AQA Invitational Meeting Summary

Report of the Reporting Workgroup

Randy Johnson, Motorola

Randy Johnson very briefly discussed next steps for reporting principles. He noted that the principles developed by his workgroup are guidelines for reporting, and that the guidelines would be tested through the pilot programs. He also expressed his personal concern that while the pilot projects are very important, the process is moving too slowly to meet the immediate needs of many employers and purchasers. We need to move faster, he said, because we are delaying opportunities.

Report of the Data Sharing and Aggregation Workgroup

Steven Waldren, American Academy of Family Physicians

Steven Waldren opened his remarks by outlining the workgroup's goals for the AQA meeting:

• Review and endorse the Characteristics of the National Health Data Stewardship Entity document.
• Review the work of the Health Information Technology (HIT) subcommittee.
• Receive an update on the status of the pilot projects.

National Health Data Stewardship Entity

Waldren said that in carrying out its information-gathering and decisionmaking processes, the National Health Data Stewardship Entity should possess 10 characteristics (based in part on the characteristics of the Securities and Exchange Commission's Financial Accounting Standards Board). The characteristics are:

• Objectivity—to be objective in its decision making and have the ability to preclude placing any particular interest above the interests of many.
• Independence—to have a governing structure that is independent of all other business and professional organizations.
• Knowledge—to demonstrate knowledge and expertise in the areas of health care delivery, data management, and security or acceptable proxy for this.
• Responsiveness—to insure input and use from key experts who possess knowledge of health care quality assessment, health data transmission, IT standards, physician and hospital systems design, and who have a concern for the public interest in matters of health care quality analysis, reporting, and patient privacy. The entity should also represent key stakeholder groups that are measured and users of this information.
• Trustworthiness—to be recognized as a trustworthy organization by multiple stakeholder groups.
• Adaptability—to be flexible enough to address issues and key stakeholder needs as the market evolves.
• Transparency—to have an existing stable infrastructure for consensus decision making that is transparent and involves the broad stakeholder communities.
• Timeliness—to have the ability to carry out activities and achieve goals in a timely manner.
• Collaboration—to have the ability to engage and work with other organizations to ensure effective implementation of rules and standards.
• Sustainability—to have adequate resources to meet long-term and short-term goals.

A participant opened the discussion with a question about the item on sustainability. Who will pay for the National Health Data Stewardship Entity? In response, Waldren said that the workgroup has started to look at this issue. He added that the workgroup has already held some informal interviews with selected entities to see if they exemplified all or most of the 10 key characteristics. Based on those preliminary discussions, Waldren said, the workgroup has decided to move forward with a Request for Proposals (RFP) to these entities to help gather the necessary information about funding and contract requirements. Carolyn Clancy added that the AQA has benefited from the fact that the HQA has hired a consultant to do some work on this topic. Clancy also noted that she thought the funding would ultimately come from a mix of public and private sources (although she also acknowledged that there has not yet been any real discussion of this).

A second participant asked whether the National Health Data Stewardship Entity has the endorsement of the Centers for Medicare & Medicaid Services (CMS) and whether CMS data would be included. In response, a participant from CMS said that his agency was committed to contributing Medicare data. This is a public good, and CMS realizes that there must be a substantial public contribution. He also indicated that his agency was in the process of implementing an updated data system that would enable the agency to better collect and aggregate its data.

Waldren joined the discussion, stressing that the National Health Data Stewardship Entity would not itself handle aggregation. Rather, he said, others would aggregate data under the entity's rules and standards.

Another participant asked if the entity would be the repository for aggregating measures. In response, Waldren indicated that he was not aware that this had yet been discussed by the workgroup.

Motion: To adopt the Characteristics of the National Health Data Stewardship Entity document. Result: The motion was adopted.

HIT Subcommittee Report

Turning to the work of the HIT subcommittee, Waldren noted that there were two items on the agenda:

• The glossary of terms
• Defining administrative data

Regarding the glossary of terms, he noted that the HIT subcommittee would continue to define and expand the glossary.

Regarding administrative data, Waldren noted that there was much discussion within the HIT subcommittee around the term administrative data as opposed to clinical data. In order to clarify the term administrative data, he said, the subcommittee decided that it was necessary to determine what data elements are being referred to and how these data flow from the point of care through the various steps of entry, collection, transmission, storage, and reporting (e.g., data entry, manual or directly electronically, transmission, and so forth). Waldren said that the subcommittee agreed that a separate task force should be created to further refine the data elements and the data flow dimension. That work, he said, is ongoing.

This work is much needed and long overdue, commented one participant. He urged his colleagues to look at electronic versus mechanical data flow, as well as data sources (where data comes from—whether from a physician record or the health plan side).

Pilot Projects Update

Before turning to the status of the AQA pilot projects, Carolyn Clancy noted that the American Health Information Community has established a quality subgroup. The AQA's specific charge in the short run is to identify barriers to electronic health records, she said, and member participation would be welcome. Additional information can be found at http://www.hhs.gov/healthit/ahic/quality/ or by contacting Carolyn Clancy.

Clancy then provided a high-level update on the AQA pilot projects. The program is continuing its progress toward the goals of meaningful performance measurement and effective public reporting, she said. Clancy noted that the central premise of the pilots is to use the starter set of AQA measures and to begin reporting on these publicly in early 2007. She said that the pilot sites would pool both public and private data.

Next Steps

Finally, Waldren outlined the data sharing and aggregation workgroup's goals for 2007:

• Determine, through a formal application process, which entity will serve as the National Health Data Stewardship Entity.
• Work to clarify the elements of administrative data, and to develop clear terminology useful to the AQA and the pilot projects.
• Test the health information technology principles at the selected pilot sites.
• Monitor the progress of the AQA pilot projects as data collection and aggregation continue.

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