Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can ask a question through My NCQA.
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To use a case management system for ECDS reporting, the system must be verified by an NCQA-Certified auditor and demonstrate (e.g., policies and procedures) that all health care providers responsible for managing a member’s condition have access to information. It is not necessary to track whether the information was accessed, but there must be evidence that data are available on request.
NCQA is evaluating existing HEDIS measures, eCQMs and other de novo measure concepts for inclusion in the ECDS domain. Selected measures will be reengineered and retested, as necessary, and must be approved by the CPM before their release in ECDS, consistent with other HEDIS measures.
Measures using the ECDS reporting method must be audited before being approved for use in a NCQA program. Measures in the HEDIS domain that use the ECDS reporting method have not yet been approved for use in any NCQA program at this time.
To qualify for HEDIS ECDS reporting, practitioners and practitioner groups that are accountable for clinical services provided to members must have access to data used by plans for quality measure reporting, regardless of the SSoR.
NCQA does not currently specify a method of data access, but a core principle of ECDS reporting is that the information needed to deliver the highest-quality care must be available to the entire health care team responsible for managing a member’s health.
Qualifying modes of access may be as simple as a provider’s phone request for member information, or as sophisticated as an integrated decision support system. The care team’s ability to access data must be documented, to provide evidence that information is available whether or not it is accessed.
Details about the data vendor or source EHR system are not required for ECDS reporting, but should be documented in the HEDIS Roadmap when identifying data sources for an NCQA-Certified auditor. Use of data from NCQA eCQM-Certified vendors will ensure that measure data extracted from these systems are considered standard.
ECDS data should be categorized by one of the four source record categories stated in ECDS General Guideline 2: Data Collection Methods (EHR, HIE/clinical registry, case management registry, administrative claims).
If a member’s data cannot be classified as ECDS, the member is not included in the ECDS coverage or the measure denominator.
There are several tools for tracking patient progress (for example, https://aims.uw.edu/resource-library/excel%C2%AE-patient-tracking-template). that “convert” data into a format that is considered an ECDS for reporting quality measures.
NCQA does not specify file formats for exchanging clinical information, but strongly encourages adherence to Health Level Seven International (HL7) standards for clinical document exchange (e.g., QRDA, CCD) and electronic health care information exchange (e.g., FHIR).
ECDS reporting encourages use of multiple data sources to provide a complete and accurate picture of the health care experience. Transactional and clinical data from several sources may be used for ECDS reporting if data meet eligibility criteria. Click here for information on allowable data sources: http://www.ncqa.org/HEDISQualityMeasurement/ECDS/AllowableData.aspx
Refer to the ECDS general guidelines for information. Request clarification through the NCQA Policy Clarification Support (PCS) system at https://my.ncqa.org or review the proposed systems with your NCQA-Certified auditor. Send requests for individual technical support with ECDS reporting to ecds@ncqa.org.
