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Data Quality, Quality Management & Data Content Standards     

Quality information is essential to all aspects of today's healthcare system, so improving the quality of data, information, and knowledge is paramount as we transition from paper to electronic health records. Many errors and adverse incidents in healthcare occur as a result of poor data and information. In addition to threatening patient safety, poor data quality increases healthcare costs and inhibits health information exchange, research, and performance measurement initiatives.

HIM professionals play a critical role by leading initiatives related to standards, technologies, education, and research which are vital to capture, use, and maintain accurate healthcare data and facilitate healthcare’s electronic evolution.

• Standards & Industry Activities
• Other Resources & Links
• AHIMA Resources

Standards & Industry Activity

Office of the National Coordinator :

The Office of the National Coordinator for Health Information Technology (ONC) provides counsel to the Secretary of HHS and Departmental leadership for the development and nationwide implementation of an interoperable health information technology infrastructure. Use of this infrastructure will improve the quality, safety and efficiency of health care and the ability of consumers to manage their health information and health care.

• Quality Use Case - The Quality Use Case was one of four use cases developed in 2007. The use case focuses on the capabilities and functionality required to measure and report hospital and clinician quality and describes how health information technology can:
  
• provide the data needed for the development of quality measures,
• automate the measurement, feedback and reporting of a comprehensive and future set of quality measures,
• accelerate the use of clinical decision support (CDS) to improve performance on these quality measures, and
• describe how performance measures should align with the capabilities and limitations for HIT.

American Health Information Community:

The American Health Information Community (AHIC) is a federal advisory body, chartered in 2005 to make recommendations to the Secretary of the U.S. Department of Health and Human Services on how to accelerate the development and adoption of health information technology.

• AHIC Quality Workgroup - This workgroup’s charge is to make recommendations to the AHIC so that health IT can provide the data needed for the development of quality measures that are useful to patients and others in the health care industry, automate the measurement and reporting of a comprehensive current and future set of quality measures, and accelerate the use of clinical decision support that can improve performance on those quality measures. Also, make recommendations for how performance measures should align with the capabilities and limitations of health IT.

           Susan Postal, MBA, RHIA, Vice President of HIM at Health Corporation of America (HCA),

               is a member of the AHIC Quality Workgroup. 

• Ad Hoc Clinical Decision Support Planning Workgroup - The topic of clinical decision support (CDS) cuts across the missions of many of the AHIC Workgroups, and each AHIC Workgroup has unique expertise and perspectives to address different aspects of CDS. For this reason, an Ad Hoc CDS Planning Group was formed in May 2007 to ensure that a common framework to address CDS would be used across Workgroups. The envisioned result was a vet of coherent and complimentary contributions that would result in recommendations to accelerate the implementation of robust and workflow-sensitive CDS interventions that will drive measurable improvement in key health care outcomes. Membership in the CDS planning Group includes representatives of the following five Workgroups that expressed significant interest in this topic:
  
• Consumer Empowerment
• Electronic Health Records
• Personalized Healthcare
• Population Health and Clinical Care Connections
• Quality

 

Health Information Technology Standards Panel:

HITSP’s objective is to achieve widely accepted and readily-implemented consensus-based standards that will enable and support widespread interoperability among healthcare information technology, especially as they would interact in a Nationwide Health Information Network (NHIN) for the United States. HITSP identifies, prioritizes and promotes relevant standards using patient-focused “use-case” scenarios. Standards Harmonization Use Cases focus on the American Health Information Community (AHIC) breakthrough areas to enable interoperability among different information systems, software applications and networks to communicate and exchange information in an accurate, effective, useful and consistent manner.

• Quality Use Case Interoperability Specifications (2007) - The intent of the Quality Use Case Interoperability Specification is to provide a method to encode clinical data obtained during the routine practice of medicine and repurpose it as information to support quality measurement.

Health Level Seven, Inc.:

Health Level 7 (HL7) is a HIT standards organization traditionally focused on messaging and exchange of data and documents. The goal of the EHR Technical Committee is to further the HL7 mission of designing standards to support the exchange of information for clinical decisions and treatments, and help lay the groundwork for nationwide interoperability by providing common language parameters that can be used in developing systems that support electronic records.

Clinical Interoperability Council

This Council provides the standards development framework, organizational processes and forums to collaborate with the clinical community to define content, flow and other domain requirements necessary to the development of robust health data standards. The CIC provides a mechanism for clinical domains to develop common approaches to standards-related activities and form consensus on issues of interest among multiple groups. The CIC is unique to HL7 in that the focus is on the clinical content, not the technology of the standards

Structured Documents Technical Committee

This Committee produces a comprehensive architecture to facilitate exchange and processing of electronic healthcare documents.

