Resources and Publications
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.
Reporting Results for Measures Leveraging Electronic Clinical Data
NCQA has published special reports summarizing HEDIS results for measures that use the Electronic Clinical Data Systems reporting standard. These reports, published in 2021 and 2022, highlight reporting trends over time as well as performance results across the measures.
Resource Guide on Leveraging Clinical Data for Measurement of Colorectal Cancer Screening
This resource guide supports health plans and other stakeholders in successfully reporting measures using electronic clinical data systems, and specifically on using electronic clinical data in the reporting the Colorectal Cancer Screening measure for HEDIS. The strategies and resources outlined in this guide can also be adapted to other quality measure and improvement use cases.
NCQA has announced public reporting for the following measures using the HEDIS Electronic Clinical Data Systems (ECDS) reporting standard. For information about the use of these measures in programs such as NCQA’s Health Plan Ratings, please see our FAQ page.
Measurement Year 2020
- Prenatal Immunization Status (PRS-E)
Measurement Year 2022
- Adult Immunization Status (AIS-E).
- Breast Cancer Screening (BCS-E).
- Prenatal Depression Screening and Follow-Up (PND-E).
- Postpartum Depression Screening and Follow-Up (PDS-E).
Measurement Year 2023
- Depression Screening and Follow-Up for Adolescents and Adults (DSF-E).
- Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E).
- Depression Remission or Response for Adolescents and Adults (DRR-E).
- Unhealthy Alcohol Use Screening and Follow-Up (ASF-E).
Why does this matter?
Public reporting of a measure that use the ECDS reporting standard 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 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.
Transition to ECDS Reporting
NCQA added the ECDS reporting standard to seven existing HEDIS measures for voluntary reporting alongside their traditional counterparts. This allows health plans to assess their ECDS reporting capabilities using familiar measures. Based on reporting results to date and stakeholder feedback, NCQA has announced the transition of these measures to ECDS-only reporting for the following years:
Measurement Year 2023:
- Breast Cancer Screening (see this blog for more information).
Measurement Year 2024:
- Colorectal Cancer Screening (see this blog for more information).
- Follow-Up Care for Children Prescribed ADHD Medication.
- Metabolic Monitoring for Children and Adolescents on Antipsychotics.
Potentially Measurement Year 2025:
- Childhood Immunization Status.
- Immunizations for Adolescents.
- Cervical Cancer Screening.
NCQA continues to explore how electronic clinical data can be leveraged in more HEDIS quality measures in the future.
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).