New Health and Human Services secretary Kathleen Sebelius was on Capitol Hill yesterday with two new reports from the Agency for Healthcare Research and Quality in hand. Both had discouraging news about the quality of healthcare Americans received in 2008.

In particular, Sebelius singled out unequal care. AHRQ’s “2008 National Healthcare Disparities Report,” she told the House Ways and Means Committee, “highlights that severe and pervasive disparities continue to persist in this county. Minority patients still receive disproportionately poor care compared to their Caucasian neighbor.”

Solving healthcare disparities is complicated by a lack of comprehensive data about its prevalence.

Last month in the Journal, Jennifer Hornung Garvin and coauthors wrote, “At the heart of … efforts to develop effective strategies to address healthcare disparities is the need for accurate and complete data. However, data describing racial, ethnic, language, cultural, and socioeconomic characteristics are frequently inaccurate, incomplete, and lacking in detail in the healthcare setting. Sometimes they are not collected at all.”

Addressing healthcare disparities, the authors stress, “requires that providers capture better data about race, ethnicity, and socioeconomic status, an effort complicated by the sensitive nature of the data and the challenges of categorizing them appropriately.” They point to several data sets that providers can adopt to improve their collection of this so-called equity data in support of efforts to create equal care for all.

See “Data Collection and Reporting for Healthcare Disparities” in the April 2008 issue.

For the past two days the National Committee on Vital and Health Statistics has been hearing testimony from the industry on what constitutes the “meaningful use” of health IT. Defining the term is no small matter, as it triggers $17 billion in Medicare and Medicaid incentives for the adoption of electronic health record systems. The incentives are part of the American Recovery and Reinvestment Act, or ARRA.

Under the provision, an eligible professional can receive $44,000 in incentives beginning in 2011. After several years, that carrot turns into a stick. In 2015 eligible providers who are not meaningful EHR users will begin receiving reduced reimbursement. Reductions will reach 97 percent of the fee schedule in 2017.

Speaking at Tuesday’s hearings, newly named national coordinator for health IT David Blumenthal noted that defining meaningful use would also affect EHR product certification, funding, and training.

AHIMA offered comments during the hearings, advising that the elements of meaningful use improve the coordination of care, promote health information exchange, and improve the capture and use of data for secondary purposes such as quality and public health reporting. (more…)

The National Quality Forum is in the process of establishing consensus standards for the use of clinically enriched administrative data for reporting performance measures in ambulatory care. In January an NQF work group began identifying and endorsing a set of measures suitable for both public accountability and quality improvement.

Given the difficulty of reporting performance measures from paper records, healthcare has been making do by using administrative data, the only data widely available in electronic form. The trade-off is the quality of the quality measures: administrative data produce a narrow and less reliable look at the care delivered.

(In the worst case, as a Boston Globe story on Google Health related earlier this month, poorly managed use of claims data can result in outright misrepresentation of care delivered. The Journal wrote about this danger in personal health records back in April 2007.) (more…)

Several stories in the current print issue describe efforts to streamline data collection and reporting for quality measures. Two touch on the Quality Reporting Document Architecture (QRDA), a Health Level Seven draft standard based on HL7’s approved clinical document architecture (CDA).

The QRDA initiative is developing CDA standards for reporting quality measure data across health IT systems that are EHR-compatible. Currently, the work is published in part as an HL7 draft standard for trial use and is being tested in pilot implementation.

In “Advancing Quality Measures Reporting in HIEs,” Randolph C. Barrows Jr. describes the use of the QRDA in the quality measure use case featured in the NHIN demonstrations earlier this year. The QRDA was used in drafting functional requirements to support the exchange of patient-level quality data from provider systems to quality data measurement and reporting facilities. It also factored in writing functional requirements for the exchange of population-level quality measures results from a measurement and reporting facility to quality data recipients. (more…)

What’s the difference between a taxonomy and a terminology? A terminology and a vocabulary? The January “e-HIM Fundamentals” column offers help in differentiating the terms that describe data management in electronic clinical records. The online version (available to AHIMA members) offers an expanded list of definitions.

If you feel there are a thousand healthcare quality measures out there, you’re about right. The Department of Health and Human Services has compiled an inventory of that many measures and more used by its agencies and operating divisions for reporting, payment, or quality improvement.

HHS says that this is the first time it has compiled a comprehensive list of the quality measures in a single location. It intends the inventory as a step in the effort to advance collaboration and synchronization within the quality measurement community. The measures and specifications in the inventory were self-reported by HHS divisions.

The list is available as a spreadsheet, sortable through dropdown menus. HHS says it will be adding more sorting options in the coming months.

An overview of industry activity around data quality, quality management, and data content standards is available on AHIMA’s Web site.