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FAQ Directory: HEDIS

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10.15.2017 ECDS What is the IP-ECDS Coverage Rate threshold for public reporting of ECDS measure results?

Organizations do not report an IP-ECDS coverage rate; they report a count of members in the initial population covered by ECDS. NCQA does not publicly report these data, which are for internal NCQA use and for benchmarking analysis to help determine the timeline for public reporting.

HEDIS 2018

10.15.2017 ECDS Must measures be audited for public reporting, or may unaudited data be reported?

Measures using the ECDS reporting method must be audited before being approved for use in a NCQA program. Measures in the HEDIS domain that use the ECDS reporting method have not yet been approved for use in any NCQA program at this time.

HEDIS 2018

10.15.2017 ECDS What does NCQA mean by “information has to be accessible by the health care team at the point of care”?

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

10.15.2017 ECDS If case management information resides solely within the plan and is not shared with the PCP, may it be used as a supplemental data source for the numerator?

Case management data that are available to the PCP on request meet the requirement for use in ECDS reporting.

Supplemental data may not be used for any part of an ECDS measure unless it meets all ECDS requirements.

HEDIS 2018

10.15.2017 ECDS If a plan wants to use its internal case management system as a data source, must there be evidence that data were shared with the provider?

To use a case management system for ECDS reporting, the system must be verified by an NCQA-Certified auditor and demonstrate (e.g., policies and procedures) that all health care providers responsible for managing a member’s condition have access to information. It is not necessary to track whether the information was accessed, but there must be evidence that data are available on request.

HEDIS 2018

10.15.2017 ECDS How do vendors get the ECDS technical specifications for the submission file format?

HEDIS ECDS technical specifications are available in the NCQA store in PDF format: http://store.ncqa.org/index.php/catalog/product/view/id/2822/s/hedis-2018-volume-2-measures-for-electronic-clinical-data-systems/. They are also available in HEDIS 2018 Technical Specifications for Health Plans, which can be purchased at the NCQA store.

Complete digital measure packages for HEDIS ECDS measures will be available for download at a future date.

HEDIS 2018

10.15.2017 ECDS How do EHR vendors submit data and to whom does the submission file go?

10.15.2017 ECDS Does the denominator only include plan members covered by ECDS who are in the initial population?

Yes. The denominator should be all members covered by ECDS who do not meet exclusion criteria.

HEDIS 2018

10.15.2017 ECDS How are ECDS measures different from the eMeasures in Meaningful Use?

HEDIS ECDS and eClinical Quality Measures (eCQM) developed for Meaningful Use are specified using the same data standards. eCQMs are specifically designed to use data extracted from an EHR, and HEDIS ECDS measures use multiple data sources to complete the picture of member experience across the care continuum.

HEDIS 2018

10.15.2017 ECDS May we use claims for ECDS reporting?

Administrative claims are considered an ECDS data source if the payment system is automated and data are accessible by the practitioner/practitioner group that is accountable for clinical services provided to plan members (e.g., if claims are used to identify an inpatient stay, the primary care provider must be able to access the details of the stay). Report all measure results identified by claims in the “Administrative claims” source system of record (SSoR) category.

HEDIS 2018

10.15.2017 ECDS Are there standard guidelines for how an auditor determines and approves an ECDS database and the amount of provider accessibility needed?

There are no specific ECDS guidelines for auditor approval of ECDS data sources. Data sources must meet the ECDS requirements and must be reputable—containing accurate, complete and reliable clinical data. Auditors use the same validation methods as for all other data sources. For example, for claims data, auditors validate the accuracy and completeness of the plan’s claims data. For a case management system, auditors review the system, the processes for capturing data and whether data can be extracted from the system. NCQA will add guidance to audit requirements as we learn more about data sources being used.

HEDIS 2018

10.15.2017 ECDS Will ECDS measures be used for Health Plan Accreditation or ratings?

ECDS measures are currently not approved for public reporting by NCQA, and are not eligible for use in HPA or health plan ratings. All measures must be approved for public reporting by the Committee on Performance Measurement (CPM) before they can be considered for inclusion in an NCQA program.

HEDIS 2018