Projects currently underway within the SDTC that may be of interest to AHIMA members include:

• CDA4CDT - Clinical Document Architecture for Common Document Types
  A standards development initiative formed to establish interoperability specifications for common types of clinical documents. The project is creating implementation guides for the most common types of dictated clinical documents. The guides use the HL7 Clinical Document Architecture (CDA), the same framework used by the ASTM/HL7 Continuity of Care Document (CCD).
  

• QRDA - Quality Reporting Document Architecture - A standards development initiative formed to develop an electronic data standard for exchange of patient-level quality measurement data between health care information systems. The exploratory phase of the project was completed in fall 2007.

National Quality Forum:

The National Quality Forum (NQF) is a not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting. The mission of the NQF is “to improve the quality of American healthcare by setting national priorities and goals for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance, and promoting the attainment of national goals through education and outreach programs.”

NQF engages in a variety of projects that support their mission to improve American healthcare through endorsement of consensus-based standards. These projects involve active participation of representatives from across the spectrum of healthcare stakeholders of which HIM professionals are involved.

• National Voluntary Consensus Standards for Hospital Care, Additional Priorities 2007: Composite Steering Committee NQF is coordinating efforts to endorse national voluntary consensus standards for selected inpatient quality indicators for public reporting of quality performance. A steering committee was formed to prioritize the areas for potential NQF endorsement within the specified areas and recommend a set of measures in each of the areas based on the analyses provided by relevant technical advisory panels, as well as make recommendations about areas for further measurement development and research.

          Margaret Foley, PhD, RHIA, CCS, Clinical Associate Professor, Temple University

          Department of Health Information Management, was appointed to this committee.

• NQF HIT Structural Measures Steering Committee  Evidence suggests that important structural processes, such as physician office and workflow redesign, optimize the impact of health IT on reducing medical errors, reporting quality/performance measurements, advancing patient education, and enhancing communication among care providers. Agreement around the recommendations will be developed through NQF’s formal Consensus Development Process (CDP). This project is guided by a Steering Committee.

          Don Mon, PhD, AHIMA Director of Practice Leadership, was appointed to this committee.

• NQF Health Information Technology Expert Panel (HITEP)  An expert panel convened to develop a set of common data elements and healthcare workflow changes to enable automation of performance measures through electronic health records (EHRs) and health information exchange. 

          Sharon Sprenger, RHIA, CPHQ, MPA, Director, Department of Performance Measurement and

          Health Informatics, Joint Commission, was appointed to this committee.

• Draft HITEP Report
• AHIMA Response to Draft HITEP Report

Joint Commission

Performance Measurement Data Strategy Roundtable

The Performance Measurement Data Strategy Roundtable has been charged to frame the key issues and make recommendations for attaining a cohesive and efficient system for the collection, aggregation, maintenance and dissemination of performance measurement data from across the continuum of care that meets the needs of all stakeholders.

Linda Hyde, RHIA, Director of Research Operations and Epidemiology, Cardinal Health, and Crystal Kallem, RHIT, AHIMA Director of Practice Leadership, participated in the roundtable discussions.

Other Resources and Links 

• Quality Measurement and Reporting
• Patient Safety

Quality Measurement and Reporting Links:

AQA Alliance

Hospital Quality Alliance

Centers for Medicare & Medicaid Services (CMS)

• Hospital Quality Initiatives
• Physician Focused Quality Initiatives
• Physician Quality Reporting Initiative (PQRI)
• Nursing Home Quality Initiatives
• Home Health Quality Initiatives
• End Stage Renal Disease (ESRD) Quality Improvement Initiatives
• Medicare Quality Improvement Community (MedQIC)
• DOQ-IT University

Institute of Medicine Reports  

• To Err is Human: Building a Safer Health System (November 1999)
• Crossing the Quality Chasm: A New Health System for the 21st Century (March 2001)
• Performance Measurement: Accelerating Improvement (December 2005)

National Association of Health Data Organizations (NAHDO) Quality Workgroup

American Society for Quality (ASQ)

National Association for Healthcare Quality (NAHQ)

International Society for Quality in Healthcare, Inc. (ISQua)

Patient Safety Links:

Institute for Healthcare Improvement (IHI)

AHIMA Resources

e-HIM Practice Briefs:
AHIMA commissioned volunteer work groups to develop practice standards for areas that play an integral role in the transition from paper to electronic health records. E-HIM practice guidelines are available at www.ahima.org/e-him/

Books:

Quality and Performance Improvement: A Tool for Programmed Learning, 3rd Edition

By Patricia L. Shaw, Med, RHIA, Chris Elliott, MS, RHIA, Polly Isaacson, RHIA, CPHQ, and Elizabeth E. Murphy, RN, BSN, MEd

FORE Library: Body of Knowledge (Member’s Only):

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