ECQM Strategy Project Outcomes Report V1-0

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Centers for Medicare & Medicaid ServicesCenter for Clinical Standards and QualityElectronic Clinical Quality Measure (eCQM) Strategy ProjectOutcomes ReportVersion 1.0August 3, 2020

Centers for Medicare & Medicaid ServicesTable of Contents1. Introduction .11.11.21.3Purpose of the eCQM Strategy Project .1Approach to Stakeholder Engagement.2eCQM Strategy Project Scope .42. Related CMS and External Program Initiatives . 63. eCQM Strategy Outcomes . 63.13.23.33.43.53.6Alignment .7Value .8Development Process .9Implementation and Reporting Process .11EHR Certification Process .17Communication, Education, and Outreach .184. Future Activities .19Acronyms .20Electronic Clinical Quality Measure (eCQM) Strategy Project Outcomes ReportVersion 1.0iiAugust 3, 2020

Centers for Medicare & Medicaid ServicesList of FiguresFigure 1. eCQM Strategy Project Timeline . 2Figure 2. Chart of Site Visit Organization Types . 3Figure 3. Chart of Site Visit Attendees . 3Figure 4. eCQM Strategy Recommendations . 5Figure 5. eCQM Strategy Recommendations by Key Issue Theme . 7Figure 6. MC Workspace Monthly User Access . 11Figure 7. DERep Monthly User Access. 15Figure 8. ONC Project Tracking System – eCQM Tracker Issues Reported and Resolved . 16Figure 9. ONC Project Tracking System – eCQM Tracker Issue Resolution . 17List of TablesTable 1. eCQM Strategy Project Scope . 4Table 2. Alignment-Related Activities and Outcomes . 8Table 3. Value-Related Activities and Outcomes . 9Table 4. Development Process-Related Activities and Outcomes. 10Table 5. Implementation and Reporting Process-Related Activities and Outcomes . 12Table 6. EHR Certification Process-Related Activities and Outcomes . 18Table 7. Communication, Education, and Outreach-Related Activities and Outcomes . 18Electronic Clinical Quality Measure (eCQM) Strategy Project Outcomes ReportVersion 1.0iiiAugust 3, 2020

Centers for Medicare & Medicaid Services1. IntroductionThe Centers for Medicare & Medicaid (CMS) introduced electronic clinical quality measures (eCQM) into their quality reportingprograms during a time of rapid adoption of electronic health records (EHR), spurred by the Health Information Technology forEconomic and Clinical Health Act (HITECH Act), which is part of the American Recovery and Reinvestment Act of 2009 (ARRA).The goal was to move away from burdensome, manual abstraction measures by leveraging the growing availability of electronicclinical data to automate the capture, calculation, and reporting of quality measures. Because of short program timelines, rapiddevelopment of eCQM specifications, and early use of available standards, the introduction of eCQMs created additional burden forstakeholders implementing and reporting eCQMs.1.1Purpose of the eCQM Strategy ProjectThe eCQM Strategy Project supported the CMS Patients Over Paperwork initiative to evaluate and streamline regulations with a goalto reduce unnecessary burden, to increase efficiencies, and to improve the beneficiary experience. The project provided CMS with anunderstanding of eCQM implementation and reporting burden and made recommendations for improvement in the use of eCQMs inCMS quality reporting programs. Figure 1 shows the eCQM Strategy Project timeline. The eCQM Strategy Project RecommendationsReport summarized stakeholder feedback to inform CMS's prioritization of actions to reduce burden related to eCQM development,implementation, data capture, reporting, and the use of associated tools. This eCQM Strategy Outcomes Report highlights theactivities and outcomes of implementing the recommendations.Electronic Clinical Quality Measure (eCQM) Strategy Project Outcomes ReportVersion 1.01August 3, 2020

Centers for Medicare & Medicaid ServicesFigure 1. eCQM Strategy Project Timeline1.2Approach to Stakeholder EngagementThe eCQM Strategy Project team gathered feedback from stakeholders on their experiences with eCQMs using a human-centereddesign approach. The team engaged more than 250 stakeholders through a two-day listening session, three facilitated conferencegallery-walk sessions, and seventeen site visits with hospitals and clinician organizations. Stakeholders included clinicians, qualitystaff, EHR analysts, health IT, quality standards experts, terminologists, and measures developers as shown in Figure 2 and Figure 3.The team collected, analyzed, and summarized the feedback from these events into key eCQM burden themes and associatedrecommendations for improvement.Electronic Clinical Quality Measure (eCQM) Strategy Project Outcomes ReportVersion 1.02August 3, 2020

Centers for Medicare & Medicaid ServicesFigure 2. Chart of Site Visit Organization TypesFigure 3. Chart of Site Visit AttendeesElectronic Clinical Quality Measure (eCQM) Strategy Project Outcomes ReportVersion 1.03August 3, 2020

