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.

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.

AHIMA also stressed that expectations of meaningful use should be applied uniformly across the entire industry and not vary by payer, patient, or provider. Providers must not be faced with providing and documenting care one way for ARRA incentives and other ways for other industry parties and partners.

Further, AHIMA urged that meaningful use requirements should be consistent with the considerable standards, certification, and information exchange work of recent years.

AHIMA also recommends that HHS establish a road map for meaningful use measures, with requirements increasing over time. This would allow users and vendors to anticipate the requirements over a period of several years. Initial criteria should reflect what can be achieved with current technology.

NCVHS chairman Harry Reynolds indicated that the committee’s report on the hearing would be posted on the NCVHS site in several weeks.

It is not known if there will be more public hearings on meaningful use before Health and Human Services issues a proposed regulation on the definition, which could come this fall.

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.)

An emerging, intermediate solution is to mix administrative data with the clinical data most likely to be available electronically now—laboratory and pharmacy information. The results are promising. Research sponsored by the Agency for Healthcare Research and Quality has shown that the blend improves the accuracy of the measures. (Also see “Improving the Quality of Quality Measures” from the Journal April 2009 print issue.)

NQF steering committee members are evaluating more than 100 potential measures on their scientific acceptability, usability, and feasibility, says Margaret Skurka, MS, RHIA, CCS, FAHIMA. Skurka, a steering committee member, is professor and director of the Department of Health Information Management at Indiana University Northwest in Gary. The group is focusing on “high-impact” measures that can improve routine care, she reports.

Skurka believes that HIM involvement has broadened the committee’s scope. For instance, physician members evaluate a measure on its ability to illustrate quality of care, and HIM expertise has helped evaluate “how easily that data piece is retrievable from coded data,” she says.

Once the group works its way through a review of each potential measure, it will submit the resulting list for public comment. NQF expects to announce the review this summer.

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.

In “Mining for Measures,” Ruth Carol profiles the Health Story Project, a consortium of EHR vendors, associations, and providers developing and promoting data standards that support the flow of information between text-based, narrative documents and electronic health records. Also working off the CDA, Health Story standards address consultation notes, history and physical, operative notes, and diagnostic imaging reports.

“The Health Story Project standards help bring important information produced through dictation and often needed for quality measures into the EHR, making that information more accessible and/or available to be included in QRDA reports of quality measure information,” says Joy Kuhl, director of health information technology for the Alliance for Pediatric Quality, a sponsor of the QRDA initiative.

The QRDA initiative is a private collaboration sponsored by the Alliance—a joint effort of the American Academy of Pediatrics, the American Board of Pediatrics, Child Health Corporation of America, and the National Association of Children’s Hospitals and Related Institutions.

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.