What is ECDS?
Electronic clinical data systems (ECDS) are the network of data containing a plan member’s personal health information and records of their experiences within the health care system. They may also support other care-related activities directly or indirectly, including evidence-based decision support, quality management and outcome reporting. Data in these systems are structured such that automated quality measurement queries can be consistently and reliably executed.
What is the HEDIS® ECDS Reporting Standard?
ECDS is a HEDIS reporting standard for health plans collecting and submitting quality measures to NCQA. This reporting standard defines the data sources and types of structured data acceptable for use for a measure. Data systems that may be eligible for ECDS reporting include, but are not limited to, administrative claims, clinical registries, health information exchanges, immunization information systems, disease/case management systems and electronic health records.
Why did NCQA develop a new reporting standard for HEDIS?
The HEDIS ECDS Reporting Standard encourages health information exchange, which is the secure sharing of patient medical information electronically. 1 ECDS reporting is part of NCQA’s larger strategy to enable a Digital Quality System and is aligned with the industry’s move to digital measures.
What is the difference between ECDS, dQMs and eCQMs?
Measures available for HEDIS ECDS reporting are provided as Digital Quality Measures (dQMs). dQMs are quality measures expressed in a digital format using standardized language and data definitions that enable sharing of the specified measure electronically between systems. Electronic Clinical Quality Measures (eCQMs), originally developed for the Centers for Medicare & Medicaid Services EHR Incentive Program (i.e., Meaningful Use), are designed for eligible providers or hospitals and primarily use EHR data for calculating results.
Does ECDS reporting use claims?
Yes, administrative claims are considered a key data source for ECDS reporting if the data can also be made available to a member’s care team. Descriptions of additional data sources used for ECDS reporting can be found here.
How are data for ECDS different from supplemental data?
Typically, there are no differences in the data sources themselves. However, ECDS reporting provides a more standardized way to incorporate many of the data sources that are considered “supplemental” for traditional HEDIS reporting. For example, immunization information systems data are considered “supplemental data” for traditional HEDIS and are classified as “Registry” for ECDS reporting. In addition, unlike supplemental data used in traditional HEDIS reporting, ECDS data can be used to identify any element of a measure’s specification (e.g., identifying the eligible population). Although the primary source of data may often be the same, ECDS reporting has specific guidelines for how data are categorized for reporting. These guidelines are published annually in the HEDIS Volume 2 publication.
Will the rules for supplemental data change for traditional HEDIS Reporting?
Currently, there are no plans to change the way supplemental data are defined and used for traditional reporting. NCQA will continue to review and make changes as needed.
Can data abstracted from medical records be used for ECDS reporting?
The intent of ECDS reporting is to encourage the electronic exchange of clinical data. However, we know not all organizations currently receive all data electronically. Therefore, we currently allow data abstracted from medical records to be used if they are captured and stored in structured formats that use standard layouts and meet the data source requirements laid out in the Guidelines for Measures Reported Using Electronic Clinical Data Systems.
What does “accessible at the point of care” mean?
A core principle of ECDS reporting is that the information needed to successfully deliver the highest-quality care must be available (e.g., through EHR-generated quality reports, electronic portals or automatically generated fax notifications) to the health care team responsible for managing a member’s health. For ECDS reporting, performance data should be available to care teams upon request. Organizations meet this requirement if they are able to provide the requested information (e.g., phone, secure email, direct feed, provider portal, file request) to providers who are treating their members. Organizations should have documented processes for tracking these requests to be reviewed as part of the HEDIS audit.
How are data transmitted between the plan and the point of care?
NCQA does not specify a method or file format for exchange of clinical information but encourages the use of Health Level Seven International (HL7) structured document standards for comprehensive quality data and exchange of data (e.g., FHIR).
What are the audit requirements for ECDS and who determines whether a system “qualifies”?
All data used for HEDIS reporting are required to be audited. Some data sources used for ECDS reporting are considered supplemental data for traditional HEDIS reporting and therefore are audited following the supplemental data validation requirements. Plans should complete an Audit Roadmap section for each source being considered for use and work with their auditors through the validation, categorization and approval process of each source. Specific questions can be asked through MyNCQA.
What types of data would typically be leveraged from case management systems?
Member information collected through a collaborative process of member assessment, care planning, care coordination or monitoring of a member’s functional status and care experience. For example, case management systems can be used as a potential data source for identifying results from patient-reported screenings and other assessments. Some health plans operate case management programs to coordinate and manage care for certain members. Depression screening and other health assessments are often delivered through these programs and captured as structured data in case management systems.
If a plan uses its internal case management system as a data source, does it need evidence it shared data with the provider?
The system must be verified by an NCQA-Certified auditor that the information can be accessed by all health care providers responsible for managing the member’s condition upon request. NCQA does not specify how providers access the information, or how frequently.
When will measures reported using ECDS be included in NCQA evaluation programs?
NCQA works with our advisory panels and other stakeholders to continuously assess when measures are ready for use in our evaluation programs, such as Health Plan Ratings. In 2022, NCQA will include the Prenatal Immunization Status measure in Health Plan Ratings for Medicaid and commercial plans (for measurement year 2021).
Will traditional HEDIS measures be respecified for ECDS reporting?
NCQA has added the ECDS reporting method to a number of existing HEDIS measures. A list of measures available for ECDS reporting can be found in the NCQA Store listing for the HEDIS Digital Measure Bundles. Allowing optional ECDS reporting for traditional HEDIS measures provides health plans an opportunity to gain experience with the reporting method using measures they are familiar with. In 2021, NCQA announced that the Breast Cancer Screening measure will transition to ECDS only reporting for measurement year 2023.
How do vendors and plans get the technical specifications?
Measures available for ECDS reporting include a basic description of the measure for each section of the technical specification, which can be found in HEDIS Volume 2: Technical Specifications. Complete digital measure packages for ECDS reporting are available for download from the NCQA Store. These digital packages will need to be referenced to program the measures.
Are vendors and plans required to consume the digital specifications or can they manually program their own code?
Vendors and plans can manually program digital measures by referencing the provided logic files in the digital specification download package. They are not required to be able to automatically ‘ingest’ the executable files. For traditional HEDIS measures that have a digital specification available, vendors and plans can also still reference the narrative specification that is published in Volume 2. For the measures reported using ECDS, there is no narrative version of the measure that can be referenced for programming. Vendors and plans will need to reference the provided logic in the digital specification download package.
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