Centers for Medicare & Medicaid Services1.3eCQM Strategy Project ScopeThe scope of the eCQM Strategy Project included eCQM development, eCQM reporting, and tools for development and reporting.Table 1 includes a brief description for each of these areas. After analysis of the stakeholder feedback, six themes emerged across thekey issues. Figure 4 presents the six key issue themes—Alignment, Value, Development Process, Implementation and ReportingProcesses, EHR Certification Process, and Communication, Outreach, and Education—and recommendations for each area.Table 1. eCQM Strategy Project ScopeScopeDescriptioneCQM Development Process starting with developing the eCQM concept and ending with measurereadiness to submit to the Measures Under Consideration (MUC) listeCQM Reporting Processes and requirements for reporting eCQMs to CMS Processes related to eCQM clinical implementation and data captureTools for Developmentand Reporting Next generation of Bonnie (open source eCQM logic testing tool)Next generation of Cypress (open source EHR certification testing tool)New pre-submission validation toolsOther tool(s) innovationsElectronic Clinical Quality Measure (eCQM) Strategy Project Outcomes ReportVersion 1.04August 3, 2020

Centers for Medicare & Medicaid ServicesFigure 4. eCQM Strategy RecommendationsElectronic Clinical Quality Measure (eCQM) Strategy Project Outcomes ReportVersion 1.05August 3, 2020

Centers for Medicare & Medicaid Services2. Related CMS and External Program InitiativesThere are many initiatives underway to improve the quality of healthcare, reduce clinician burden, and use technology moreeffectively and efficiently. Aspects of the eCQM Strategy Project may complement and inform these related initiatives. The projectteam suggests that the following initiatives, and CMS’s collaboration on them, may produce more impactful and sustainable solutionsas well as improve alignment with other federal and non-federal entities: In June 2020, CMS announced the creation of the Office of Burden Reduction and Health Informatics to unify the Agency’sefforts to reduce regulatory and administrative burden and to further the goal of putting patients first. The National Health Quality Roadmap published in May 2020 identifies specific actions to drive change through governanceand oversight, data collection and reporting, and aligned measures in federal quality programs. The CMS Digital Quality Measure (dQM) initiative explores a full transition to dQMs across all CMS quality reportingprograms by 2030. The National Committee for Quality Assurance (NCQA) Digital Measurement Community (DMC) launched in July 2020 tointeract online with other stakeholders to share knowledge, challenges and experiences; learn about the latest strategies andbest practices; post unique perspectives; and help to shape the future of digital measurement.3. eCQM Strategy OutcomesFor each of the identified recommendations, the eCQM Strategy Project team worked with CMS staff to identify accountable groupsto further explore and implement recommendations. These accountable groups included internal CMS staff, supporting contractors,and groups external to CMS such as federal health agencies and non-government partners in the quality measurement community.From July 2018 to July 2020, the eCQM Strategy Project team collaborated with and communicated findings to these groups toimplement recommendations and/or develop plans for action.There were 117 recommendations in total across the six key issue theme areas, with 114 recommendations that were eitherimplemented or with a plan of action in place. Three recommendations related to eCQM provider attribution continue to be explored.Figure 5 reflects distribution of recommendations by key issue themes. This section highlights the activities to support burdenreduction within each of the key issue themes.Electronic Clinical Quality Measure (eCQM) Strategy Project Outcomes ReportVersion 1.06August 3, 2020

Centers for Medicare & Medicaid ServicesFigure 5. eCQM Strategy Recommendations by Key Issue Theme3.1AlignmentThe Alignment recommendations address the lack of alignment of eCQM requirements across CMS programs, other payers, andregulatory agencies. The National Quality Forum defines alignment in quality measurement as “encouraging the use of similarstandardized performance measures across and within public and private sector efforts.” In sharing their concerns and opinions aboutalignment challenges, stakeholders spoke of measures, reporting requirements, standards, specifications, supporting materials, andcommunications. Table 2 highlights the activities and outcomes to support burden reduction related to alignment.Electronic Clinical Quality Measure (eCQM) Strategy Project Outcomes ReportVersion 1.07August 3, 2020

Centers for Medicare & Medicaid ServicesTable 2. Alignment-Related Activities and OutcomesAction TakenExpanded eCQMGovernance GroupMembership3.2Stakeholders InvolvedFederal partners across theDepartment of Health andHuman Services, Departmentof Defense, and Department ofVeterans AffairsImpact and OutcomeImproved interagency collaboration by sharing qualitymeasurement initiatives and experience across federal healthagencies.Topics include the Da Vinci Project Fast Healthcare InteroperabilityResources (FHIR ) initiatives and COVID-19 response efforts tosupport use of eCQMs with telehealth visits, terminologies, codesets for new testing, data exchange, and reporting.Established Value SetWorkgroupMeasure and clinical decisionsupport (CDS) developers,standards and terminologyexperts, CMS quality reportingprograms, Centers for DiseaseControl, Agency for HealthcareResearch and Quality, andNational Library of MedicineHarmonization of value sets and providing guidelines to improvethe usability and clarity of value sets across eCQMs and CDS.Established QMVIG eCQMWorkgroupCMS quality reporting programrepresentativesProvided a forum to discuss eCQM related topics and breakdownsilos across CMS quality reporting programs.ValueThe Value recommendations address challenges of hospitals and clinicians who feel the burden of eCQM reporting while not seeingthe value. Hospitals and clinicians frequently indicated that the eCQMs are not relevant to them because they do not contribute to theirquality initiatives, and do not accurately represent the care they provide to their patients. Table 3 highlights the activities contributingto increased value of eCQMs.Electronic Clinical Quality Measure (eCQM) Strategy Project Outcomes ReportVersion 1.08August 3, 2020

