Data Quality and Reporting Guide

New approaches to both measuring and exchanging clinical information are key drivers for going deeper with data quality and reporting. Electronic clinical quality measures, also known as eCQMs, are measures specified in a standard electronic format that use data electronically extracted from health information systems, in contrast to the more typical approach of using claims data, data abstraction or chart review to compile population data.^[1] For more information about the development and electronic specifications for eCQMs, visit the eCQI Resource Center. Electronic clinical quality measures offer the potential to save time through electronic measurement, enable access to real-time clinical data to drive quality improvement, and improve the accuracy and comprehensiveness of clinical data for value-based payment arrangements.^[2]

Despite the potential for eCQMs to substantially improve data quality and reporting, there are technical, human and system-level challenges to surmount for successful implementation.^[3] In a qualitative study about the implementation experience of smallto-medium primary care practices using eCQMs through the Agency for Healthcare Research and Quality EvidenceNOW initiative, practices report a number of key strategies for successfully adopting eCQMs for quality measurement and quality improvement.

Implementation suggestions include:

• Remain nimble about technological approaches, as native EMR functions relating to eCQMs may not be adequate to achieve reporting and quality improvement (QI) goals. Third-party services may be needed, and navigating these technical challenges requires a team with the appropriate resources and technical expertise.
• Be prepared to invest in strategies for eCQM data extraction, validation and reporting. This step not only improves data quality, but also creates an opportunity to engage providers and promote buy-in and acceptance of this approach to measurement.
• Consider deploying a practice facilitator with specific expertise in health information technology and eCQMs. Health information technology (IT) facilitators hold specific knowledge and capabilities for engaging primary care providers and teams on EMR and eCQM issues, which are generally beyond the scope of a typical QI-focused practice facilitator.
• Provide clinical feedback using eCQMs to primary care teams, including panel-level data, along with both local and national comparisons on the same eCQMs.^[4]

In addition to adopting eCQMs, practices interested in going deeper with quality measurement for population health might consider participating in health and community information exchange platforms in order to create business intelligence tools offering more robust, timely and holistic insights into service utilization and health outcomes. Health information exchange refers to the electronic exchange of information across healthcare provider settings, while community information exchange refers to the electronic exchange of information between a multidisciplinary group of healthcare systems, social service providers and community-based organizations in order to improve community care planning.^[5][6]

As organizations consider entering into value-based payment arrangements with increasing levels of risk for population-level outcomes, adequate and holistic data describing population health and social service utilization, health behaviors, and social conditions will be critical to predicting and managing both risk and health improvement strategies.^[7] Information exchange is not only critical for building population-level health management capacity, but is also a key driver for addressing individual health concerns. Health information exchange can reduce duplication of services and improve patient safety and outcomes, while community information exchange platforms can enable healthcare organizations to more effectively make referrals to needed social services.^[8][9]

As with any other technology adoption, implementation of health and community information exchanges can be rocky. To support successful engagement, facilitators can:

• Include adequate organizational participation and change leadership, end-user engagement and workflow improvement.
• Address privacy parameters and concerns.
• Conduct ongoing community-level partnership and collaboration to optimize impact.^[10][11]

For California healthcare providers, participation in data exchange is newly mandated by California’s Health and Human Services Data Exchange Framework, a statewide data sharing agreement that will require information sharing by healthcare providers, government agencies and social service providers. With the goal of improving the provision of “safe, effective, whole-person care,” the Data Exchange Framework takes a phased approach to requiring organizations of different types and sizes to engage in systematic data exchange. Entities are required to sign the Data Exchange Framework by the end of 2023, and data exchange begins on or before January 31, 2024. Some organizations have until January 31, 2026, to begin exchanging information. More information is available on the California Center for Data Insights and Innovation website.