Electronic Clinical Data Systems (ECDS) are a network of databases containing plan members’ personal health information and records of their experiences with the health care system. ECDS may also support other care-related activities, directly or indirectly, through various interfaces that include evidence-based decision support, quality management and outcome reporting.
HEDIS 2018
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.
HEDIS 2018
IP-ECDS coverage count includes all members in the initial population who are being managed by at least one provider with the capacity to send, receive and use electronic data for quality improvement purposes.The Initial Population includes all members (covered and not covered by ECDS) who are identified as eligible for the measure reported by the data source category used to determine eligibility.
HEDIS 2018
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.
HEDIS 2018
Case management data may be used for measures using the ECDS reporting method if the information collected by case managers is available on request to all providers treating the same member in another setting.
Data are not required to be accessed to qualify for ECDS reporting, but must be available on request to providers providing care to the member.
HEDIS 2018
Yes. Data collected by care/case managers employed by a health plan are appropriate, and are reported in the Case Management category in the measure report.
Care/case managers are considered part of the member’s care team because they help members manage a condition and/or their use of health care services.
HEDIS 2018
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
HEDIS 2018
To qualify for HEDIS ECDS reporting, practitioners/practitioner groups that are accountable for clinical services provided to members must be able to access all ECDS data used by a health plan for quality measure reporting.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.
HEDIS 2018
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.
HEDIS 2018
The audit process for HEDIS ECDS measures is evolving. Data sources fall under audit requirements for standard supplemental data. Plans complete a Roadmap for each data source so the NCQA-Certified auditor is aware of all data that are being considered for reporting. Auditors validate policies and procedures for each data source (e.g., file layout, mapping). Although primary source verification is not required, auditors may want to validate the primary source during an initial review of data, to ensure accuracy and validity.
HEDIS 2018
