Driving excellence in hospital care

Quality initiatives in the hospital today are no longer an issue of choice. The relevance of quality improvement efforts cuts across issues related to patient care and implies the overall efficacy and performance of healthcare delivery.

The quality initiatives of the regulatory bodies and accrediting organizations, such as the Centres for Medicare & Medicaid Services (CMS) and The Joint Commission (TJC), are molded by having strict reporting requirements. These institutions require quality measures to evaluate and enhance multiple aspects of patient services. By these measures, hospitals will become aware of the areas for improvement, implement data-driven strategies, and eventually advance the standard of care they offer. Furthermore, the connection between quality reporting and financial incentives must be emphasized. Reimbursement rates for the quality of care offered are affected by the Quality Reporting Programs of CMS; therefore, hospitals need to excel in their quality reporting.

In addition, quality obligation of a hospital is closely related to reputation and brand of the hospital. High performance in quality measures, in addition to not suffering financial penalties, puts the hospital into an advantageous position as the leader in patient-centered care, which can only strengthen the brand, attract more patients to the hospital, and gain trust among the community.

This article explores the origins and development of Electronic Clinical Quality Measures (eCQMs) and their implementation by regulatory bodies, along with practical strategies to effectively use measures by healthcare organizations. We will also comment upon the ramifications for healthcare quality and where these initiatives are headed.

Origins and development

eCQMs have been an influential tool in the review and improvement of the quality of care for patients in the changing healthcare environment. Generally, the background of eCQMs is rooted in the general objective of creating a digitalized information system for healthcare and improving quality measurement. Created in the late 2000s by the CMS, these were really designed to be a resource to tap into the possibilities of electronic health records in order to make quality reporting more streamlined and definitive. This was a huge step away from chart abstraction and held the promise of decreasing burdens around reporting while delivering current insights into care quality.

Implementation and use

CMS has added eCQMs to several key quality reporting and value-based care programs, including:

Hospital Inpatient Quality Reporting (IQR) program

The IQR Program aims to drive hospitals to higher inpatient quality. Hospitals are mandated, when participating in this program, to report on a specific set of eCQMs capturing multiple aspects of patient care quality. This reporting is not about looking good at regulations; it is about the hospitals having a closer look at themselves and improving their areas. Hospitals that implement the IQR Program avoid penalties while positioning themselves as patient-centered care leaders.

Medicare Promoting Interoperability program

It was previously termed the Medicare EHR Incentive Program. It drives hospitals to accept and utilize electronic health records (EHRs) properly. The idea is to use technology and enhance care for patients. The concept of eCQMs has its role in this objective since it offers an opportunity to calculate how EHRs input to achieve a better outcome. Through participating in the Promoting Interoperability Program, hospitals declare interest in modernization and efficiency and make incentive payments since they maintain the standards of healthcare technology, which is time-evolving.

These programs underscore the need for hospitals to provide and improve quality measurement across various care settings. In seeking standard measures of quality, CMS will foster a more holistic and data-driven means of measuring healthcare quality. Standardization of quality measures will allow for meaningful benchmarking; healthcare organizations will compare with their peers and know where they must change.

Another major user of eCQMs is The Joint Commission or TJC. The Joint Commission mandates the reporting of eCQMs for hospitals seeking accreditation. The reporting gives insight into the quality of care that hospitals offer and assures TJC that these meet recommended standards for service delivery. The Joint Commission promotes continuous quality improvement among hospitals by including eCQMs in accreditation.

Impact of the use of eCQMs on Hospital Operations

• Improved Quality of Care: Hospitals have a motive to monitor and improve their results on the key quality measures constantly. This is because this will lead to good patient care outcomes.
• Accreditation and Reputation: The successful reporting and improved performance on eCQMs can enable a hospital to attract more patients as well as payers based on the accreditation status and reputation.
• Financial Incentives: With high performance on eCQMs come financial rewards. Higher reimbursement rates for hospitals and avert penalties for bad performance.
• Operational Efficiency: The use of eCQMs assist hospitals in easing the process of their quality reporting and reducing administrative burdens, thereby giving healthcare providers much more time to devote to patient care.
  By leveraging eCQMs, CMS and TJC motivate the hospitals to ensure quality care with safe, efficient, and patient-centered care.

