Quality measures in the HEDIS Electronic Clinical Data Systems (ECDS) domain inspire innovative use of electronic clinical data to document high-quality patient care that demonstrates commitment to evidence-based practice. Organizations that report ECDS for HEDIS encourage sharing and interoperability of health data systems, and ensure that the information needed to provide high-quality services reaches the right people when it is most useful. The ECDS reporting standard represents a step forward in adapting HEDIS® to accommodate the expansive information available in electronic clinical datasets for quality improvement.
What Are 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 healthcare system. They may also support other care-related activities directly or indirectly through various interfaces including evidence-based decision support, quality management and outcome reporting. Data are structured such that automated quality measurement queries can be consistently and reliably executed to provide results to the team responsible for the care of health plan members. Health plans that establish an enterprise network of interoperable data systems will foster a member-centered, team-based approach to improving health care quality and better communication across health care service providers.
To qualify for HEDIS ECDS reporting, the data must use standard layouts, meet the measure technical specification requirements and be accessible by the care team upon request.
Type 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. Eligible data sources used for HEDIS® ECDS reporting are defined as follows:
- Electronic health record (EHR). 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.1
- 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.2 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.3
- 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 ECDS, please submit questions to the Policy Clarification Support system.