Measuring the quality of health care delivery is one of the most critical
challenges facing US health care. Performance measurement can be used to track
the quality of care that health plans and medical groups deliver, but effective
performance measurement requires timely access to detailed and accurate data.
In 1996, the National Committee for Quality Assurance (NCQA) commissioned
a report to learn what actions would improve health plans' capacity to electronically
report performance data for the Health Plan Employer Data and Information
Set (HEDIS). Tracking clinical performance will require not just clinical
data stored in information systems, but an integrated health information framework.
Seven features are essential to this framework: (1) it specifies data elements;
(2) it establishes linkage capability among data elements and records; (3)
it standardizes the element definitions; (4) it is automated to the greatest
possible extent; (5) it specifies procedures for continually assessing data
quality; (6) it maintains strict controls for protecting security and confidentiality
of the data; and (7) it specifies protocols for sharing data across institutions
under appropriate and well-defined circumstances. Health plans should anticipate
the use of computerized patient records and prepare their data management
for an information framework by (1) expanding and improving the capture and
use of currently available data; (2) creating an environment that rewards
the automation of data; (3) improving the quality of currently automated data;
(4) implementing national standards; (5) improving clinical data management
practices; (6) establishing a clear commitment to protecting the confidentiality
of enrollee information; and (7) careful capital planning. Health care purchasers
can provide the impetus for implementing the information framework if they
demand detailed, accurate data on the quality of care.
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