[Federal Register Volume 77, Number 163 (Wednesday, August 22, 2012)]
[Notices]
[Pages 50692-50693]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-20550]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Request for Information on Quality Measurement Enabled by Health
IT--Extension Date for Responses
AGENCY: Agency for Healthcare Research and Quality (AHRQ), Health and
Human Services (HHS).
ACTION: Notice of extension in comment period.
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SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) requests
information from the Public, including diversified stakeholders (health
information technology (IT) system developers, including vendors;
payers, quality measure developers, end-users, clinicians, health care
consumers) regarding current successful strategies and challenges
regarding quality measurement enabled by health IT. Quality
measurement--the assessment of the timeliness, completeness and
appropriateness of preventive services, diagnostic services, and
treatment provided in health care--has been most generally conducted
via paper chart information capture, manual chart abstraction, and the
analysis of administrative claims data. Through this notice, the
comment period has been extended. The subject matter content remains
unchanged from the original notice which was previously published on
July 20, 2012 (www.GPO.gov/fdsys/PKG/FR-2012-07-20/html/2012-17530.htm)
DATES: Submit comments on or before September 21, 2012.
ADDRESSES: Electronic responses are preferred and should be addressed
to HIT-PTQ@AHRQ.hhs.gov. Non-electronic responses will also be
accepted. Please send by mail to: Rebecca Roper, Agency for Healthcare
Research and Quality, Attention: HIT-Enabled QM RFI Responses, 540
Gaither Road, Room 6000, Rockville, MD 20850, Phone: 301-427-1535.
FOR FURTHER INFORMATION CONTACT: Please identify in the subject line of
emails that you are inquiring about the ``Question about HIT-enabled QM
RFI''. Contact Angela Nunley, email: Angela.Nunley@AHRQ.hhs.gov, Phone:
301-427- 1505, or, Rebecca Roper, email: Rebecca.Roper@.AHRQ.hhs.gov,
Phone: 301-427-1535.
SUPPLEMENTARY INFORMATION:
Background
Health information technology (IT), such as, electronic health
records (EHR) which may include clinical decision support and health
information exchange, has seen a tremendous increase in adoption in
recent years. Some institutions have successfully used health IT to
generate health IT-enabled quality measures which may be retooled
versions of established paper-based or administrative data-driven
quality measures or (preferably) they are ``de novo'' quality measures
that were developed with the capabilities of health IT in mind. These
new health IT-enabled quality measures seek to leverage the use of
electronic clinical data capture, analysis and reporting to measure and
report electronically enabled quality measures in order to facilitate
improvements in the quality of care provided. AHRQ supports research to
improve health care quality through enhancements in the safety,
efficiency, and effectiveness of health care available to all
Americans. Through this RFI, AHRQ is seeking information related to
successful strategies and/or remaining challenges encountered regarding
the development of health IT-enabled quality measure development and
reporting.
Health IT has the potential to advance quality measurement and
reporting through the use of efficient automated data collection,
analysis, processing, and its ability to facilitate information
exchange among and across care settings, providers, and patients.
Quality measurement enabled by health IT, referred to as health IT-
enabled quality measurement, is an emerging field. There are numerous
perspectives on how to achieve the future state of quality measurement.
These varied perspectives sometimes include competing choices and
challenges: (1) Underdeveloped or unavailable infrastructure (e.g.,
whether the measure set should be extensive or parsimonious); (2)
incompleteness of the measure set (e.g., developing measures that
matter to consumers, how to measure value); and (3) technology
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challenges (e.g., how might unstructured data be captured in the EHR to
be used for measurement, if and how to integrate patient-generated and
clinician-generated data).
In preparation for the development of this RFI, AHRQ generated a
high-level overview of the current state of quality measurement through
health IT, challenges facing the advancement of quality measurement
enabled by health IT, a partial catalog of current efforts seeking to
address those challenges, and, possibilities for the next generation of
health IT-enabled quality measurement. This report, ``An environmental
snapshot -- Quality Measurement Enabled by Health IT: Overview,
Possibilities, and Challenges'' can be found at http://healthit.AHRQ.gov/HealthITEnabledQualityMeasurement/Snapshot.pdf.
AHRQ is committed to garnering further insight in order to
facilitate meaningful advancements in the next generation of quality
measurement. Through this Request for Information AHRQ is seeking
information on the building blocks of health IT-enabled quality
measurement in terms of perspectives, practicalities, and priorities.
Responses will be used in conjunction with deliberative activities to
inform the development of a summary report to be released to the public
approximately in summer 2013.
