Pathways to Quality through Health Information Technology

Historically, quality measurement has relied on data collected from electronic claims, manual chart reviews, and patient surveys. With the increase in adoption of health information technology (IT) the ability to more efficiently collect data for quality measurement has improved, allowing for the development of new measures and increased integration of quality measurement and improvement. Although health care stakeholders agree on a number of recurring ideals for health IT-enabled quality measurement, stakeholders prioritize them differently.

This project sought to identify obstacles to improving quality through health IT by developing a report that characterizes an ideal future health information infrastructure for actionable and prioritized national quality measurement and reporting.

The specific objectives of this project were to:

• Develop a background report on the current state of quality measurement through health IT and relevant initiatives in health IT and quality measurement. 
• Gather stakeholder input on gaps in resources and knowledge in health IT and quality measurement. 
• Develop a final report. 

Early in the project, the team developed and published Environmental Snapshot—Quality Measurement Enabled by Health IT: Overview, Possibilities, and Challenges (PDF, 2.87 MB). This report presented the then-current state of health IT-enabled quality measurement; presented elements of the next generation of quality measurement as identified in the literature; identified gaps in knowledge; and presented ways to achieve the ideal future state.

Following its publication the project team developed questions for a request for information (RFI) release to examine stakeholder perspectives on the key issues and challenges to achieving the next generation of quality measurement. AHRQ received 63 responses to the RFI, with representation from a variety of stakeholders including measure developers, providers and associations representing providers, vendors and organizations representing vendors, health plans and payers, and consumer-oriented organizations.

The project team analyzed the RFI responses to determine trends, challenges, and practical solutions for the near-term (1-to-2 years) and mid-term (3-to-5 years). The findings were used to frame and develop questions for six stakeholder focus group sessions that were held in 2013. Five of the focus groups were stakeholder-specific, representing each of the following groups: measure developers, payers, providers, consumers, and vendors. The sixth group was a cross-stakeholder group that discussed common and consistent issues as well as areas of divergence between groups.

Four primary perspectives were synthesized from the RFI responses and focus groups: 1) the highest priority of quality measurement should be accelerating systemic quality improvement; 2) measurement should leverage all currently available health IT necessary but should minimize implementation burden by being constrained to information generally available and widely accessible; 3) measurement should be a byproduct of care delivery and minimize the impact on clinician workflow; and 4) there should be central prioritization of measures, with new measurement priorities being driven by an authoritative entity that explicitly manages the other perspectives.

In addition, the RFI respondents and focus group participants identified several topics as essential building blocks for improving health IT-enabled quality measurement. These included the categories of measure development, implementation, and testing; data elements and data capture and tools to process unstructured data; data access, sharing, aggregation, and integration; patient engagement; and collaboration and education.

Findings were published in a report, Health IT-Enabled Quality Measurement: Perspectives, Pathways, and Practical Guidance (PDF, 1.67 MB). Its purpose is to share information, stimulate discussion, assist communication among stakeholders, facilitate understanding, and provide guidance on potential infrastructure enhancements that could be pursued individually or collectively. The report contains 111 specific recommendations in the areas of measure development, implementation, and testing; data elements and data capture and tools to process unstructured data; data access, sharing, aggregation, and integration; patient engagement; collaboration and education; and other topics and recommendations. Five appendices in the report summarize the input from the RFI and focus groups, and catalog the efforts of many organizations that are engaged in efforts to improve quality through health IT.