Before diving into the role the HL7 Clinical Document Architecture (C-CDA) can play in electronic clinical quality measures (eCQMs), it’s important to take a step back and consider the current standards landscape and their role in exchange and quality measurement. With this background, we’ll have a better understanding of the opportunities to improve eCQM generation.
Currently, C-CDA document templates include approximately 80 percent of the data resources commonly exchanged in healthcare. The most commonly shared of these document templates is the Continuity of Care Document (CCD), which captures most of these data resources within its template. For quality measure reporting, standards such as Health Quality Measure Format (HQMF) and Quality Reporting Document Architecture (QRDA) are leveraged for the capture and reporting of clinical data. Within these quality standards, what you will often find is that the data pulled for these templates is often similar to the C-CDA template.
If these two templates contain similar data entries, are standards and technology creating an opportunity to bring these two silos of work collecting clinical data vs. quality data closer together? Would combining the clinical and quality views of the information make the patient’s story more useful and more meaningful for clinicians, patients, payers and other users of this data? Could streamlining this data capture help reduce the burden of this extra layer of work we call quality measurement?
With a focus on educating health professionals on the benefits of creating comprehensive electronic records that tell a patient's complete health story, the Health Story Project explored how the HL7 C-CDA standard has the power to provide clinicians the information they need to capture quality measures and improve the delivery of care.
Xidong Deng, PhD, health scientist (informatics) with the National Center on Birth Defects and Developmental Disabilities within the Centers for Disease Control and Prevention, explained how standards are used to execute quality measurement. “Clinical quality measures are tools, just like a tape measure, used to help measure and track the quality of healthcare services and to ensure the success of our healthcare system. This means the healthcare system can deliver effective, safe, efficient, patient-centered, equitable and timely patient care,” Dr. Deng said. More information on this topic can be found in the Integrating the Healthcare Enterprise Quality, Research and Public Health white paper, Electronic Clinical Quality Measure (eCQM) Standards Landscape.
Salim Kizaraly, senior vice president for business development and founder of Stella Technology, described the relationship between data sets needed for eCQMs that can be found in C-CDA, but raised points about the importance of quality in these documents, describing the data quality journey as a continuous improvement process.
While there can be tremendous value to leveraging these documents in quality reporting, it is important to note that there are considerable data quality challenges in current product of C-CDA documents that create barriers for the use of this data to compute quality measures.
Kizaraly also shared a framework for understanding the evolution toward better data and showed how a continuous improvement process could be used to make progress toward data quality improvements.
So what are the possibilities once we achieve high quality data in these documents?
Can the information be used to improve more than just quality reporting?
John D’Amore, president and chief strategy officer with Diameter Health, showed the power of longitudinal quality measurement to produce a view of the patient’s story that included care gaps and envisions a not too distant future where interoperability would supply data that improved quality and quality improvements would produce savings that driving greater interoperability.
We still have a long way to go to optimize the capture of quality measurements and to use that information in a way that can be meaningful for patient care.
Numerous challenges around approaches to improve data quality, C-CDA and QRDA mapping, the role of Qualified Clinical Data Registries and more persist. But I am optimistic – our systems are equipped to capture this information in C-CDA documents and there is a growing focus on data quality in these systems. If leveraged correctly, we can reduce physician burden, streamline reporting and, most importantly, improve quality care.
The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.
Our Health Story Project helps the health IT community tell a patient’s complete health story with tools and resources that aid in creating comprehensive, shareable electronic records—improving care through collaboration and analysis.