HEDIS® MY2020 Data Management – Expanding Use of Electronic Clinical Data Systems


Wednesday, September 23, 2020 | By Amy Salls, Sr. Director, Revenue and Quality Analytics

HEDIS® MY2020 Data Management – Expanding Use of Electronic Clinical Data Systems

In the final blog in this series, I want to touch on the evolution of using electronic clinical data in HEDIS measures. Data collection is one of the biggest challenges health plans face in preparation for HEDIS measures. The Electronic Clinical Data Systems (ECDS) framework was designed to increase the efficiency of quality reporting while also providing an incentive to connect to primary clinical information systems. Organizations that successfully report ECDS measures demonstrate interoperability of health data systems in the provision of high-quality care. NCQA’s commitment to the ECDS architecture was bolstered by the standards for interoperability finalized earlier this year.[1],[2]

HEDIS Measurement Year 2020 (MY 2020) represents the sixth year since the introduction of ECDS measures. There will be eleven of these measures, including eight that are exclusively specified for ECDS, and three traditional HEDIS measures that have been re-specified for ECDS. Although some plans have been voluntarily reporting on ECDS measures, this has not been a requirement. HEDIS MY 2020 changes that, with Prenatal Immunization Status (PRS) becoming the first publicly reported ECDS measure.[3]

How do I know if data could be used for ECDS measures?

Data for this HEDIS reporting domain comes from a variety of sources including:

  • EHR or Point of Service (the system of data origin such as laboratory, pharmacy, pathology, radiology)
  • Health information exchange (HIE)/clinical registry
  • Case management system
  • Administrative system

In order for data to be eligible for ECDS reporting, the data must be available to the care team upon request.  For reporting purposes, each data element is assigned to a Source System of Record (SSoR) from the list above based on the source of the evidence used to support the measure. Each electronic data source used for HEDIS ECDS reporting must have:

  • Policies and procedures for establishing and maintaining database management systems
  • Standard layout requirements
  • An automated process for incremental loading of all data elements
  • All structured quality data elements required to meet the measure specifications

Additionally, each SSoR is subject to audit and may have requirements for proof of service or other primary source verification.

Looking to the future using ECDS

ECDS measures hold great promise in reducing the burden on providers to collect data for quality reporting. In addition to supporting ECDS measures, this primary clinical data can also be used as standard supplemental data to enhance traditional HEDIS measures. Further, ECDS measures are based on definitions that align with other quality incentive programs available to providers. 

However, there are some challenges health plans must overcome to achieve this promise.

  • Collaborate with providers to exchange data based on emerging standards, such as Fast Healthcare Interoperability Resources (FHIR) and Quality Reporting Document Architecture (QRDA) 
  • Enable new processes for patient matching and data validation required to access new data resources
  • Prepare for new taxonomies utilized by EHRs, such as SNOMED CT, which can be nested to modify a procedure or diagnosis with information about laterality, site, severity, or method.  Observations may include values in addition to standard coding, e.g., Patient Health Questionnaire-9 (PHQ-9) scores for measuring depression. This additional granularity will ultimately allow quality measures to move from measuring the process of care to measuring outcomes.

All of this will become increasingly important as stakeholders continue to align in determining how to provide maximum value and quality of care for health consumers.

How SS&C Health can help

I hope our blog series discussing strategy for understanding an effective HEDIS program has been helpful. Now I’d like to take a moment to let you know how we can help. Identifying and resolving care gaps are essential to improving member health outcomes and performing well with HEDIS measures. Each year, you face the need to meet new data and performance measurement challenges. We offer an integrated, state-of-the-art HEDIS solution for all health plans, regardless of size or line of business. Please download our "Checklist for Choosing a HEDIS® Vendor" to see how we compare, and reach out at any time for a personal conversation.

To read previous blogs in this HEDIS series and other topics of interest, you may reference our blog page and sign up to receive updates on our health content.  

 

[1]  21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program, Office of the National Coordinator (ONC)

[2]  Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-facilitated Exchanges, and Health Care Providers,  Centers for Medicare & Medicaid Services (CMS), HHS.



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