from these modalities as measured in improved clinical outcomes and lower cost of care.
That’s good news, along with the cost savings that comes with standardizing clinical information. Providers will be able to act more quickly on quality initiatives because of the automated sync of clinical data between providers and payers unencumbered by paper, spreadsheets and proprietary formats.
Interoperability rules drive open data and digital quality measurement
But this transformation won’t be an optional, adopt-as-you-go technology implementation. Providers and payers must be ready. The shift to digital measurement is already underway, as signaled by Centers for Medicare & Medicaid Services (CMS) and National Committee for Quality Assurance standardizing on Clinical Quality Language. Other accreditation bodies such as The Joint Commission recently transformed their annual accreditation process with electronic clinical quality measures.
It is no surprise that the call for more precise, standardized measurement comes at the same time federal health IT leaders in the Office of the National Coordinator for Health Information Technology (ONC) and CMS push for interoperability through regulations promulgated from the 21st Century Cures Act.
Several new interoperability rules will accelerate digital healthcare in general, including quality measurement.
- Payers will need to adopt the Patient Access API by July 1,2021. This regulation requires payers to send data via a secure, HL7 FHIR 4.0.1 API that allows patients to easily access their claims and encounter information. Payers will also need to comply with the Provider Directory API regulation, which makes provider directory information publicly available for care coordination. On Jan. 1, 2022, they must adopt the Payer-to-Payer Data Exchange, which allows patients to take their information with them as they move from payer to payer to create a longitudinal health record over time.
- Providers, too, will need to comply with new data standards. The Admission, Discharge, and Transfer Notifications data standards go into effect July 1, 2021. This requires hospitals to send electronic patient event notifications in order to improve care coordination by allowing the recipient provider to deliver appropriate follow-up care. Not to mention ONC’s information blocking prohibitions, which go into effect this year. In order to have precise, digital measurement, the industry needs access to data, and there can be no precise quality measurement when information blocking occurs.
All of these rules will promote the free flow of clinical data, which can also be measured and analyzed for the purpose of improving care quality. So the argument of “You can’t manage what you can’t measure” can no longer be a valid excuse.
What next-generation quality measurement looks like
Today, a single quality measure can be subject to human variation from provider to provider. A great deal of research has been conducted around the reasons why this variation exists—some of it even intentional—in quality measure implementation.
A digital quality measurement platform that can exchange FHIR-standard data between payers and providers not only will promote the interoperability and patient data access that these rules require, but it also will make quality measurement instantaneous. It will relieve the months of anxiety that providers, along with their measurement vendors, feel as they wait for their results from CMS. Because digital measurement is error-proof, there is no such thing as a human error with digital measurement.
The next generation of digital measurement will allow for calculation in near real time, with simple-to-comprehend dashboards to inform where to focus quality improvement efforts and allow for seamless integration to workflow and regulatory reporting to be completed with a click of a button, all in the service of delivering improved patient outcomes.
The standards have been written, the rules are in place. The question becomes, will you be able to keep up with the transformation by making the switch to digital measurement when the regulations go into effect?
Kareem Saad is president and chief operating officer of insurer technology company Apervita.