CMS Report: EHRs Not Mature Enough to Report Clinical Quality Measures Correctly

Hospitals suggest improvements

The Centers for Medicare and Medicaid Services (CMS) has released a summary of the findings from a validation pilot study of electronic clinical quality measures (eCQMs) conducted during the spring and summer of 2015. The findings indicate that, at the time of the study, hospitals were struggling to use their electronic health records (EHRs) to accurately report eCQMs.

Specifically, the CMS found that while EHRs helped contractors collect data remotely with hospital staff support, many EHR processing procedures “had not yet matured” to permit the creation of complete and accurate Quality Reporting Data Architecture (QRDA)-I files based on 2014 eCQM specifications. 

Hospitals indicated that they encountered difficulties in mapping the information in the EHR systems to the QRDA-I specifications, given the use of unstructured data fields and multiple sources of information for various events. Consequently, the measures match rates were low, ranging from 12% to 49%.

Data mapping and workflow issues presented the biggest problems. For example, much information was in free text, notes, or scanned documents, not in discrete data fields. As a result, the data could not be extracted to create the data elements in the QRDA-I files.

The goal of the pilot study was to evaluate strategies to validate eCQMs for the Hospital Inpatient Quality Reporting (IQR) program. The study assessed hospitals’ readiness to submit eCQM medical record information through the following methods: 1) a CMS contractor extracted eCQMs from hospital medical records by remotely viewing hospital EHR systems, and 2) the CMS contractor examined hospital-reported eCQMs as QRDA-I files of patient-level data.

The pilot hospitals recommended that the CMS consider strategies and actions to promote the adoption and implementation of eCQM reporting by focusing on three areas: 1) improve communication, outreach, and education to increase hospital and vendor understanding of eCQMs; 2) reduce the burden of eCQM adoption; and 3) provide tools and guidance for eCQM implementation.

Sources: FierceHealthcare; June 20, 2016; and eCQM Validation Pilot Summary; June 10, 2016.