NQF endorses 70 measures to improve gathering of clinical electronic data

70 Endorsed Measures Improve Ease of Gathering Quality Information

As an incremental step toward wider use of electronic data platforms to measure, report, and improve quality, the National Quality Forum (NQF) has endorsed 70 measures that combine data from two or more common electronic sources such as administrative claims, pharmacy and laboratory systems, and registries. Fifteen of the most robust endorsed measures use clinical data elements from personal health records (PHRs), electronic health records (EHRs), or case management registries. The measures cover sixteen conditions, including bone and joint conditions, cardiovascular disease, asthma and respiratory illness, and diabetes. An important goal of the project was to harmonize physician-level performance measures used by different health plans.

NQF's steering committee on clinically enriched administrative data sources was co-chaired by Dr. Michael O'Toole, cardiologist and chief information officer at Midwest Heart Specialists, and Dr. Charles Cutler, internist and former National Medical Director at Aetna.

The steering committee identified three levels of measures based on data source and complexity of methodology.

• Level one measures collect data from a single, electronic administrative data source, such as encounter or pharmacy claims. Many current quality improvement measures rely on administrative data like claims data that only provide one piece of information, such as a charge for a doctor's visit or an ordered lab test.
• Level two measures rely on merged data from multiple administrative data sources, such as laboratory, pharmacy, imaging or other claims data.
• Level three measures are constructed from common electronic administrative data sources enriched with clinical data such as laboratory results or blood-pressure values.

The steering committee reviewed over 200 measures, all of which are currently used by private health plans to assess physician performance. A total of 70 measures were endorsed by NQF and include 55 level two and 15 level three measures.

There were no Level One measures that satisfied NQF endorsement criteria. Many of the measures submitted assessed similar aspects of performance, but used slightly different measure specifications. It is anticipated that NQF-endorsement of these 70 measures will result in significant harmonization of measures used by various health plans, consequently reducing burden while ensuring greater consistency and understanding of performance information.

The steering committee acknowledged that use of the more complex level-three measures will be limited right now, but will likely become widespread as more and more ambulatory practices invest in electronic health records and as participation in clinical registries becomes more prevalent.

"By taking advantage of multiple sources of data, these measures can provide a more complete picture of the care provided," said Cutler. "These measures are also an important step down the path toward harmonized performance measures fully driven off of an electronic data platform."

"The overarching goal is better ambulatory care," said Dr. O'Toole. "Clinically enhanced physician measures are a representation of quality. The more we can promote the use of electronic data, the more quality becomes part of routine clinical care, rather than a by-product or another form that needs to be filled out."