According to the American Hospital, slow and steady wins the race when dealing with electronic reporting of quality measures. In response to the Agency for Healthcare Research and Quality (AHRQ) “Request for Information on Quality Measurement Enabled by Health IT,” Linda Fishman, the association’s Senior Vice President for Public Policy Analysis & Development, has urged the federal to take more time before upping the ante on electronic measures (e-measures). “If automated quality measurement is to become widely used, it is more important to get a small number of measures right before moving on to more measures or moving too quickly,” argued Fishman in the September 19 letter.
The challenging experience of hospitals with Stage 1 Meaningful Use has led the AHA to contend that quality reporting through electronic health record and health information technology (IT) systems is barely achievable with today’s technology. “Realizing the promise of EHRs as a tool for quality reporting, and ultimately quality improvement, will depend on the ability of providers, payers, and other users of the information to know that health IT-enabled quality measures (e-measures) provide valid and reliable data,” wrote Fishman. In particular, certified EHR technology (CEHRT) does not include sufficient testing of functionality crucial to reporting clinical quality measures (CQMs) electronically:
The certification process for EHRs does not include testing the accuracy of the embedded measure calculations, nor does it look to see if the needed data are available in the EHR. It requires only that vendors, using their own data, show that their product can electronically produce numerators, denominators and exclusions in the required standardized format. There is no verification of the accuracy of these numbers.
Although physicians and hospitals are recording CQMs, they have to do so using a hybrid system of paper-based and electronic records. “Much of the data for the inpatient measures comes from physician documentation that is currently contained in written or dictated notes,” Fishman continued, “Thus, the needed data are often not gathered electronically during the course of care.” And those who have exerted “significant effort” to adapt their systems have indicated a serious lack of trust in the integrity of these data.
On top of the myriad resources it requires of both providers and vendors, individually customizing CERHT does little to correct the problem for the whole healthcare industry. In fact, it may do more harm than good when it comes to establish a consensus about CQMs:
Many AHA members report working with individual vendors to fix errors discovered during validation processes. However, to have comparable data across vendors and hospitals, there needs to be a process that ensures these changes are broadly communicated and systematically incorporated.
Although AHA still maintains that automated quality reporting will pay dividends, its leadership fears that the current approach of too much, too soon could jeopardize the actual purpose of electronically-enabled quality measurements. “Early experience from the hospital field in implementing Stage 1 of meaningful use calls into question whether e-measures, as currently configured, will deliver on that promise,” Fishman revealed.
There’s a fine line between motivating the healthcare industry forward with reasonable expectations and burdening hospitals and health systems with additional responsibilities. Many have expressed opinions in support or against the AHA’s claims on the subject on EHR and health IT, so it’s a wonder what type of response the association’s recent remarks with elicit.
Read the entire AHA letter for its recommendations to the AHRQ.
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