Thanks to recent public and private sector trends linking reimbursements to health outcomes, hospital executives are

now paying close attention to their institution’s quality metrics. Of particular interest are electronic Clinical Quality

Measures (eCQMs), which hospitals are now required to use to provide such data to the Centers for Medicare and

Medicaid Services (CMS), the Joint Commission, patient registries and other organizations.

Several factors will further elevate the importance of quality reporting, including:

• The announced goal of CMS to tie 50% of all traditional Medicare payments to quality or value by 2018

through new payment models, including ACOs.1

• The continued evolvement of Electronic Health Records (EHR) incentive programs for the meaningful use of

certified EHR technology by eligible hospitals and providers, including physicians, physician assistants, nurse

practitioners, clinical nurse specialists, and certified registered nurse anesthetists.2

• Hospitals’ increasing use of quality data in structured formats to manage quality and population health and

coordinate care across their networks.

eCQMs:

It’s Time to Make Data Quality the No. 1 Priority

50% of all traditional Medicare payments will be tied to quality or value by 2018

Since 2011, the EHR Meaningful Use program has been the prime driver for the development and adoption of

eCQMs. From the outset, however, CMS has focused on determining whether professionals and hospitals were able

to report quality metrics with “the necessary technological capability, functionality, and security.”3

In other words, eCQMs have been all about technology. But what’s missing in the CMS certification criteria is

something far more important – requirements relating to the quality of the data. Given the difficulty of data quality

management, it’s not surprising to find that the American Medical Informatics Association (AMIA) reports that

“healthcare providers generally lack faith in the accuracy and completeness of eCQMs.”4

As healthcare moves inexorably toward widespread use of value-based payment models, the quality of eCQM content

can no longer be neglected. Although it will be a long time before eCQMs can be fully automated, hospitals must take

action today to:

Beginning in 2017, CMS will penalize hospitals for patients who contract MRSA

Poor Quality Puts Hospitals at Risk

Each new CMS quality measure clearly indicates that it plans to link payments or financial incentives to a hospital’s

performance on quality benchmarks. For example:

• CMS lowered its 2016 payments by 1% for 758 hospitals with high rates of potentially avoidable

infections and complications as part of its Hospital-Acquired Conditions Reduction Program.5

• Beginning in 2017, CMS will penalize hospitals for patients who contract MRSA (methicillin-resistant

staphylococcus aureus) infections during their stay – a move that could cost many institutions millions

of dollars in Medicare revenue.6

In fact, hospitals already are experiencing the cumulative effect of this transformation. One survey in 2015 found

that 42% of hospitals received 10% or more of their revenue from value-based contracts. And, as a portent for the

unprepared, more than one in five hospitals anticipated that these types of contracts will constitute 50% or more of

their revenue by 2017.7

In parallel with this trend is an increased emphasis on electronic reporting. As we’ve seen, CMS programs as well as

other quality initiatives are now mandating that eligible hospitals and providers electronically submit their quality

reports. In light of this transformational shift to value-based healthcare and eCQMs, hospitals need to better

understand how poor data quality is affecting their finances, reputation and physician relationships.

1. Meet increasing eCQM reporting demands

2. Ensure the accuracy and completeness of eCQM clinical data without disrupting clinical

workflows or overburdening physicians and the clinical staff

This white paper will examine eCQM data quality issues and their implications. It will raise questions hospitals

should consider when developing strategies to improve their eCQM capabilities. Lastly, it will outline how they

can benefit from implementing better data quality control practices and present new developments in eCQM data

collection and reporting.

Elusive Data

To improve the accuracy and completeness of their eCQM data, hospitals

must first identify what’s causing most of the problems. Their source often

can be traced to the inability to capture the right data in the right format in

the right place.

Remember, today, e-measure calculations are done using only the structured

data collected in certified EHR technology (CEHRT). Data is often missing or

incomplete because it is captured on paper but not electronically. Or even if

captured electronically, it is not in a structured format.

And even when structured data is captured, it may only be available in a

different setting of care or a standalone special software system. When a

hospital’s internal systems (such as those in labs or emergency departments)

have this necessary data but are not interoperable with EHRs, CEHRT data

becomes inaccurate.

For example, if the date and time of a urinary catheter insertion in the

emergency department (ED) patient resides in the ED information system

and not in the CEHRT being used to calculate and submit eMeasures,

the hospital will not be able to accurately calculate the relevant Catheter

Associated Urinary Tract Infection (CAUTI) e-measures.8 Typically, eCQM

reporting compared to manual abstraction will show a significant under-

reporting of performance.

Inefficiencies in Workflow and Data Extraction

In their efforts to collect and share the right data in the right formats,

hospitals often must adjust various clinical workflow processes. Many also

set up makeshift quality control monitoring systems to review eCQMs for

omissions and errors. These changes can disrupt or delay workflows and

overburden the clinical staff.

Despite the significant resources hospitals spend on EHRs and their promise

of supporting eCQMs, data extraction remains a vexing challenge that will

only be exacerbated by the increases in electronic quality measurements.

CMS estimates that data capture using CEHRT could save a hospital up to

800 hours of chart abstraction in one quarter of quality reporting. In the

near term, however, much of this “saved” time will be shifted from traditional

abstractors to the nursing staff or even senior medical, quality or IT leaders

who inevitably will have to deal with the data inaccuracies.

