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 for capture, use, and maintenance of accurate healthcare data and facilitating healthcare's electronic evolution.

AHIMA Statement on Quality Health Data and Information (December 2007)
AHIMA Statement on Data Stewardship (December 2008)

AHIMA Comments on Draft NQF Report, ICD-10-CM/PCS Code Maintenance

In August 2009, the National Quality Forum (NQF) initiated a project to develop a process for updating and maintaining the NQF-endorsed® measure portfolio with ICD-10-CM/PCS codes. In an effort to understand the full implications of this process for NQF and other relevant stakeholders, NQF convened an expert panel representing the diverse stakeholders to examine the implications and make recommendations to guide NQF and the field going forward. The panel outlined central themes and concerns to highlight during the transition period between now and October 2013. The draft Code Maintenance Framework and Operational Guidance report identifies best practices for approaching the measure conversion process and discusses recommendations and guidance to NQF maintenance operations for the coding transition process. AHIMA members and staff compiled comments in response to the report that were submitted to NQF on April 16, 2010.

Industry and Standards Activities

Technical Standards

HL7 Health Quality Measure Format (HQMF)

• HL7 draft standard for representing a quality measure’s structure, metadata, definitions and logic in an electronic format.
• Quality measures encoded in the HQMF format are referred to as "eMeasures".
• Download the HL7 draft standard
• Submit comments on the draft standard

• HL7 draft standard that defines the way quality measurement data should be structured to create interoperability between reporting and receiving systems
• Download theHL7 draft standard
• Submit comments on the draft standard
• Read more about the use of QRDA in the NHIN demonstrations in the Journal of AHIMA
  

HL7 Healthcare Associated Infection (HAI) Reports

• HL7 draft standards for trial use that were created in conjunction with the Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID), and Centers for Disease Control and Prevention (CDC).
• Specifies a standard for electronic submission of Healthcare Associated Infection (HAI) Reports to the National Healthcare Safety Network (NHSN) of the Centers for Disease Control and Prevention (CDC).
• Download the draft HL7 HAI standards:
• HAI Reports Release 1
• HAI Reports Release 2
• HAI Reports Release 3
• HAI Reports Release 4

Consensus Standards

National Quality Forum (NQF):

• Not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting
• Conducts a variety of projects aimed at improving American healthcare through endorsement of consensus-based standards
• AHIMA joined NQF in 2008 and actively engages in a variety of NQF's consensus standards initiatives

NQF Code Maintenance Expert Panel

• An expert Panel convened to conduct an in-depth examination of the impact of changes to coding criteria and measure specification on measure development and submission for NQF-endorsement.
• Linda Hyde, RHIA and Kathy Giannangelo, RHIA, CCS, MA, CPHIMS, FAHIMA, were nominated by AHIMA and appointed to the expert panel, in addition to several other HIM experts.
• AHIMA comments on the draft Code Maintenance Framework and Operational Guidance Report

NQF Health IT Utilization Expert Panel

• An expert Panel convened to assess the current landscape of EHR utilization measurement around effective use and provide recommendations related to necessary additional systems capabilities.
• While quality measures evaluate clinical conditions and structural measures evaluate infrastructure, utilization measures hope to determine effective HIT usage automatically from logs in EHR systems.
• Donald T. Mon, PhD, AHIMA Vice President of Practice Leadership, was appointed and served on the Expert Panel.
• A draft report is expected in July/August 2010.

• An expert panel convened to develop a quality data set (QDS) and identify healthcare workflow changes to enable automation of performance measures through electronic health records (EHRs) and health information exchanges
• Two workgroups, Quality Data Set and Workflow, are defining the quality data set (QDS) and clinical data workflow maps, respectively
• The QDS intends to provide a base of core data needed to bridge clinical guidelines with Clinical Decision Support (CDS), the key effector arm for quality improvement using EHRs in clinical settings.
• The Workflow efforts intend to identify existing and preferred clinical workflow to generate data needed for performance measurement
• Crystal Kallem, RHIA, CPHQ, AHIMA Director of Practice Leadership, was appointed to serve on the QDS Workgroup.
• AHIMA comments on the draft HITEP Phase II Report
• Phase II Final Report: Health Information Technology Automation of Quality Measurement: Quality Data Set and Data Flow 

NQF Ambulatory Care Enriched Administrative Data

• Project to consider quality measures for ambulatory care based on administrative data, enriched by laboratory and pharmacy data and other electronic clinical data, that can provide additional tools for purchasers, health plans, consumers, clinicians and other stakeholders working to create more feasible approaches to ongoing performance measurement and quality improvement.
• Margaret Skurka, MS, RHIA, CCS, Director of HIM Programs at Indiana University Northwest, was appointed to serve on the Steering Committee.
• NQF endorsed 70 clinically enriched administrative data measures.

