American Health Information Community
Quality Workgroup
Summary of the 21st Web Conference of This Workgroup
Friday, October 17, 2008

PURPOSE OF MEETING
The American Health Information Community (AHIC) Quality Workgroup (QWG) convened to finalize the QWG’s Vision Roadmap. All meeting materials referenced below are available at http://www.hhs.gov/health IT/ahic/quality/quality_archive.html.

KEY TOPICS
1. Call to Order
AHIC Director Judy Sparrow called the Web conference to order at 1:04 p.m. and noted that this is the final web conference of the QWG.

2. Opening Remarks and Approval of September 5, 2008, Draft Meeting Summary

Co-chair Dr. Carolyn Clancy asked for and received approval of the September 5, 2008, Draft Meeting Summary.

Dr. Charles (Chuck) Friedman mentioned that on this occasion of the QWG’s last meeting, he would like to express appreciation on behalf of himself and National Coordinator Robert M. Kolodner for all that the QWG has accomplished. Dr. Friedman extended a particular note of thanks to co-chairs Dr. Clancy and Rick Stephens for their leadership.

Dr. Clancy shared that the purpose of the meeting would be to review the updated Quality Vision Roadmap Narrative and discuss the lessons learned from participating as a member of the QWG.

3. Workgroup Discussion: Finalizing the Vision Roadmap

During the September 5 meeting, the QWG reached agreement on the content of the Quality Vision Roadmap. Since then, members have had the opportunity to comment on a draft narrative companion document to the Roadmap. Several comments were received, some of which have not yet been addressed in the narrative document because they did not appear to reflect workgroup discussion to date. Dr. Clancy stated that the QWG would discuss some of these change requests as well as any other comments that members may have.

Discussion of General Topics Related to the Vision Roadmap

Dr. Clancy noted that QWG members had suggested additional topics of interest over the past week when submitting suggestions for changes to the Roadmap narrative document. While reviewing these topics today, members should consider the following questions: (1) whether these topics are in line with the QWG’s vision and, if so, (2) whether they should be added to the document as a key theme or as part of one of the Roadmap’s components.

General topics for discussion included:

EHR Adoption: Charlene Underwood believes that the concept of EHR adoption needs to be stressed as it is more than just reporting; there is a need to continue to incentivize adoption because the rates are still low. Dr. Clancy agreed and believes that adoption should be broader to reflect adoption of EHRs and support other applications for physician and clinician support.

CDS Alignment: Dr. Clancy commented that alignment of CDS is critical in order to bring value to the front lines of care. Hearing no objection, Dr. Clancy concluded that QWG endorsement of CDS alignment is a key theme.

Discussion of Specific Suggested Changes to the Roadmap Components

Data Element Standardization: Dr. Clancy asked whether the title of the “Data Element Standardization” component should be expanded to “Data Element Strategy” and, if so, what should be added to the component content. Ensuing discussion clarified that the Data Element Standardization and Quality Data Set components would remain separate. It was agreed upon that referring to a data element strategy and standardization in the description of the Data Element Standardization component would be sufficient.

Measure Set Evolution: Dr. Clancy asked whether the end date of 2012 is realistic for a dominant set of quality metrics or whether that end date should be extended due to some industry concerns over the timeline for implementation of ICD-10-CM and version 5010 of the X12 transaction standards. It was suggested that the narrative reflect continued work by the Health IT Expert Panel (HITEP) without getting into detail. Brief discussion ensued as to whether the adjective modifying the measure set should be “single” or “dominant,” and it was agreed upon that “single” would be used.

Clinical Decision Support: Jerry Osheroff commented that the Clinical Decision Support component, specifically the current state, discusses the alignment with national priorities, yet the interim and end states make no mention of achieving that alignment. He also believes that the end state should be more closely tied to the prioritized outcomes and the work that the National Priority Partners is doing.

