As the process for applying to become a Qualified Health Information Network (QHIN) under TEFCA begins to take shape, the Recognized Coordinating Entity (RCE) is developing proposed measures for network performance and security as well as some near- and long-term process and outcome measures.
During a July 21 webinar, the RCE described some proposed metrics and provided stakeholders with an opportunity to share questions and ideas.
The RCE has been tasked with developing a set of metrics to be reported on a regular basis by QHINs that assess compliance with the Common Agreement and process and outcome measures that demonstrate compliance. Metrics will be submitted for review and approval to the Office of Management and Budget (OMB) in February 2021.
Proposed measures focus initially on structural measures related to compliance; most additional measures related to process and outcomes are proposed as longer-term and/or voluntary.
Dave Cassel, executive director of Carequality, detailed work on the application process and onboarding and ongoing compliance. He also said that one proposal would be to ask QHINs to report the response times they are seeing from all the other QHINs on document retrievals and message delivery. That would be useful information in crafting reasonable service-level agreements going forward, he said.
Stephanie Rizk, manager of health IT policy for RTI International, spoke about work on process and outcome measures. The TEFCA ecosystem offers an opportunity to measure certain concepts that would be beneficial to study and may even be able to help show where the healthcare system is moving the needle on outcomes, she said.
The RCE team has been weighing what is feasible in the near term vs. the long term. “In the near term, we are proposing two measures that would be mandatory in the first year of functionality of each QHIN,” she said.
• Report on the number of member organizations participating in each QHIN.
• Report on the number of document deliveries/healthcare organization transaction volume.
She described the following measures are proposed for voluntary reporting to the RCE within three years of successful on-boarding as a QHIN:
• Amount of health data exchange supported by HL7 FHIR API conforming to nationally certified standards.
• Number of messages delivered by QHIN participants to a public health agency in support of syndromic surveillance reporting. “We would like to get a handle on how much information is flowing to public health agencies,” Rizk said. “That will be an important thing to be able to support in terms of value the HIE brings. TEFCA allows for us to collect and report that on a national level. It is a very interesting possibility.”
• Percentage of available structured elements that were electronically exchanged per patient.
• Number of times a complete and current medical record was accessible to both a patient and provider during a clinical encounter.
• Percentage of closed-loop referrals where electronic health information is sent and received.
Depending on advancements in the ecosystem, some or all of these measures may become mandatory in later years. In the longer term, they are thinking about other quality, usability and care coordination metrics.
For instance, one metric under consideration is the number of connected clinicians affiliated with a QHIN and participating in HIE. “That lays the foundation for a number of other types of measures or reports if we could get a good handle on the number,” she said, “but there are complications with collecting and analyzing this data.”
“There is a potential to look at existing data and metadata,” Rizk added. “We want to focus on items that we could potentially report on a large scale without requiring the QHINs to support surveys on a regular basis. We want to ensure we are talking about concepts that are less burdensome over time and collected on a regular basis without having to rely on survey data.”