Implementing eCQMs in Hospitals: A Strategic Approach 

It is a complex activity for healthcare organizations, particularly for hospitals, to implement electronic Clinical Quality Measures (eCQMs). It needs careful planning and implementation. Here is the strategic approach for it.

EHR integration

• Certification for eCQM reporting: Have your reporting systems certified to support eCQM reporting. Ensure that your system captures and reports in accordance with the required standards.
• EHR vendor collaboration: Engage with your EHR vendors in activating and configuring eCQM modules or enabling extraction of key data elements from the EHR for eCQM calculations. This is what will fit the system to your needs.
• Data mapping: Maps the hospital's data elements to what the eCQM specifications require. In return, this makes sure that the collected data is in alignment with the measures needed for reporting.

Data validation

• Automated data validation: The data is validated using automated processes. Automated processes easily identify and correct errors and maintain the integrity of the data.
• Regular audits: Monitor the quality of data through regular audits to ensure it is accurate and complete. Regular audits help in ensuring that data is of good quality at all times.
• Reviews: Review the electronic data by cross-checking it. The review process adds another verification layer to confirm whether the data is accurate.

Staff training

• Clinical staff education: Educate the clinical staff on proper documentation practices. Good documentation is important for valid data capture and reporting.
• Training quality improvement teams: Train the quality improvement teams on eCQM specifications and reporting requirements. These trainings will equip the team with the best knowledge of the measures and make them cope with the reporting process
• Ongoing support: Ongoing support as measure specifications change. Ongoing support will help a person adjust to changes and maintain compliance.

Performance observation

• Dashboards: Develop dashboards to view performance in eCQM. Dashboards allow real time views of performance and highlight areas of opportunity.
• Alerts on measure failure: Provide alerts whenever measures could potentially fail or the data will be inconsistent. Alerts will proactively identify failure, hence solving it before the problem arises.
• Performance reviews: Regularly review performance data with the clinical teams for improvement opportunities. Performance reviews instill a culture of continuous improvement and accountability.

This strategic approach enables healthcare organizations to effectively implement eCQMs and ensure accurate reporting, as well as continuous quality improvement. It enhances patient care while meeting regulatory requirements and improving overall organizational performance.

Secure Submission to regulatory bodies

Submission of eCQM data to CMS and TJC should be ensured to be secure:

Submission to CMS

Submission of eCQM data to CMS by an organization can take place in the following manners:

• Submit through the Quality Net Secure Portal: This is the main entry point for submitting eCQM data. For this purpose, organizations need to register for a Quality Net account and  ensure that only authorized individuals may access confidential information.
• Generating and validating QRDA files from EHR: Healthcare providers will have to generate QRDA files from their Electronic Health Records. They would need to use validation tools so that the generated files meet CMS standards so as not to make any error in submissions.
• Submit files: After verification, submissions can be made through the Quality Net Secure Portal or with assistance via secure SFTP. Most of the time, the portal will immediately give the user feedback on whether the submission has been done correctly.

TJC Submissions

To submit to TJC, the following process can be followed:

• TJC Direct Data Submission Platform (DDSP): DDSP is a TJC-specific submission tool, and this would ensure that the eCQM data submitted would be confidential. Registration would ensure that access to the tool would only be available to authorized persons.
• Generation of QRDA files: Just like in the CMS submission, the organizations must prepare and submit QRDA  files devoid of errors and complete enough to enhance positive influence on the compliance status as well as quality scores.
• Uploading files: With the creation and validation of correct QRDA files, stakeholders can upload them either directly to DDSP or through secure transfer. Making sure that all data is submitted in response to TJC requirements and by their deadline is important.