Next Steps for the Vision Roadmap

Dr. Clancy reiterated that she and Mr. Stephens would be presenting the final Vision Roadmap narrative document to AHIC at its November 12, 2008, meeting. She noted that the Vision Roadmap document is intended for wider dissemination after the AHIC meeting. After receiving assurance from Michelle Murray that other AHIC workgroups have similar plans for wider dissemination of their work, Dr. Clancy asked members to provide input on: (1) to whom the document should be disseminated and for what purpose, and (2) whether the Roadmap overview section on pages 2 and 3 requires changes to effectively reach the referenced audiences and convey that purpose.

Jerry Shea commented that it would be useful to disseminate the report widely as there is a lot of consumer activity in this area. Dr. Clancy said she foresees QWG members sharing the document with their colleagues with a cover page to remind people why the narrative is important.

4. Workgroup Discussion: Reflecting Back on the QWG and Looking Forward at New Opportunities

Dr. Clancy then asked the QWG members to shift gears and reflect on the past two years. She believes that participating in the QWG has been incredible opportunity for each member, although there is still much work to be completed. She asked if there was anything the QWG should have done differently. Jerry Osheroff commented that clearly this is a complicated process, and bringing together this diverse group of stakeholders to attempt to dissect and plan for quality has been of value. One opportunity that he had hoped the QWG would have accomplished was a tangible outcome. Dr. Clancy agreed that it would be nice to say that we fixed a specific problem, though she does believe there have been some outcomes, for example, the HITEP initiative that will continue some of the QWG efforts.

Ms. Underwood reported that the AMA-NCQA Collaborative recently discussed how, at a minimum, the focus and visibility given to quality better enabled by health IT has been valuable. She added that it is amazing that the QWG was able to fashion a streamlined document after so many months of hard work and that she particularly appreciates its vision for a set of national priorities and the means to automate toward that goal. She said that to a certain extent, chaos theory has been in operation out in the wider world, but the QWG’s work has started to frame the moving parts through a very well done and open process.

Dr. Clancy proposed that the workgroup consider a statement for the narrative document that explains the evolution of the thinking of the QWG. She said that “at the start of our work we assumed widespread adoption would lead to improving quality and safety but we found that proposition to be far more complicated than we first thought.” She stated that a map for moving forward now exists and the work will move forward, in part through the use of contracts.

Mr. Shea agreed and said that the problem should be stated more starkly in the Vision Roadmap document as there is a real danger that if we do not harmonize these processes as we will not achieve improved quality. People often see health IT as the solution, when it is a tool to help achieve quality. As for the QWG outcome, it can be portrayed as a map, as the problem has been identified and now there is a guide that describes how to address the problem.

Dr. Clancy then asked the QWG if there were additional stakeholders that should have been invited to participate. She indicated that she would have liked to have had practicing physicians participate. No others were identified.

Dr. Osheroff believes that structural measures can lead to better quality at practice sites which can drive more utilization of these components. This in turn circles back to encouraging vendors to make the components available (and useable) to others. There are incentives on the user side to maintain accreditation and to show that those functions are actually in use. This approach will drive more innovation.
Ms. Underwood added that some of the current measures are not standardized or useable. It is hard for vendors to create this ideal system without proper input from others. Vendors will not invest in this ideal system until the measures are standardized. She believes we are early on in this process.

Looking Forward

Dr. Clancy noted that the QWG had already detailed existing entities for achieving the end state but has not yet identified “the big gear…the specific component that is the game changer.”

Ms. Underwood reported that at the Collaborative’s meeting, the impact of the upcoming new Administration and the current financial situation were discussed. She added that the industry will most likely try to continue to work with the AHIC Successor and that calls for another workgroup and continued leadership. Other discussions were around ongoing collaboration involving entities such as the e-Health Initiative and the National Quality Forum (NQF) to ensure in some way that efforts are aligned and coordinated on a national level to prevent redevelopment of silos.

Dr. Clancy commented that the AHIC Successor scope is slowly taking shape and she is excited that Janet Corrigan will be a member of this new group. She thinks it is critical that the AHIC Successor’s board include people who understand the importance of longitudinal data and quality measures.

