Transforming Clinical Quality
Measures for EHR Use
NQF Refines eMeasures for Use in EHRs and Meaningful Use Program
By Crystal Kallem, RHIA, CPHQ
THE MEANINGFUL USE incentive program and increasing emphasis on improving healthcare quality have highlighted the need for clinical quality measures that are EHR-compatible. To address this need and advance these efforts, the National Qual- ity Forum (NQF), under contract with the Department of Health and Human Services (HHS), worked with a number of measure development organizations to establish a process for retooling existing paper-based clinical quality measures into a format hat can be interpreted and used by electronic applications. Through this process, NQF delivered 113 electronic measure specifications, or eMeasures, to HHS in 2010. The eMeasures have the potential to:
x Reduce the burden associated with manual data collec-
x Address ambiguity in existing measure specifications
x Advance meaningful use of EHR systems
The eMeasures are represented using Health Level Seven’s
Health Quality Measure Format, a standard for representing
quality measures as an electronic document. 1
Refining the eMeasures for EHR Use
The panel included a wide range of expertise, including HIM
leadership. The 113 measures were divided among four review
cycles that were managed over the course of nine months.
During each cycle, the panel evaluated the eMeasures against
a set of criteria to ensure the meaning between the original measure specification and the retooled eMeasure was preserved.
Specifically, the panel addressed the following components:
x Consistency with endorsed measure logic. The panel en-
sured each measure’s logic makes sense and preserves the
original intent of the NQF-endorsed measure.
x Appropriate use of quality data model elements. The
panel ensured that the application of quality data model
data types in the eMeasure fit a given data type’s defini-
tion in the model.
x Appropriate use of accepted value sets. The panel en-
sured that the value set used in the eMeasure matches the
In addition to the panel’s evaluation, the eMeasures were
posted for public comment between February and April 2011.
During this time, AHIMA convened a group of member volunteers to review a subset of the 113 measures. The group spent a
majority of its time validating the ICD-9-CM, ICD-10-CM, and
SNOMED CT code sets associated with approximately 22 eMeasures from four disease domains, including diabetes, coronary
artery disease, ischemic vascular disease, and heart failure. 2
NQF received more than 600 comments from the public, in
addition to the comments obtained through the panel’s review.
All public and panel comments were sorted into five categories:
code lists, logic, meaning, quality data model elements, readability, and other.
A large number of the comments ( 35 percent) were related to
issues with code lists, such as use of appropriate taxonomies
and errors of omission or commission within each code list