NCQA Is Launching a New Data Quality Solution for Digital HEDIS® and Seeks Beta Partners

As the healthcare industry moves toward interoperability, health plans are using more clinical data in HEDIS^® reporting. Clinical data come from many sources: care delivery organizations, health information exchanges, qualified health information networks and vendors. As the volume and complexity of clinical data used in HEDIS evolve, organizations need more scalable ways to evaluate whether data are fit for use for HEDIS reporting.

NCQA has been exploring ways to drive improvement in data quality while reducing the burden of manual data verification. We have shared insights about this topic in our blog, Improving HEDIS Data Quality in a Digital World, and on the Quality Matters podcast, What the Quest for Data Quality is Really About.

“Our goal is to eliminate primary source verification (PSV) as a requirement for HEDIS health plan reporting and move toward scalable ways to validate and continuously improve data quality across clinical data pipelines,” says Tom Fluegel, NCQA’s Chief Operating Officer. “PSV should only be used in targeted situations when other verification mechanisms fail. NCQA is convening industry stakeholders to define the frameworks needed to make this possible.”

A Framework for Evaluating Clinical Data Quality

NCQA is committed to developing automated, scalable methods of data validation that can help organizations assess the reliability and trustworthiness of clinical data sources.

Our approach addresses four key areas:

• Ensuring data are complete and properly structured for HEDIS calculations.
• Showing that data are reasonable and likely to depict reality.
• Monitoring changes in data content and delivery for consistency over time.
• Understanding where data originated and how the data have been exchanged and transformed.

Data quality assessment is not a one-size-fits-all approach. “Organizations will need a combination of tools to validate different aspects of the data,” says Ben Hanley, NCQA’s Director of Product Management. “The assessments will also vary based on the use case. Not all data sources need validation across all four areas.”

Announcing NCQA’s Data Quality Solutions

We are excited to announce our first product offering related to automated data quality assessment—and we are looking for early adopters to implement this new tool and provide feedback.

NCQA developed the HEDIS^® Data Quality Specifications to enable standardized assessments of the quality of electronic clinical data. It includes over 100 specifications for data quality metrics that cover a range of clinical domains such as encounters, medications, laboratory results, conditions, immunizations and demographics.

Each specification includes a metric denominator and a metric numerator. This enables organizations to calculate how often an electronic clinical data source meets the requirements identified in the specifications. Combining relevant data quality metrics for an electronic clinical data source can provide a snapshot of overall fitness for use in HEDIS.

Organizations can use the HEDIS^® Data Quality Specifications in the following ways:

• To evaluate the level of data quality between different electronic clinical data sources.
• To identify targeted areas for electronic clinical data quality improvements.
• To establish standards for how electronic clinical data should be received from or exchanged with external partners.
• To evaluate data sources being considered for use in HEDIS reporting.

The HEDIS^® Data Quality Specifications were released in March for beta testing. NCQA plans to release an updated version of the specifications later this year.

How to Get Involved

NCQA is looking for a limited number of partners to participate in beta testing of the new data quality specifications. To participate, organizations should be:

• Creating, sharing or aggregating data for HEDIS reporting.
• Exchanging and using clinical data files in a FHIR^® format.

Participation in the beta testing offers an opportunity to influence how automated data quality assessment evolves and to ensure the specifications meet real‑world implementation needs. To learn more, please fill out an interest form on our website.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

HL7® and FHIR® are the registered trademarks of Health Level Seven International and their use does not constitute endorsement by HL7.

Editor’s Note: The goal of eliminating PSV only applies to HEDIS reporting and does not impact requirements for other Accreditation programs, such as Credentialing Accreditation and Certification.