AQA Invitational Meeting Summary (continued)

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AQA Invitational Meeting Summary

Report of the Data Sharing and Aggregation Workgroup

Steve Waldren, Health Partners American Academy of Family Physicians

Steve Waldren, cochair of the Workgroup on Data Sharing and Aggregation, said he wanted to cover two items:

National Health Data Stewardship Entity Request for Information (RFI).
Work of the Health Information Technology (HIT) Subcommittee and the Administrative Data Task Force.

First, Waldren discussed the proposed Request for Information for the National Health Data Stewardship Entity. The purpose of the RFI is to solicit information to foster discussion.

According to the RFI summary:

There is a growing demand for health care data from many sectors. Key drivers for this demand have been surging interest in health care performance measurement and the information systems needed to aggregate, process, and transmit health care data from which measures of health care quality may be derived and to which the measures could be applied. This need has raised the question of responsibility for safeguarding the data beyond the original care setting. This issue has led various stakeholders to propose the formation of a public-private national health care data stewardship organization with oversight of the various uses of health care data, as described below.

For the purpose of achieving a broader understanding of the issues that establishment of such an entity may present, input is requested from the public and private sectors on the concept of a national health data stewardship entity (NHDSE). The primary purpose of this RFI is to gather information to foster broad stakeholder discussion; there are no current plans to issue a related request for proposals (RFP).

Waldren briefly walked through the contents of the document and noted that its aim was to solicit information on the structure of the entity and guidance on the AQA's future work. The proposal will be published shortly in the Federal Register, with responses due no later than July 27. Responses will be aggregated by AHRQ and then vetted by the Data Sharing and Aggregation Workgroup.

Update on the HIT Subcommittee and Administrative Data Task Force

Turning to health information technology, Waldren said that the workgroup is looking at the work that other organizations, including the Certification Commission for Healthcare Information Technology, the American Health Information Community, and the Health Information Technology Standards Panel, are doing in the area of data aggregation for quality purposes. He indicated that the aim is to build strategic alliances, identify gaps, and work to address the gaps. He asked if this was a reasonable approach.

Discussion

The first question concerned the definition of administrative data. In response, Waldren said that defining administrative data is a key task, and that the workgroup has tried to define the characteristics of data. These include answering such questions as these:

How is the data being captured?
Where is it being stored?
Is it being submitted in claims?
How is it currently being sent—or is it?

Waldren added that the goal was to identify the different metadata levels and then map them to define the requirements for implementing, capturing, storing, and transmitting data.

Carolyn Clancy said that data collection must become more efficient. She noted that there are issues with multiple data sources and with updating HIT applications (including electronic health records). Clancy noted that to get data on quality, it will be necessary to go beyond simply looking at the information in a medical chart. She also raised another issue that needs to be addressed: What happens if you get information on the same subject from three sources, but the data from the sources differ? How do you choose which data is primary—and why?

One participant noted that the AQA's HIT Committee had determined that it was not possible to describe administrative data per se. He said that what was important was to understand the nature of the data and to figure out what to do with the data. In addition, he noted that it was important to take a certain number of performance measures and figure out the data elements that were needed to populate those measures. If the data elements exist, he said, then the next step is to map them out. The participant concluded that the key was to go through a multiple mapping process on a measure-by-measure basis.

Another participant concurred that "administrative" had become a meaningless term and said that the discussion was really about electronically retrievable data as opposed to manual chart data.

A participant noted that the National Quality Forum (NQF) recently received a grant from AHRQ to look at Hospital Quality Alliance- and AQA-approved measures, and come up with a set of criteria for prioritizing the measures. Once a priority list is set, the next step will be to trace the measures down to the data element level. She indicated that a second component of the grant was to develop a set of criteria to rate the quality of the data (to assess the data on the basis of where it was coming from). As an example, she suggested that a data source from a clinician would rate more highly than that from a nonclinician. Finally, she stressed that it was important for developers of quality measurements to specify their measures in ways that can be incorporated or generated in electronic medical records.

Stressing that the goal was to improve quality of care, Clancy added that it was important for the HIT Committee to think strategically about how the AQA could weigh in. "How can information technology help support the drive to better quality?" she asked.

In response to a comment about the need for vendors to create HIT systems that work, Clancy stressed the importance of establishing certification standards. She said that if a software system doesn't have that seal of approval, then it might not have the necessary functionality.

Wrapping up the discussion, Waldren reiterated that the AQA would like to collaborate with other groups on HIT initiatives (rather than reinventing the wheel).

Goals for 2007

Next, Waldren highlighted the Data Aggregation and Sharing Workgroup's work for 2007. He said that while vetting comments in response to the Request for Information will be the major focus, the workgroup also intends to:

Start to look at strategic alliances with multiple entities.
Test the health information technology principles in the selected pilot sites.
Continue to monitor the progress of the AQA pilot projects.

Discussion

A participant expressed concern that some organizations that should respond to the Request for Information might not think the RFI was the best way to communicate their capabilities. He warned against overstating what the RFI will accomplish and questioned whether a National Health Data Stewardship Entity was economically feasible. In response, Clancy concurred that it will be a challenge to develop the business model.

Finally, a participant asked what comes between the pilot projects and the establishment of a National Health Data Stewardship Entity. Wrapping up the discussion, Waldren indicated that the next steps had not yet been defined.

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