Mr. Stephens raised the issue of standardization; he pointed out that it is a critical foundation for several industries, including aviation and cell phones. He asked if the quality enterprise has progressed enough to know who should be responsible for creating these standards as it is extremely important.

Dr. Osheroff stated that the “forcing event” should be identified to move quality forward, and that the “forcing event” should come from the government. The new administration will have support from the public to fix the infrastructure of the healthcare system. He believes we may be better off focusing on what the “forcing event” is, rather than identifying the next steps.

Dr. Clancy reiterated that with the roadmap, we know where we need to go and how to get there. She described the need for two forces to support the process: a national commitment and continued pressure for payers who demand better value.

Dr. Osheroff commented that there is a need to convey the QWG message in a way that can be understood by the average citizen so they can recognize what it means and how it will benefit them.

It was noted that CMS has contracted with the Healthcare IT Standards Panel (HITSP) to reconfigure three existing measures, import them into EHRs, and then export the results in standardized format using computerized analysis. This contract will track measures as they flow from start to finish in the measure process, and will document the efficiencies and gaps.

Dr. Clancy concluded the discussion, thanking the QWG members for their dedication and time over the past two years. She observed that much work remains, “but the difference now is that we know what needs to be done and have created important steps and momentum for getting there.”

5. Recap of Action Items from Today’s Meeting

Final versions of the Quality Vision Roadmap documents and information about dissemination of the narrative document will be circulated to all members.

All members are invited to attend AHIC’s November 12, 2008, meeting. Details about the meeting can be found at http://www.hhs.gov/healthit/community/meetings/m20081112.html

Action Item #1: Staff will circulate final versions of the Quality Vision Roadmap documents to all members, as well as information about wider dissemination of the narrative document.

6. Public Comments

Comment: Richard Singerman from IBM asked if the federal government is planning to issue a request for information and/or a request for proposal on the scaleable model described as existing by 2010 in the Roadmap’s “Data Exchange and Aggregation” component.

Response: Dr. Clancy interpreted Dr. Singerman’s comments as indicating that “the earlier you get a signal, the earlier you can get moving and get answers,” to which Dr. Singerman responded in the affirmative.

7. Closing Remarks

Following Dr. Clancy’s closing remarks above, Mr. Stephens also thanked everyone for the time, commitment, and energy they have devoted to the QWG and for the momentum gained by their efforts. He added that he has learned a lot from the Quality Workgroup and now has much more insight from an employer’s perspective on “how to help this journey continue.”

8. Adjournment

The meeting was adjourned at 2:16 p.m.

SUMMARY OF ACTION ITEMS

Action Item #1: Staff will circulate final versions of the Quality Vision Roadmap documents to all members, as well as information about wider dissemination of the narrative document.

MEETING MATERIALS

Quality Workgroup Members and Alternates
Participating in the October 17, 2008, Web Conference

Co-chairs

Carolyn Clancy Department of Health and Human Services

(HHS)/Agency for Healthcare Research

and Quality (AHRQ)

Rick Stephens (and Pam French) The Boeing Company

Office of the National Coordinator for Health Information Technology Staff

Charles Friedman

Michelle Murray

Members and Alternates

Floyd Eisenberg (for Janet Corrigan) National Quality Forum

Mike Kaszynski (for Anne Easton) U.S. Office of Personnel Management

Jason Ormsby (for Margaret VanAmringe) Joint Commission

Susan Postal Hospital Corporation of America

Marty Rice, Kristie Baus (for Barry Straube) HHS/CMS

Gerald Shea AFL-CIO

Jonathan Teich Brigham & Women’s Hospital

William Tierney Regenstrief Institute, Inc.

Charlene Underwood Siemens Medical Solutions

Senior Advisors

Kristine Martin Anderson Booz Allen Hamilton

Mike Carroll (for Theresa Cullen) HHS/Indian Health Service

James Ellzy II TRICARE Management (DoD)

Jerry Osheroff Thomson Healthcare

Jonathan White AHRQ

Disclaimer: The views expressed in written conference materials or publications and by speakers and moderators at HHS-sponsored conferences do not necessarily reflect the official policies of HHS; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.