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The shift to digital quality standards—more specifically, to FHIR-CQL—does not only improve quality measures; digital measures are already in an executable format, so plans and vendors no longer need to interpret and code the measure rules. A number of additional benefits can be attributed to the dramatic progress with interoperability technology and regulations, which complement digital quality standards. Together, these developments provide significant advantages for health plans:
- Speed. The ability to source data much faster (often, in real-time) will not only improve the ability to keeping current with quality rates, there are also financial benefits: a significant reduction in duplicate efforts, provider abrasion and member frustration, resulting in better care.
- Reduced costs. Standardizing data retrieval protocols, consolidating data sources (through aggregators), reducing—and eventually eliminating—MRR will save large portions of a typical quality operations budget, both internal to the health plan and with third-party vendors.
- Improved security. Using FHIR-API technologies and the related security protocols will enable more direct data access, which in addition to speed, will improve security for a number of reasons, including:
- Data will be encrypted (as opposed to PDFs, paper records and data in various formats at various intermediaries and transfer points).
- There will be fewer “hops.” Direct and encrypted access doesn’t only speed things up, it also can (and will) remove many (if not all) intermediaries that store and transform data or raw documents that make inviting “attack surfaces” for hacks and data breaches.
- Streamlined data operations. Standardization and consolidation of data sources—especially when coordinated across all functional areas in a health plan—can result in dramatically reduced data operations. Complexity and cost, duplication, missed opportunities and the frustration of plan silos also disappear.
- Simplified audit and validation. Eventually, all clinical data needed for quality measurement will be sourced in a standard format (FHIR) and incorporate data provenance capabilities, which will allow automated source validation. NCQA’s Data Aggregator Validation Program (DAV) is moving toward that goal: HIEs can earn certification as sources of pre-validated
Spillover benefits from these changes may coincide with—and can certainly be part of—broader streamlining of data acquisition efforts for clinical data-related use cases and functional areas, including risk adjustment, care management, population health, gaps in care (identification and closure), patient outreach and communication and provider communication and education.
So, while digital quality measures are an important development and an impetus for plans to undergo digital quality transformation, the resulting broader changes will improve health care for all stakeholders: health plans, providers and patients.
- What benefits of the digital quality transformation are most important for your organization?
- What additional advantages and benefits do you expect to see from the shift to dQM?
Michael Klotz, Healthcare IT Entrepreneur, MK Advisory Services
Michael is a Healthcare IT entrepreneur, consultant and expert in the flow of data between patients, providers and payers (the healthcare data ecosystem), healthcare interoperability, digital quality and digital prescriptions. He applies his understanding of technology and standards, including HL7 FHIR, the regulatory environment, NCQA’s quality measures, the emerging digital quality standards (QDM-CQL, FHIR-CQL) and NCPDP standards to simplifying and automating secure data exchanges between patients, providers and payers.
Michael has built three successful companies, brought the first SaaS platforms for Medical Records Review to market and has been delivering strategic solutions for 120+ consulting clients for over 20 years.