Security measures

Since sensitive health information in the eCQM process is involved, therefore rigorous security measures are to be integrated:

• Data encryption: Protect data at rest through data encryption and data in motion through encryption. Encrypts patient information, protecting patient information from unauthorized access as the intercepted data cannot be read.
• Use of secure transfer protocols such that they guarantee an encrypted channel for transfers when using SFTP or even HTTPS for file transfer of confidential data to prevent intercept eavesdropping.
• Access control: Implement role-based access control, allowing only access based on the role. Coupled with MFA, this decreases access with wrongful intentions.
• Audit trails: Maintain all logs of data accesses and submissions. This traces who accessed what data and when which is great for tracing any potential breaches and compliance.
• Adherence to rules and regulations: The organization should ensure it is in compliance with HIPAA and other applicable rules and regulations. Implement policies and procedures to ensure that patient information is protected. The absence of these measures can lead to serious penalties.
• Schedule security audits: Schedule security audits to help discover vulnerabilities existing in the systems and ensure third-party vendors operate at high standards of security.

Impact of eCQMs

Implementation and utilization of eCQMs also have an influence that goes beyond mere compliance and reporting. They facilitate a culture of continuous improvement in healthcare organizations. Better quality measurement accuracy is translated to improved care for patients and outcomes due to the ease with which eCQMs help healthcare providers identify gaps and act accordingly through targeted interventions. Automated quality reporting reduces administrative burdens so that health professionals can better focus on care for patients. Under the shifting reimbursement models toward value-based care, eCQMs provide the data that will demonstrate value, ensuring the right funding. Moreover, eCQMs promote healthcare delivery transparency by encouraging providers to be accountable for the quality of care they deliver, which ensures informed choices for patients.

Given the complexities involved in the accurate calculation and secure submission of eCQMs, healthcare organizations often find it advantageous to collaborate with experts who specialize in these processes. By leveraging the expertise of specialized partners, hospitals can ensure compliance with regulatory requirements, optimize their quality reporting processes, and focus their internal resources on delivering exceptional patient care.

Future Directions

With the continued advancement in the health care technology, CMS is concentrated on a few priority areas to amplify the impact of eCQMs:

Evolution of eCQMs to Digital Quality Measures (DQMs)

Integration of FHIR Standards for Quality Reporting: The future of quality measurement is moving toward DQMs, which rely on FHIR standards. FHIR is a way of exchanging healthcare information electronically in a standardized way, which easily captures, shares, and analyzes quality data. Integrating FHIR standards into quality reporting will improve the accuracy, efficiency, and interoperability of quality measures while advancing to better, more comprehensive quality assessments.

Conclusion

Electronic clinical quality measures (eCQMs) mark a significant advance in healthcare quality reporting and improvement. Using EHR data, eCQMs have facilitated a more efficient and precise mechanism to assess care quality. As CMS makes improvements and uses these measures extensively, healthcare organizations are called to modify their processes to account for the effective implementation and reporting of the eCQMs.

Developing eCQMs into an effective tool for healthcare provider operations involves a more elaborate approach, encompassed within EHR integration, high data validation, thorough staff training, and constant performance monitoring. Also, ensuring that such sensitive data is transmitted to the regulatory bodies for approval has been done securely would be part of maintaining quality reporting.

Several vital areas shape the face of eCQMs in the future. Efforts toward more alignment and standardization of measures will improve consistency and allow for more meaningful benchmarking and performance improvement. Therefore, more reliable, and valid measures will be possible through better data capture methods and advanced analytics to shed further light on healthcare performance. Reducing reporting burdens by streamlining the process and implementing user-friendly tools and interfaces will ease the workload on the caregiver community. Besides this, the measures' scope will be broadened to include patient experience and outcomes and current clinical guidelines for quality measures as relevant and inclusive as possible. Proactive detection of errors and timely feedback will contribute to a continuous improvement culture combined with a spirit of accountability. The transformation of eCQMs to DQMs by integrating the FHIR standard will also improve the accuracy, efficiency, and interoperability of quality measures.

In the advancing healthcare industry, eCQMs and DQMs will continue to improve quality, inform reimbursement decisions, and positively impact patient outcomes. As these measures and technological applications enable them to be accepted, health organizations will be at the forefront of data-driven and quality care delivery.