NQF National Voluntary Consensus Standards for Hospital Care: Outcomes and Efficiency

• Project to identify and endorse measures suitable for both public accountability and quality improvement related to outcomes and efficiency of hospital care.
• The project was divided into two separate phases: 1) hospital readmission measures; 2) hospital outcomes, including for example, quality of the hospital transition, improvement in health-related quality of life and functional status, palliative care symptom control, surgical outcomes, and efficiency.
• Jill Fainter, RHIT, Vice President of Quality Standards at the Hospital Corporation of America (HCA), was appointed to serve on the Steering Committee.
• Phase I endorsed measures
• Phase II project

Collaborative Initiatives

Health Story Project

• Alliance of healthcare vendors, providers and associations
• Rapid-development initiative to produce data standards for the flow of information between common types of healthcare documents and electronic health records
• AHIMA is a member and one of five founding organizations of the Health Story Project
• Susan M. Lucci, RHIT, CMT, AHDI-F represents AHIMA on Health Story Project's Executive Committee
• Technical implementation guides for common narrative documents are now available as draft standards for trial use through HL7, including history and physical notes, consultation notes, operative notes, and diagnostic imaging reports
• Learn more in the Journal of AHIMA as author Ruth Carol profiles the Health Story Project in "Mining for Measures"
• What's the Story? Read recent cover stories about the initiative in Advance and For the Record

Resources and Links

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)

Centers for Medicare & Medicaid Services (CMS) Quality Initiatives / Patient Assessment Instruments

• Quality Initiatives - General Information
• Better Quality Information
• E-Prescribing Incentive Program
• Generating Medicare Physician Quality
• Home Health Quality Initiatives
• Hospital Quality Initiatives
• Nursing Home Quality Initiatives
• Outcome and Assessment Information Set (OASIS)
• Physician Quality Reporting Initiative (PQRI)
• Quality Improvement Organizations
• Medicare Quality Improvement Community (MedQIC)

Agency for Healthcare Research and Quality (AHRQ) Quality and Patient Safety Initiatives

• AHRQ updated common formats for HIT Device 
• AHRQ Quality Indicators
• National Quality Measures Clearinghouse™
• Consumer Assessment of Healthcare Providers and Systems (CAHPS)
• AHRQ Resources on Measuring Healthcare Quality
• AHRQ Resources on Medical Errors and Patient Safety
• AHRQ Resources on Quality Information and Improvement
• AHRQ Patient Safety Network (PSNet)
• AHRQ Morbidity and Mortality Rounds on the Web (Web M&M)
• Healthcare 411 (consumer information for improving healthcare quality)
• AHRQ Talking Quality (talking to consumers about healthcare quality)
• AHRQ National Resource Center for Health Information Technology

Metadata Registries

• United States Health Information Knowledgebase (USHIK)
• Cancer Data Standards Registry and Repository (caDSR)

Reports

• AHRQ Conference on Health Care Data Collection and Reporting. Collecting and Reporting Data for Performance Measurement: Moving Toward Alignment

Research

• Screening Algorithms to Assess the Accuracy of Present-on-Admission Coding by Michael Pine, MD, MBA; Donald E. Fry, MD; Barbara Jones, MA; and Roger Meimban, PhD Perspectives in Health Information Management 2009 6:2 (February 11, 2009)
• Impact of Creating a Pay for Quality Improvement (P4QI) Incentive Program on Healthcare Disparity: Leveraging HIT in Rural Hospitals and Small Physician Offices by Susan Hart-Hester, PhD; Warren Jones, MD; Valerie J. M. Watzlaf, PhD, RHIA, FAHIMA; Susan H. Fenton, PhD; Carol Nielsen, MLS; Mary Madison, MPA; Chris Arthur, PhD; David Marbury, MA; LeeAnn Rudman; Randi Patterson; Rebecca Reynolds, PhD; and William Rudman, PhD Perspectives in Health Information Management 2008 5:14 (September 19, 2008) (Commentary)

Testimony

• AHIMA Statement on Meaningful Use (April 2009)
• AHIMA and MGMA Testimony to the NCVHS Workgroup on Quality (June 2007)
• AHIMA Testimony to American Health Information Community (AHIC) Quality Workgroup on Health Care Data Collection and Reporting (March 2007)

Comments

• AHIMA Comments on NQF's Call for Action on the Proposed Recommendation Letter "Key Outcomes of a Public Private Measurement & Improvement Infrastructure" (January 2009)
• AHIMA Comments on the AHRQ Data Inventory Project (January 2009)
• AHIMA Comments on ONC Consumer Adverse Event Reporting Extension/Gap (November 2008)
• AHIMA Comments on AHRQ Common Data Formats for Patient Safety Organizations (October 2008)
• AHIMA Comments on CMS Proposed Changes to the Physician Fee Schedule - PQRI (August 2008)
• AHIMA Comments on Proposed Changes to the Hospital Outpatient PPS for Calendar Year 2008 (August 2008)
• AHIMA Comments on Proposed Changes to IP-PPS for Fiscal Year 2009 (June 2008)
• AHIMA Comments on AHRQ Notice of Proposed Rulemaking for Patient Safety Organization Framework (April 2008)
• AHIMA Comments on ONC Public Health Case Reporting Draft Detailed Use Case (February 2008)
• AHIMA Comments on Common Data Types and Prioritized Performance Measures for EHIS to NQF HIT Expert Panel (January 2008)
• AHIMA Comments on AHRQ's proposed data collection project Chartering Value Exchanges for Value-driven Health Care (September 2007)
• AHIMA Comments on ONC Quality Draft Detailed Use Case (May 2007)
• AHIMA Comments on CMS Options Paper for Medicare Hospital Value-Based Purchasing (April 2007)
• AHIMA Comments on the ONC Quality Prototype Use Case (April 2007)

Access all AHIMA Resources on Data Management