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Improving Care Communication and Coordination through EHRs


CMS EHR Quality Promoting Interoperability

Care communication and coordination have been a centerpiece of recent policy discussions for the Centers for Medicare & Medicaid Services (CMS) recently -- from the recent MIPS measures proposals to the broader conversation around the interoperability of this data occurring. So what can we expect from this push towards measuring care communication and coordination through Electronic Health Records (EHRs)? 

A new report this week came out about this very topic, published by the National Quality Forum (NQF). Paying close attention to reports commissioned by CMS, like this one, can give us information about what we can expect from the future of programs like MIPS or the ASCQR.

In this blog we'll review where this report came from, why EHR-sourced measures on care communication and coordination are such a hot topic right now, and what the future of EHR-sourced quality measures of care communication and coordination may look like. 

Background

The National Quality Forum (NQF) is a non-profit organization that consists of experts on healthcare quality measurement. We usually interact with the NQF when they decide to endorse (or not endorse) quality measures for MIPS. 

CMS commissioned this report from NQF to answer the following question: "How can EHRs improve care communication and care coordination and how we can better measure those functions?"

There is a key but often overlooked distinction between care communication and care coordination.

  • Care communication is defined as "the transfer of information for patient care", like ensuring a specialist's report gets back to the referring physician.
  • Care coordination is defined as "the deliberate synchronization of activities and information to improve health outcomes to ensure patients’ and families’ needs and preferences for healthcare and community services are met over the course of their treatment and care", like making sure that patients have access to their information in a language they understand.

Why is CMS Funding Exploratory Research into EHR-sourced Measures of Care Communication and Care Coordination? 

The current set of quality measures that focus on care communication and coordination are claims-based measures. This report shows that CMS is interested in broadening the set of measures to include ones sourced from EHRs. According to the report, these are some benefits of EHR-sourced quality measures on care communication and coordination:

  • EHRs are a central location for all information around care communication and coordination. Using EHR data could decrease the administrative burden to practices that report these measures. 

    • This is part of a larger push towards digital quality measurement (dQM). We can see other initiatives like this in Trusted Exchange Framework and Common Agreement (TEFCA), Fast Healthcare Interoperability Resources (FHIR), and the Gravity Project.
  • EHR-sourced measures would allow for more detailed information– did a readmission occur due to a failure in care communication or did it occur due to a medical complication?

    • Seeing as gaps in care coordination can be impacted by things outside of physician control, like patient's transportation access, having this much information could be helpful to help develop ways to support patients experiencing social risk factors, and could reduce health disparities in the long-term.
  • Using EHRs as the source of information would enable measures to be calculated in almost real-time vs. the months-long timeline required by currently used claims-based measures.

The Future of Care Communication and Coordination Quality Measures

This report consists of five recommendations to make EHR-sourced quality measures on care communication and coordination a reality:

  1. Collect and Share Standardized Data: EHR-sourced data should become increasingly standardized and should include elements that help identify health disparities to improve equity and for use in measurement. 

  2. Optimize EHR Usability for Patients and Caregivers: EHRs should emphasize user-friendliness and provide information in ways that is relevant and actionable for patients and caregivers.

  3. Optimize EHR Usability for Clinicians: EHRs should improve clinical workflow and enhance evidence-based care, not create additional administrative burden.

  4. Develop Novel EHR Data Elements to Improve Measurement: New data elements should be developed and standardized to allow for evaluation of care communication and coordination, like expanding patient and caregiver data entry opportunities.

  5. Leverage EHR Data to Fill Care Measurement Gaps: EHRs should create data elements that include activities like care planning, shared decision making, and initiating and completing communication between providers (known as "closing the loop"). 

CMS' goal is to identify and manage care delays and errors while lowering costs by reducing redundant testing and imaging. NQF's report supports this goal and delivers strategies on how to attain it while minimizing burden to providers. We can expect more action by CMS and other government agencies towards integrating EHRs into quality measurement, so we will keep you updated. 


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Juliette Walle

Written by Juliette Walle

Juliette Walle is a Health Policy Analyst at the consulting firm MarsdenAdvisors.

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