Centers for Medicare & Medicaid ServicesTable 3. Value-Related Activities and OutcomesAction Taken3.3Stakeholders InvolvedImpact and OutcomeDelivered a ClinicalDashboard Best PracticesWebinarCMS, patients, clinicians,health systems, health ITvendorsThe webinar provided education to improve awareness of the valueof using clinical dashboards to support quality improvementinitiatives to over 1200 attendees. The webinar, facilitated sharingbest practices of hospital and provider organizations’ initiatives thatuse clinical dashboards to display eCQM performance to improvepatient care and outcomes and to close care gaps.Developed MeasureCollaboration (MC)Workspace eCQM ConceptModuleCMS, clinicians, healthsystems, health IT vendors,measure developersImproves relevance of eCQMs to provider organizations byshowing transparency and the capability to submit eCQM Conceptideas for feedback from the Electronic Quality Improvement (eCQI)Resource Center community. Users can submit eCQM conceptideas directly to CMS measure developer staff for review andalignment with CMS quality reporting program priorityareas.(Please refer to subsection 3.3, Development Process.)Development ProcessThe Development Process recommendations address the burdens related to eCQM development. Providers mainly emphasized theworkflow-related problems with eCQMs and that the workflow is highly complex. Providers shared that their greatest burdeninvolves the health IT system documentation that is needed only to satisfy the requirements for the measure specification. Measuredevelopers and health IT vendors recommended an eCQM development collaborative environment to improve transparency for futuremeasure needs and access to better testing data to support the eCQM development life cycle. Table 4 highlights the activities to reduceburden associated with eCQM development. Figure 6 shows the MC Workspace monthly user access.Electronic Clinical Quality Measure (eCQM) Strategy Project Outcomes ReportVersion 1.09August 3, 2020

Centers for Medicare & Medicaid ServicesTable 4. Development Process-Related Activities and OutcomesAction TakenStakeholders InvolvedImpact and OutcomeIdentified Opportunities toStreamline the MeasureDevelopment Life CycleCMS, measure developersDiscussed opportunities with measure developers to achieve timesavings in the measure development process by using the CMSMeasures Inventory Tool (CMIT) Environmental Scan featureduring conceptualization; focusing on reliability and validity testingof new data elements during specification and testing; andleveraging the MC Workspace to elicit stakeholder feedbackthroughout the measure development process.Launched the MCWorkspace: New eCQMClinical Workflow, and eCQMTest Results modulesCMS, clinicians, healthsystems, health IT vendors,measure developersProvides a collaborative portal to promote transparency and betterinteraction across stakeholder communities that develop,implement, and report eCQMs. The modules provide a platform formeasure developers to publish information about their eCQMsunder development for stakeholder feedback on clinical workflowand the feasibility of capturing data elements within the eCQMs.Planned MC WorkspaceWebinar Series to IncreaseAwareness of AvailableTools to SupportStakeholdersCMS, clinicians, healthsystems, health IT vendors,measure developersEducated stakeholders about the MC Workspace modules andcompanion tools, including the eCQI Resource Center, CMIT,eCQM Flows, and prototypes. The first webinar reached 1365attendees. The MC Workspace team anticipates the webinar seriesto increase MC Workspace tool usage.Supported the CMS HospitalMeasure Development andMaintenance (H-MDM)Implementation SupportWorkflow Analysis InitiativeCMS Hospital-MDMImplementation Support team,hospitals, health systems,measure developersThe CMS Hospital-MDM team facilitated stakeholder sessions todevelop an implementation workflow support tool and helphospitals understand measure intent and data collectionrequirements.ContributedRecommendations to CMSMeasure ManagementSystem (MMS) BlueprintCMS MMS Blueprint team,measure developersRecommendations for inclusion in the 2020 CMS MMS Blueprintwill increase awareness of new tools and processes to increasestakeholder engagement and streamline the measure developmentprocesses across the measure development community.Identified Opportunities toStreamline the MeasureDevelopment Life CycleCMS, measure developersDiscussed opportunities with measure developers to achieve timesavings in the measure development process by using the CM

Electronic Clinical Quality Measure (eCQM) Strategy Project Outcomes Report 1 Version 1.0 August 3, 2020 1. Introduction The Centers for Medicare & Medicaid (CMS) introduced electronic clinical quality measures (eCQM) into their quality reporting

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