Clinical Quality and Safety

Measurement is essential to optimizing health care. It offers insight into provider performance, identifies areas for improvement, and increases transparency. Measurement is integral to value‐based payment programs, which payers are increasingly using to reward providers for the quality and results of the care they deliver to patients.

Common types of measures used to assess health care quality include structure, process, outcome, patient experience, and cost. The data that health IT helps manage to support patient care can be re-used for various types of measures, alone or in combination with other types of data such as results of patient surveys.  Measures empower providers, from the largest hospital system to the smallest physician practice, to assess the quality and results of their current processes and prioritize improvements.

Data Registries

The data needed to calculate quality measures can be reported to a registry. A registry is a repository of information about individuals or populations, often focused on a specific health condition or clinical specialty. Clinicians and researchers can use information in registries to monitor and improve clinical quality, as well as for research to develop new knowledge. Registries might choose to collect, calculate, and report measures using electronic clinical quality measures or other mechanisms. It has become increasingly common to report quality data through a registry as part of a payment program.

Electronic Clinical Quality Measures (eCQMs)

eCQMs are measures of health care quality specified to be calculated using electronic clinical data  stored in and shared by health IT systems, such as EHRs.  eCQMs differ from older clinical quality measures because they rely on structured (formally coded) data fields analyzed by computers rather than expert abstraction from paper charts, or a combination of structured and free-text fields of an EHR. They convert information about care processes or outcomes into a rate or percentage that allows providers, facilities, and patients to measure and evaluate aspects of care. Once eCQMs have been integrated into a health IT system, they can run in the background, seamlessly measuring practice results.

For more information about how eCQMs are calculated and used, please visit the eCQI Resource Center. 

By examining quality measure data from available sources, such as local systems and data registries, clinicians and health care team members can identify and prioritize opportunities for improvement.

Organizations can use quality measurement results to help identify areas for improvement and develop improvement plans. Improvement targets are often associated with various reimbursement or recognition programs, and may include internal objectives aligned with progress toward these program goals or benchmarks. Internal priorities for improvement might also be identified supporting more internal goals for performance improvement.

Building a plan requires a quality improvement strategy and methodology. Clinician practices and other health care organizations that may not have these in place can access a variety of resources to help develop them. 

Using quality measurement results and a quality improvement strategy, an organization can identify meaningful goals and a practical approach to pursue those goals. Many components of health IT can factor into improvement opportunities and potentially accelerate strategies. However, while considering opportunities and developing strategy, organizations should remain focused on activities that will yield the highest value, through such benefits as improved patient care and clinician work satisfaction.

Methodology Example

Widely used and recognized methods and strategies for clinical quality improvement include the Institute for Healthcare Improvement (IHI)  Model for Improvement, Lean, and Six Sigma. HHS’ Agency for Healthcare Research & Quality (AHRQ) Ambulatory Care Improvement Guide includes an overview of these improvement models as well as ways to approach the quality improvement process.

After identifying meaningful goals, improvement often begins with defining the workflow and process updates likely to achieve the desired results. Improvement experts often observe that all improvement represents change, but not all changes lead to improvement. Organizations must continuously evaluate whether their process changes are having the desired effects. If not, they can make further modifications until they achieve their performance improvement goals.

Structured tools that help document and manage processes, as well as any challenges or barriers, help monitor and optimize the impact of improvement approaches. Ongoing measurement and process assessment is critical to identifying success and opportunities for further progress. Learn more about eCQMs and other quality measures that may aid the monitoring and continuous quality improvement process.

Clinical Decision Support (CDS)

The goal of a robust clinical quality improvement program is to enable health care providers and patients to make use of all assets and resources available to them, effectively and efficiently, to maximize safety, quality, and outcomes of care concordant with patients’ values. Clinical Decision Support (CDS) is a health IT tool that can offer relevant information at opportune times to help health care providers and patients make better care decisions. When properly integrated with workflows that respect clinicians’ and patients’ experience of the care process and the clinician-patient relationship, CDS can be an effective  tool for managing the increasingly large and complex volumes of data pertinent to clinical decisions.

CDS uses patient-specific information and clinical knowledge such as evidence-based guidelines to intelligently manage and display data so that the right information is presented at the times to the right people and in usable ways to support safe, high-quality care. The majority of CDS applications operate as components of comprehensive EHR systems, although stand-alone CDS systems are also used. Data and interoperability standards are evolving rapidly to support more sophisticated CDS applications and better use the data captured in the routine course of care. For those interested in the technical details of how health IT captures and analyzes data to support clinical quality tools such as CDS and eCQMs, the CMS-ONC eCQI Resource Center provides extensive information about current quality data standards.