Using HIE Data to Calculate Digital Quality Measures

As quality measurement and performance improvement in healthcare strives to increase use of technology to improve comprehensiveness, efficiency, and accuracy, clinical data from electronic health record systems and Health Information Exchanges (HIEs) has increasingly become a focus. In order to leverage this for quality reporting, new standards that work with electronic clinical data need to be developed.

In the interest of progressing this work, and the ongoing support of value based care, the New York eHealth Collaborative (NYeC) partnered with the New York State Department of Health (DOH) and NYSTEC. The group worked with National Committee for Quality Assurance (NCQA) to further investigate the capacity of the Statewide Health Information Network for New York’s (SHIN-NY) regional HIEs, to calculate existing electronic clinical quality measures through a pilot project that concluded earlier this year.

NCQA uses the Healthcare Effectiveness Data and Information Set (HEDIS) program to measure quality and performance improvement of health plans, which traditionally uses administrative data for quality reporting. NCQA is currently updating that program to better align health plan and provider quality measures. This includes efforts to increase the utilization of electronic clinical data. For purposes of this project, NCQA provided a selection of digital measure specifications for review, and NYSTEC assessed the HIEs’ capacity to meet the specifications, helping to inform the project scope. Following a competitive request for proposal (RFP) process administered by NYeC, the Bronx RHIO and HEALTHeLINK were selected as pilot participants. Both HIE also demonstrated support from a variety of healthcare organizations in their communities interested increased incorporation of electronic clinical data in quality measurement reporting.

The project asked the HIEs to define patient cohorts and calculate quality measures using NCQA specifications. Results were then compared with existing quality measurement calculations for the same sample size to understand the impact of HIE data.

Some adjustments were anticipated in terms of exact measure criteria, accounting for differences in data sources, lack of standardization and in some instances identified gaps in data. After those adjustments the analysis identified some insightful findings.

One key area of project success was demonstrated around the calculation of cancer screening rates by both participating HIEs. One HIE was able to achieve breast and colorectal cancer screening similar to NCQA reported rates, and higher than average 2018 national screening rates for Medicaid patients. The other HIE was able to achieve rates close to national Medicaid reported averages.

Overall, it can be concluded that existing standards and criteria for measurement calculation, initially derived from administrative data sets cannot be applied exactly to HIE data in their current formats. However, with appropriately modified criteria, HIEs can calculate rates for cancer screening measures that are comparable to nationally reported rates. This is very promising and should be explored further, as HIEs have data across many sources and networks that span and impact multiple domains of care.

Building on these results, three SHIN-NY HIEs are currently participating in a subsequent pilot project with NCQA in support their development of Certified Data Aggregator program, which could reduce burden on health plans, offering them an electronic data set to leverage for HEDIS reporting. If successful, this could create a national model for other HIEs to follow.

This type of innovation is critical in order to effectively support the healthcare continuum in today’s rapidly changing environment, NYeC is proud to support this work.