The HEDIS® Transitions of Care Measure Is Moving to ECDS Reporting: How You Can Start Preparing Now

To align with the industry’s transition to digital quality measurement and the need for more streamlined data exchange, NCQA is creating a new HEDIS^® measure for Transitions of Care (TRC) that uses the Electronic Clinical Data Systems (ECDS) reporting methodology.

The current TRC measure assesses performance through a hybrid reporting methodology that combines administrative claims data and medical record review for a sample of eligible members. Because the hybrid TRC measure is included in the CMS Medicare Star Ratings, NCQA is coordinating this effort with CMS and other stakeholders.

“This measure is important because it evaluates care transitions, which present opportunities for missed connections that often require patients and families to fill in the gaps,” says Fern McCree, Director of Digital Quality Informatics at NCQA. “We know that health plans, technology vendors and policymakers are heavily invested in this measure, so we want to be as transparent as possible and allow organizations enough time to prepare for the changes.”

The earliest implementation of the new ECDS TRC measure would be Measurement Year (MY) 2028, with the intention of retiring the hybrid version of the TRC measure in MY 2029.

Building on Existing Standards

The current TRC measure relies heavily on medical record data. As NCQA develops a framework for the new measure, we are evaluating how nationally recognized interoperability standards and terminology, such as Fast Healthcare Interoperability Resources (FHIR^®) and the United States Core Data for Interoperability (USCDI), can support key transitions of care concepts.

Current terminology and administrative code sets, such as LOINC, CPT, HCPCS, SNOMED CT, UBREV and CPT Cat II, support many transitions of care activities. However, some measure components cannot currently be represented using these standards.

“The hybrid Transitions of Care measure has multiple components, some of which may not directly translate to electronic clinical data,” says McCree. “Our ECDS measure development process needs to solve for that while making sure the measure remains useful and meaningful.”

Manual Workflows Add Complexity

While many transitions of care concepts are supported by existing standards, data collection and exchange often depend on manual processes. Through interviews with health plans, care delivery organizations and technology vendors, NCQA identified the following challenges:

• Admission notifications are often automated through admission, discharge, transfer (ADT) feeds, but there is no automated workflow that incorporates those notifications into the patient’s medical record.
• Discharge information is often captured through manual workflows, such as sending faxes and uploading PDFs into medical records.
• Information is not always exchanged, integrated or made accessible in ways that support efficient care coordination or automated quality reporting.

As the interoperability landscape continues to evolve, standards development organizations, federal initiatives and industry collaboratives are actively working to expand and refine interoperability standards and implementation guidance.

What Organizations Can Do Now

As NCQA continues to explore a TRC measure that leverages the ECDS reporting method, we encourage health plans to begin preparing now by identifying opportunities to reduce manual workflows and increase the availability of structured clinical data.

Here are some practical steps organizations can take to prepare:

• Understand how information is exchanged between clinicians, facilities, health plans and technology partners.
• Evaluate where transitions of care workflows rely on manual processes (e.g., fax, manual chart abstraction).
• Look for opportunities to increase automation and reduce manual handoffs during transitions of care from inpatient settings.
• Identify whether key transition and follow-up activities are documented in structured data formats.
• Engage with EHR vendors, interoperability partners and care delivery networks to identify ways to capture, exchange and make data available across systems.

“The one piece of advice I have for health plans is to get started now,” says Tricia Elliott, Vice President of Quality Implementation at NCQA. “Many of the foundational elements needed for digital quality measurement are also valuable for improving care coordination for your population today.”

Looking Ahead

NCQA will continue to work with CMS and other stakeholders as we develop the new ECDS TRC measure specification. Public comment is an important part of the measure development process and organizations will have the opportunity to review and provide feedback on the proposed measure specification before it is implemented.

Learn More

Visit our website to learn more about the transition to ECDS reporting. Submit questions to us through My NCQA.

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

FHIR^® is a registered trademark of Health Level Seven International and its use does not constitute endorsement by HL7.