Key Benefits

An effective eCQM solution

enhances data integrity

and enables hospitals and

physician to:

• Develop clinical protocols

better aligned with quality

initiatives and reporting needs

• Reduce abstraction burdens

• Gain access to richer and more

useful information for better

decision-making

• Redeploy valuable clinical

quality management resources

from low-value data capture to

high-value analysis and on-the-

floor support for clinicians

• Improve workflows and

operational efficiency

The evolution of eCQMs will need a more holistic approach that encompasses and integrates all components in the

data collection and extraction processes. This would enable hospitals to fully align clinical workflows with the IT

capabilities required to successfully submit accurate, high fidelity data to regulatory bodies and patient registries

Not Just an IT Challenge

As of January 2016, nearly 5,000 hospitals and more than 460,000 health-care providers had received nearly $32

billion in Medicare and Medicaid incentive payments through the CMS Meaningful Use program since 2011.9 Clearly,

the program has been successful in attaining its primary goal – encouraging a more rapid implementation of electronic

health records at hospitals, physician practices and other providers of medical care.

But this is only the first baby step towards a much more complex and difficult objective – the efficient electronic

exchange of standardized, high quality health information. Yet because eCQMs are an offshoot of Meaningful Use,

many hospitals see eCQMs as simply an IT function that could easily be built into their current EHR system. As we’ve

seen, this narrow view undervalues the importance of data quality, which impacts not only a hospital’s scores on CMS

and other programs but also clinical and operational decision-making.

eCQMs: Which Approach is Right For You?

Various stand-alone eCQM solutions offer an alternative. When deciding which approach – built in or bolted on

– would be the right choice to develop or expand their eCQM capabilities, hospitals should consider asking such

questions as:

• Does the eCQM provider have the in-depth clinical knowledge needed to help us optimize data

collection and extraction without affecting our clinical workflow?

• Will we be able to easily gather and share the required data within our existing hospital

information systems?

• Will the eCQM solution work well with the reporting requirements of other organizations such as

The Joint Commission?

• Is the eCQM certified by the Office of The National Coordinator (ONC) certification for all its

electronic Quality Measures for both eligible hospitals and physicians?

• Is the quality control process for eCQMs designed with sufficient safeguards, rigor and

transparency to enable hospitals to monitor and ensure data accuracy and integrity?

• Will the EHR/eCQM modules be easy to use?

• Can the eCQM provider help our executives and clinical staff make better use of the data results?

New Developments in eCQM Data Quality Management

Ideally, an eCQM solution should be able to easily integrate clinical data in various formats and calculate and submit

a variety of other quality measures. Since data quality is so critical, it also should make the data collection process

transparent so that inevitable quality problems can be identified and resolved before submission.

One exciting advance in quality data management is the new Q-Apps technology platform from Q-Centrix. This cloud-

based, patient-centric solution was recently introduced as the first fully-integrated healthcare quality information

system and was newly certified by the ONC as an EHR Module for all inpatient and ambulatory Clinical Quality

Measures.10 It empowers users to easily drill down into the quality data to check and confirm accuracy and offers

other benefits, including:

Looking for an eCQM Partner? Talk to Us. Visit www.q-centrix.com or call us at (603) 294-1145.

• Transparency throughout the entire eCQM lifecycle, a gap in most EHR systems

• Concurrent review capabilities, not only of eCQMs but also Core Measures, patient registries and any

other clinical care protocols

• Access to the market-leading expertise of Q-Centrix’s 600+ quality information specialists who can

provide an additional level of data accuracy validation

1 http://www.hhs.gov/about/news/2015/01/26/better-smarter-healthier-in-historic-announcement-hhs-sets-clear-goals-and-timeline-for-shifting-medicare-

reimbursements-from-volume-to-value.html

2 https://ehrincentives.cms.gov/hitech/loginCredentials.action

3 https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/certification.html

4 http://www.healthleadersmedia.com/technology/amia-seeks-overhaul-electronic-clinical-quality-reporting-measures

5 http://khn.org/news/758-hospitals-penalized-for-patient-safety-in-2016-data-table/

6 http://www.fiercehealthfinance.com/story/medicare-penalties-mrsa-infections-could-cost-some-hospitals-millions/2016-01-04

7 http://www.kaufmanhall.com/thought-leadership/resources/full-details/momentum-toward-value-based-payment-in-hospitals-growing-significantly-new-sur-

veys-find

8 https://www.healthcatalyst.com/electronic-clinical-quality-measures-impact-data-quality

9 http://www.bna.com/fewer-doctors-hospitals-n57982068638/

10 http://www.q-centrix.com/intelligence/q-centrix-achieves-certification-its-q-apps-technology-platform-ehr-module-all

There’s no question that eCQMs will play an increasingly prominent role in quality management as well as payment

and incentive models. Some experts believe that, in the near future, CMS will require hospitals and physicians to verify

the quality of their eCQM data.

Q-Centrix processes more than one million quality data transactions annually and provides comprehensive clinical

surveillance, abstraction, analysis and improvement services to hundreds of hospitals. Talk to us to learn more about

our Q-Apps platform for eCQMs and how we can customize a service to fit your needs and ensure your data quality.