Respondents should note that this Request for Information is
completely voluntary; respondents are welcome to address as many of the
questions posed as they wish.
AHRQ would appreciate if you clearly indicate the number of the
question area to which you are providing a response. This RFI is for
planning purposes only. Responses to this are not offers, cannot be
accepted by the Government to form a binding contract, and are not
intended to influence regulation.
Questions Regarding Quality Measurement Enabled by Health IT
1. Briefly describe what motivates your interest in clinically-
informed quality measures through health information technology. To
what extent is your interest informed by a particular role (e.g.,
provider, payer, government, vendor, quality measure developer, quality
improvement organization, standards organization, consumer advocate) in
this area?
2. Whose voices are not being heard or effectively engaged at the
crucial intersection of health IT and quality measurement? What non-
regulatory approaches could facilitate enhanced engagement of these
parties?
3. Some quality measures of interest have been more difficult to
generate, such as measures of greater interest to consumers, measures
to assess value, specialty-specific measures, measures across care
settings (i.e., measures enabled by health information exchange), and
measures that take into account variations in risk. Describe the
infrastructure that would be needed to ensure development of such
measures.
4. What health IT-enabled quality measures, communication channels,
and/or technologies are needed to better engage consumers either as
contributors of quality information or as users of quality information?
5. How do we motivate measure developers to create new health IT-
enabled quality measures (which are distinct from existing measures
which were retooled into electronically-produced quality measures) that
leverage the unique data available through health IT? Please provide
examples of where this has been successfully. What new measures are in
the pipeline to leverage data available through health IT?
6. Describe how quality measurement and ``real-time'' reporting
could inform clinical activity, and the extent to which it could be
considered synonymous with clinical decision support.
7. Among health IT-enabled quality measures you are seeking to
generate in a reliable fashion, including the currently proposed
Meaningful Use Stage 2 measure set, what types of advances and/or
strategies for e-measure generation if pursued, would support more
efficient generation of quality measures?
8. Many EHR, HIE, and other health IT vendors are developing
software code to support measures. Tools such as the Measure Authoring
Tool (MAT) were created to improve efficiencies in the process of
creating and implementing eMeasures. What additional approaches might
be used to enable consistent, accurate, and efficient quality
measurement when using health IT?
9. How do you see the establishment and adoption of data standards
impacting the future of health IT-enabled quality measurement? For what
types of quality measures should a combination of natural language
processing and structured data be considered?
10. Much support has been voiced for the need of longitudinal data
in quality measurement. What are the strengths and weaknesses of
different information architectures and technologies to support health
IT-enabled quality measurement across time and care settings? How can
data reuse (capture once, use many times) be supported in different
models? What examples might you provide of successful longitudinal
health IT-enabled quality measurement (across time and/or across
multiples care settings)?
11. What are the most effective means by which to educate providers
on the importance of health IT-enabled quality measurement and how
clinical information is used to support health IT-enabled quality
measurement and reporting? How can providers be better engaged in the
health IT-enabled quality measurement process?
12. What is the best way to facilitate bi-directional communication
between vendors and measure developers to facilitate collaboration in
health IT-enabled measure development?
13. To what extent do you anticipate adopting payment models that
use quality measurement informed by electronic clinical records (as
opposed to exclusively using claims data)? What strategies are you
pursuing to gain access to clinical data and test the reliability of
health IT-enabled clinical outcome measures? How do you anticipate
sharing quality measure results with consumers and other stakeholders?
14. What tools, systems, and/or strategies has your organization
been using to aggregate information from various EHRs and other health
IT for use in quality measurement? What strategies is your organization
pursuing to move toward greater automation in quality measurement?
15. Please describe scalable programs, demonstrations, or solutions
(domestic or internationally) that show material progress toward
quality measurement enabled by health IT.
Reference Material
Anderson KM, Marsh CA, lsenstein H, Flemming AC, Reynolds J. An
Environmental Snapshot: Health IT-enabled Quality Measurement:
Efforts, Challenges, and Possibilities (Prepared by Booz Allen
Hamilton, under Contract No. HHSA290200900024I.) AHRQ Publication
No. 12-0061-EF. Rockville, MD: Agency for Healthcare Research and
Quality. July 2012. See: http://healthit.AHRQ.gov/HealthITEnabledQualityMeasurement/Snapshot.pdf
Dated: August 15, 2012.
Carolyn M. Clancy,
AHRQ Director.
[FR Doc. 2012-20550 Filed 8-21-12; 8:45 am]
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