Issue Brief on Leveraging Electronic Clinical Data for HEDIS
In 2019 and 2020, NCQA interviewed health plans that have begun reporting HEDIS measures using the ECDS reporting standard. This issue brief showcases strategies and opportunities to advance the collection and use of clinical data for improving care and quality measurement.
Public Reporting for Measurement Year 2020
In September 2019, NCQA announced that Prenatal Immunization Status (PRS) will be the first publicly reported measure using the HEDIS®1 Electronic Clinical Data System (ECDS) reporting standard.
Health plans will use the measure in HEDIS Measurement Year 2020 and report the results in June 2021.
Why does this matter?
Public reporting of a measure using ECDS reporting is a critical step in the use of clinical data systems to measure quality.
Using and sharing clinical data will enrich the information available to patients, providers and health plans. Measures that leverage clinical data captured routinely during the care delivery can also reduce the burden on providers to collect data for quality reporting.
Ultimately, ECDS reporting creates insight for managing the health of individuals and groups. Public reporting helps make the promise of ECDS a reality.
Why HEDIS Measurement Year 2020?
Knowing in 2019 that the first public reporting of a measure reported using ECDS was going to be for HEDIS Measurement Year 2020 gave health plans advance notice – a year earlier than our typical announcement.
Why this measure?
When NCQA considers whether to advance measures to public reporting, we work with our multi-stakeholder advisory panels to assess:
- The number of plans that have shown they can report the measure.
- If measure results match what we expect based on other sources.
- Whether results seem indicative of true performance.
- Whether performance indicates an opportunity for improvement for the industry overall.
Prenatal Immunization Status meets all those criteria. In particular, the measure had:
- A high number of valid submissions. Many health plans reported PRS results for Measurement Years 2018 and 2019, which suggests that health plans can feasibly collect and report PRS. In addition, denominators were large. This means that health plans have enough members for reporting.
- Variation in performance. Performance rates reflect expected results and show opportunity for improvement.
All of these are signs of an effective measure that is ready for public reporting.
ECDS IN BRIEF
Electronic Clinical Data Systems (ECDS) are a network of data containing a plan member’s personal health information and records of their experiences within the health-care system. The HEDIS® ECDS Reporting Standard provides health plans a method to collect and report structured electronic clinical data for HEDIS quality measurement and quality improvement.
The ECDS architecture was designed to help HEDIS implementers understand how health IT can increase the efficiency of quality reporting, while also providing an incentive to connect to data in these other sources.
HEDIS quality measures reported using ECDS inspire innovative use of electronic clinical data to document high-quality patient care. Organizations that report HEDIS using ECDS encourage exchange of the information needed to provide high-quality services, ensuring that the information reaches the right people at the right time.
The ECDS reporting standard represents a step forward in adapting HEDIS to accommodate the expansive information available in electronic clinical datasets used for patient care and quality improvement.
TYPES OF ECDS DATA
Organizations may use several data sources to provide complete information about the quality of health services delivered to its members. Data systems that may be eligible for HEDIS® ECDS reporting include, but are not limited to, member eligibility files, EHRs, clinical registries, HIEs, administrative claims systems, electronic laboratory reports (ELR), electronic pharmacy systems, immunization information systems (IIS) and disease/case management registries.
The data within these systems come in a variety of formats. The format type determines how the source is audited. Data sources used for HEDIS ECDS reporting are categorized as follows:
- Electronic health record (EHR)/personal health record (PHR). Real-time, patient-centered records that make information available instantly and securely to authorized users. EHRs eligible for this category of ECDS reporting include the NCQA eMeasure certification program or any system that meets the 2015 Edition Base Electronic Health Record (EHR) definition.2
- Health information exchange (HIE)/clinical registry. HIEs and clinical registries eligible for this reporting category include state HIEs, immunization information systems (IIS), public health agency systems, regional HIEs (RHIO), Patient-Centered Data Homes™ or other registries developed for research or to support quality improvement and patient safety initiatives. Doctors, nurses, pharmacists, other health care providers and patients can use HIEs to access and share vital medical information, with the goal of creating a complete patient record.3 Clinical registries can be sponsored by a government agency, nonprofit organization, health care facility or private company, and decisions regarding use of the data in the registry are the responsibility of the registry’s governing committee.4
- Case management system. A shared database of 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. Case management systems eligible for this category of ECDS reporting include any system developed to support the organization’s case/disease management activities, including activities performed by delegates.
- Administrative. Includes data from administrative claim processing systems for all services incurred (i.e., paid, suspended, pending and denied) during the period defined by each measure’s participation as well as member management files, member eligibility and enrollment files, electronic member rosters, internal audit files, and member call service databases.
For specific information on HEDIS ECDS reporting, please submit questions to the Policy Clarification Support system.
ECDS FREQUENTLY ASKED QUESTIONS
See FAQs here.
- HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).