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AQA Invitational Meeting Summary
Report of the Reporting Workgroup
Randy Johnson, Motorola
Randy Johnson very briefly discussed next steps for reporting principles.
He noted that the principles developed by his workgroup are guidelines for
reporting, and that the guidelines would be tested through the pilot programs.
He also expressed his personal concern that while the pilot projects are
very important, the process is moving too slowly to meet the immediate needs
of many employers and purchasers. We need to move faster, he said, because
we are delaying opportunities.
Report of the Data Sharing and Aggregation Workgroup
Steven Waldren, American Academy of Family Physicians
Steven Waldren opened his remarks by outlining the workgroup's goals
for the AQA meeting:
- Review and endorse the Characteristics of the National Health Data
Stewardship Entity document.
- Review the work of the Health Information Technology (HIT) subcommittee.
- Receive an update on the status of the pilot projects.
National Health Data Stewardship Entity
Waldren said that in carrying out its information-gathering and decisionmaking
processes, the National Health Data Stewardship Entity should possess 10
characteristics (based in part on the characteristics of the Securities and
Exchange Commission's Financial Accounting Standards Board). The characteristics
- Objectivity—to be objective in its decision making and have the
ability to preclude placing any particular interest above the interests
- Independence—to have a governing structure that is independent
of all other business and professional organizations.
- Knowledge—to demonstrate knowledge and expertise in the areas of
health care delivery, data management, and security or acceptable proxy
- Responsiveness—to insure input and use from key experts who possess
knowledge of health care quality assessment, health data transmission,
IT standards, physician and hospital systems design, and who have a concern
for the public interest in matters of health care quality analysis, reporting,
and patient privacy. The entity should also represent key stakeholder groups
that are measured and users of this information.
- Trustworthiness—to be recognized as a trustworthy organization
by multiple stakeholder groups.
- Adaptability—to be flexible enough to address issues and key stakeholder
needs as the market evolves.
- Transparency—to have an existing stable infrastructure for consensus
decision making that is transparent and involves the broad stakeholder
- Timeliness—to have the ability to carry out activities and achieve
goals in a timely manner.
- Collaboration—to have the ability to engage and work with other
organizations to ensure effective implementation of rules and standards.
- Sustainability—to have adequate resources to meet long-term and
A participant opened the discussion with a question about the item on sustainability.
Who will pay for the National Health Data Stewardship Entity? In response,
Waldren said that the workgroup has started to look at this issue. He added
that the workgroup has already held some informal interviews with selected
entities to see if they exemplified all or most of the 10 key characteristics.
Based on those preliminary discussions, Waldren said, the workgroup has decided
to move forward with a Request for Proposals (RFP) to these entities to help gather the necessary
information about funding and contract requirements. Carolyn Clancy added
that the AQA has benefited from the fact that the HQA has hired a consultant
to do some work on this topic. Clancy also noted that she thought the funding
would ultimately come from a mix of public and private sources (although
she also acknowledged that there has not yet been any real discussion of
A second participant asked whether the National Health Data Stewardship
Entity has the endorsement of the Centers for Medicare & Medicaid Services
(CMS) and whether CMS data would be included. In response, a participant
from CMS said that his agency was committed to contributing Medicare data.
This is a public good, and CMS realizes that there must be a substantial
public contribution. He also indicated that his agency was in the process
of implementing an updated data system that would enable the agency to better
collect and aggregate its data.
Waldren joined the discussion, stressing that the National Health
Data Stewardship Entity would not itself handle aggregation. Rather, he said,
others would aggregate data under the entity's rules and standards.
asked if the entity would be the repository for aggregating measures. In
response, Waldren indicated that he was not aware that this had yet been
discussed by the workgroup.
Motion: To adopt the Characteristics of the National Health Data
Stewardship Entity document.
Result: The motion was adopted.
HIT Subcommittee Report
Turning to the work of the HIT subcommittee, Waldren noted that there were
two items on the agenda:
- The glossary of terms
- Defining administrative data
Regarding the glossary of terms, he noted that the HIT subcommittee would
continue to define and expand the glossary.
Regarding administrative data,
Waldren noted that there was much discussion within the HIT subcommittee around
the term administrative data as
opposed to clinical data. In order to clarify the term administrative
data, he said, the subcommittee decided that it was necessary to determine
what data elements are being referred to and how these data flow from the
point of care through the various steps of entry, collection, transmission,
storage, and reporting (e.g., data entry, manual or directly electronically,
transmission, and so forth). Waldren said that the subcommittee agreed that
a separate task force should be created to further refine the data elements
and the data flow dimension. That work, he said, is ongoing.
This work is much needed and long overdue, commented one participant. He
urged his colleagues to look at electronic versus mechanical data flow, as
well as data sources (where data comes from—whether from a physician
record or the health plan side).
Pilot Projects Update
Before turning to the status of the AQA pilot projects, Carolyn Clancy noted
that the American Health Information Community has established a quality
subgroup. The AQA's specific charge in the short run is to identify barriers
to electronic health records, she said, and member participation would be
welcome. Additional information can be found at http://www.hhs.gov/healthit/ahic/quality/ or
by contacting Carolyn Clancy.
Clancy then provided a high-level update on the AQA pilot projects. The
program is continuing its progress toward the goals of meaningful performance
measurement and effective public reporting, she said. Clancy noted that the
central premise of the pilots is to use the starter set of AQA measures and
to begin reporting on these publicly in early 2007. She said that the pilot
sites would pool both public and private data.
Finally, Waldren outlined the data sharing and aggregation workgroup's
goals for 2007:
- Determine, through a formal application process, which entity will serve
as the National Health Data Stewardship Entity.
- Work to clarify the elements of administrative data, and to develop clear
terminology useful to the AQA and the pilot projects.
- Test the health information technology principles at the selected pilot
- Monitor the progress of the AQA pilot projects as data collection and