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As I have been advocating and promoting all things digital quality measure (dQM) and interoperability, my colleagues in the industry frequently tell me, I kinda get it, but what do I really need to know? Do I really need to understand FHIR and CQL and FHIR-CQL? And aren’t those the same? Why does that matter to me? Addressing exactly that is the aim of this blog.
Everyone involved in health care quality should know the fundamental information about dQMs and should be able to answer the following questions:
· What are dQMs—specifically in the context of HEDIS?
· What are the dQM key concepts?
· What are the operational implications and opportunities?
· How will the transition to dQMs work?
· What is the timeline for the transition to dQMs?
We have answered some of these questions in blogs here in the DMC and there is a myriad of additional information if anyone wants to go deeper (see links below). You may have also seen technical details about how dQMs will be implemented with FHIR-CQL.
But what do you really need to know and do to work with dQMs going forward? For most of us—at least, with regard to the technical details—the answer is actually “not that much.” A more nuanced answer is: It depends on the organization or stakeholder you belong to.
Health plans and (going forward) data platform vendors and data aggregators who assist plans with their data represent the largest stakeholder group. They don’t need to know how to write or run (i.e., execute) measure rules (unless they don’t use a commercial quality software reporting tool). In essence, they need to know just as much—or as little—about the technicalities of measures as they knew with traditional measures. The big difference is the implications of dQMs: how the introduction of dQMs will change and dramatically speed and streamline data operations, data validation and related use cases.
This table summarizes the major aspects of dQMs and which ones are relevant to stakeholder groups.
|dQM Aspect||Measure Developers||HEDIS Certified Vendors||Payers||Data Aggregators & Data Platform Vendors||Providers & EMR Vendors|
|FHIR Concepts & Resources||Yes||Yes||Yes||Yes||Yes|
Although, the table should answer many questions that prompted this blog, I hope it also serves as a framework for further dialogue (in the DMC and beyond) that can lead to a broader and deeper understanding across all stakeholder groups.
· How well do you understand what your organization needs to know and do to transition to dQMs?
· What questions do you have that haven’t been answered?
· How well do you think your organization is equipped to make the transition?
· What resources would you like to have from the community, NCQA and/or vendors?
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.