Clinical Quality Measures
Clinical Quality Measures
Quality health care is a high priority for President Obama, the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), and the Office of the National Coordinator of Health Information Technology (ONC). CMS uses clinical quality measures (CQMs) in a variety of quality initiatives that include quality improvement and public reporting. ONC certifies that electronic health record (EHR) technologies are capable of accurately calculating the CQM results for the meaningful use incentive program.
Meaningful Use Clinical Quality Measures for 2013
Eligible Professionals (EPs) will continue to report from the 44 measures finalized for Stage 1 and
Eligible Hospitals (EHs) and and Critical Access Hospitals (CAHs) will continue to report from the 15 measures finalized for Stage 1.
In 2013, there are two reporting methods available for reporting the Stage 1 measures:
- eReporting Pilots: (Physician Quality Reporting System EHR Incentive Program Pilot for EPs eReporting Pilot for EHs and CAHs)
Meaningful Use Clinical Quality Measures for 2014 and Beyond
All providers are required to report on CQMs in order to demonstrate meaningful use. Beginning in 2014, all providers regardless of their stage of meaningful use will report on CQMs in the same way.
- EPs must report on 9 out of 64 total CQMs.
- EHs and CAHs must report on 16 out of 29 total CQMs.
In addition, all providers must select CQMs from at least 3 of the 6 key health care policy domains recommended by HHS's National Quality Strategy:
- Patient and Family Engagement
- Patient Safety
- Care Coordination
- Population and Public Health
- Efficient Use of Healthcare Resources
- Clinical Processes/Effectiveness
A complete list of the 2014 CQMs, along with their associated National Quality Strategy domains, usage guides, release notes, fact sheets, etc. are available at: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html
Quality Measure Code Sets
The Clinical Quality Measures used by the HHS EHR incentive program are comprised of definitions, measure logic, data elements, and value sets. Four federal agencies: the Agency for Healthcare Research and Quality (AHRQ), CMS, the National Library of Medicine (NLM), and ONC are providing these components in various formats in order to be understood by technical, non-technical, and clinical consumers. The Value Set Authority Center will provide downloadable access to all official versions of vocabulary Value Sets contained in CQMs that support Meaningful Use Stage 2.
Data Elements Catalog (DEC) – A data element is a representation of a clinical concept that represents a patient state or attribute. This may be a diagnosis, lab value, gender, etc. that is encoded using standardized terminologies. The DEC is maintained by NLM and available through the Value Set Authority Center (VSAC).
Value Sets – Value sets define clinical concepts unambiguously. They provide list of numerical values and the individual descriptions from standard vocabularies used to define the clinical concepts (e.g., diabetes, clinical visit) within the quality measures. NLM maintains the value sets with the Value Set Authority Center.
USHIK – The United States Health Information Knowledgebase (USHIK) is AHRQ's portal for Meaningful Use. The USHIK is intended as a one-stop shop for publically accessing the components of meaningful use quality measures, providing technical specifications including definitions, measure computation logic, data elements, context, version comparisons, and value (code) sets. Measures and value sets are available in Excel, PDF, XML, and SVS.
Note: Viewing and/or downloading Meaningful Use proprietary value sets, such as those including CPT codes or SNOMED CT codes from NLM-VSAC or AHRQ-USHIK, requires a free Unified Medical Language System® Metathesaurus License (UMLS). Authentication via an UMLS ID and password is obtainable through the National Library of Medicine.
The ONC Certification Program provides a defined process to ensure that EHR technologies meet the adopted standards and certification criteria to help providers and hospitals achieve Meaningful Use objectives and measures established by CMS. Eligible professionals and eligible hospitals that seek to qualify for incentive payments under the Medicare and Medicaid EHR Incentive Programs are required to demonstrate meaningful use of certified EHR technology. For more information on the ONC Certification Programs, please visit http://www.healthit.gov/policy-researchers-implementers/certification-programs-policy
Certification of EHR technologies under the ONC certification program requires that EHR software products and EHR modules be tested, as applicable, for the capability to accurately and appropriately calculate the CQM results. ONC has commissioned the development of the Cypress certification tool. The process for submitting the Cypress tool for official approval to be used in the ONC Certification Program is currently under way. http://www.healthit.gov/cypress