Until recently, quality measures were components of nutrition
care which affected only certain experts in that domain. With the proposed new health care regulations (HITECH,
ACOs and PCMH), things are a changing-as they say! A good “cliff notes” version of where we are
going is available, published by the National Quality Forum: Quality
Data Model (QDM) Call for Comments (comments are due July 16, 2012).
Here are a few “Myths” of Quality Measures of the Future:
They are only for
research and experts to develop and use: False.
Quality measures are being rebuilt to “fit” well
with health IT: this will allow capture of performance data as part of the care
process and provide immediate feedback and clinical decision support to clinicians and patients to improve care.
Example: A quality measure for a
diabetic will allow the doctor and the patient to examine results in real time,
by allowing digital capture, comparison with past values and peers with the
Quality measures have
been based upon claims (insurance) and clinically enriched administrative data
in the past: True
Until standardized clinical data is available
digitally, the claims and administrative data was easiest to evaluate and
process. As health IT is adopted, it allows ALL members of the health team to
converge on what values should be measured, how to adapt clinical treatment to
the data over time and how best to use the individual results for patient
Many dietetics professionals
have successfully integrated nutrition terms and processes into electronic
health records; this will assure quality measures reporting in nutrition:
We have written previously about the need to
capture specific content as “structured data” in electronic health records,
personal health records and across all exchanged health data. Structured data just means that specific
content and value sets (answers) are agreed to and used. Unstructured data, in brief, is commonly
thought of as a free text field or a “text blob.” This creates a measurement nightmare, in
part, due to human error and variability.
(For example, if someone is typing in “120 pounds”, they could (and
have!) write: “#”, “lb”, “LB”, “pounds”, “pnds” or any self
interpretation/abbreviation. This makes
it difficult to “query” as you must be aware of what everyone has entered to be
able to ask the system to pull all answers.
short, The QDM provides a method, or grammar, to express patient, consumer,
clinical, and community characteristics as well as the basic logic required to
articulate quality measure criteria. The QDM provides the potential for more
precisely defined, universally adopted electronic quality measures to automate
measurement and compare and improve quality using electronic health
information. Use of the QDM will enable more standardized, less-burdensome
quality measurement and reporting, and more consistent use and exchange of
information with EHRs for direct patient care.
And for those my age or older, you will
appreciate a re-use of the "sentence structure diagrams" we use to do in middle school! See page 10 of the report for an example!
More later as eMeasures become a mainstay of health care.