Clinical Data For Quality Use: The Basics

New Digital measures can deliver significantly better value and be more relevant because they make use of increasingly more structured clinical data. There are multiple ways to source clinical data and they come from various sources. With the advancement of interoperability, most significantly the FHIR® standard, collection data from various data sources will become less burdensome while the uniformity of the data will benefit better measure results and insights.

       Who is involved in leveraging standardized clinical data?

  • Your own interoperability and clinical data teams
  • Data vendors and interoperability
  • Data sources (provider systems, EMR vendors)
  • Aggregators (e.g. HIEs)
  • Registries

How to access clinical data via FHIR®

A common thread in engaging with stakeholders around clinical data enablement is FHIR®. Interoperability teams at the abovementioned data partners and enablers need to work with a shared understanding of the 21st Century Cures Act provisions in Title IV, which among other things mandates that clinical data needs to be accessible with ‘No Special Effort.’ ONC and CMS rules further define the implementation of FHIR® APIs, data elements via USCDI and more.

Data quality is another key aspect. Standard best practices are expected to evolve as the digital quality transition progresses.

Enabling Digital Quality with FHIR®

Not all clinical data will be available in the FHIR® format right away. During the transition to digital quality, significant amounts of data will only be available in other formats. To ensure that digital quality systems received the FHIR® formatted data they need, two approaches need to be considered and typically deployed side-by-side. Engaging with interoperability and data management teams to determine an approach and available options for FHIR® enabling clinical data is important.

Data Sources for dQMs

While administrative data sources remain important for HEDIS – and they need to be converted to FHIR® for digital quality, additional data sources are important to meet the needs for clinical data as existing measures evolve and new measures become available.

As a general guideline, data sources defined as allowable by ECDS will become the standard even as supplemental data and chart reviews get deprecated during the transition to digital quality. The following graphic shows data sources relevant to digital quality:

These sources (and measure design for dQMs) also consider the need for leveraging clinical data that is being generated from routine workflows, i.e. in the course of delivering care to patients. The data is no (and should not be) use-case specific to digital quality measurement and can be used to support other use cases, like pubic health and patient care treatment. Such broader useability of structured clinical data is key to getting maximum value from clinical data in the future.