The Standard

Anthem, Cedars-Sinai, and CareEvolution to share on project to implement Data Exchange for Quality Measures and Event Notification on Wednesday, October 28

Like peeling back the layers of an onion, exchanging information to support value-based care involves complex data challenges for providers and payers alike.

That’s particularly true when it comes to navigating essential communications between providers and payers, using that dialogue to better coordinate care and achieve the best possible results for patients.

Two key areas that challenge everyone is ensuring that quality measures are met and that everyone in the chain is on the same page when it comes to events. Typically, these are hard for all parties in sharing relevant information.

HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard offers an approach that everyone can use to facilitate data exchanges. In an upcoming community roundtable scheduled for 4 to 5:30 p.m. ET on Wednesday, October 28, HL7 Da Vinci Project members Anthem, Cedars-Sinai and CareEvolution will discuss their efforts to put implementation guides for Data Exchange for Quality Measures and Event Notification in place.

HL7 Da Vinci Project Event Wednesday, July 22, from 4:00 – 5:30 p.m. EDT

Quality measurement is a key factor in improving the delivery of care, especially in value-based care arrangements. And it has become clear that as the shift to value-based care continues, the need for payer-provider collaboration has become essential.

The exchange of data among healthcare industry members can help organizations improve quality, and HL7’s Fast Healthcare Interoperability Resources (FHIR®) can play a significant role. The next Community Roundtable hosted by the HL7 Da Vinci Project entitled “What It Takes: How to Leverage the HL7 Da Vinci Project to Drive Quality Measurement and Value-Based Care,” will examine how organizations are making progress in sharing information for quality purposes.

The roundtable discussion will begin with Jocelyn Keegan, the Da Vinci program manager, providing an overview on the status, maturity and resources available for emerging implementations across Da Vinci focus areas.

Presenters at the May 27 HL7 Da Vinci Project community roundtable provided concrete evidence demonstrating how the use cases represent specific ways to use HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard for specific purposes in value-based care data exchange interactions between providers and payers.

FHIR for Data Exchange for Quality Measurement (DEQM) Use Case

A clear indication of the value of the medication reconciliation process use case was provided by Kirk Anderson, chief technology officer for Cambia Health Solutions, a nonprofit healthcare organization that’s the parent company of Regence, a member of the Blue Cross Blue Shield Association. Initial efforts to use the FHIR use case with MultiCare, a Tacoma, Washington-based healthcare system, resulted in a dramatic boost in the insurer’s ability to get information on members’ prescribed medications from the provider.

Since the fall of 2017, electronic Clinical Quality Measures (eCQMs) logic has been written using Clinical Quality Language (CQL). With the introduction of CQL, the eCQMs included in the CMS federal programs had to be translated from Quality Data Model (QDM)-based expression logic to CQL.

Though CQL provides more flexibility in expressing measure criteria within the logic that allows measure developers to include greater specificity and precision within the measure requirements, this did not result in a direct translation process, as new attributes and timings were made available. What this means is that clinical workflow and input are perhaps more important because CQL is able to convey these nuances, whereas the QDM-based logic expressions were limited. CQL can also be used to develop Clinical Decision Support (CDS) rules and can reuse logic from measures in those CDS rules.

When composing measures using the CQL syntax, the QDM is still used in conjunction with CQL as the means to characterize required data elements within the measure logic. This conceptual model defines what type of clinical data is needed to satisfy the measure requirements. Therefore, the QDM is still very much a part of electronically specified measures, which is incorporated into the logic definitions written using CQL.

Health Level Seven (HL7^®) drives the standards upon which electronic Clinical Quality Measures (eCQMs) sit, so participation in these venues is crucial. The HL7 community already has a lot of technical input but lacks input from the clinical side – either from clinicians or clinical informaticists. There is a gap between the clinical intent of quality measures and the technical standard, but clinical informatics experts can help bridge this gap by contributing to the conversation and development of the HL7 standards and resources.

Measure development, as we know it, is changing. Quality improvement is important to keeping healthcare costs affordable and patients safe; however, it should not come as a huge burden to clinicians. Goals of electronic Clinical Quality Measures (eCQMs) include reducing the burden of manual abstraction and reporting for provider organizations, as well as fostering the goal of access to real-time data for bedside quality improvement and clinical decision support. We want to hit the “sweet spot” as depicted in this diagram: