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AQA Invitational Meeting Summary
Report of the Data Sharing and Aggregation Workgroup
George Isham, Health Partners American Academy of Family Physicians
George Isham opened his
remarks by highlighting past accomplishments:
- Approval of the Characteristics of the National Health Data Stewardship
- Approval of the National
Health Data Steward document.
- Approval of the AQA
Data Sharing and Aggregation Subgroup on Health Information Technology Principles
for Health Information Technology and Measurement Aggregation.
- Approval of the Data
Sharing and Aggregation Principles for Performance Measurement and
Isham then outlined his workgroup's
- Provide an update on
activities in the health information technology (IT) arena.
- Provide an update on the
AQA pilot projects.
- Discuss the proposed request
for information (RFI) for the National Health Data Stewardship Entity.
Update on Health IT Administrative Task Force Activities
Carolyn Clancy opened the
discussion on health IT with an update on the American Health Information Community
(AHIC). AHIC is a Federal advisory board chartered in 2005 to make
recommendations to the Secretary of Health and Human Services
on how to accelerate the development and adoption of health IT.
Clancy noted that, right
now, it is not possible to purchase an off-the-shelf product that has built-in
capability to report on quality—let alone on measures endorsed by the AQA, the
Hospital Quality Alliance, or both. This is the challenge that AHIC's Quality
Workgroup is trying to address. She added that the Quality Workgroup is looking
at a certification roadmap for 2008. Finally, Clancy noted that the workgroup is examining strategies to add
clinical data elements (that is, lab results and pharmacy data) to make
aggregation of administrative data more meaningful clinically.
George Isham then provided
an update on the work of the Health IT Subcommittee's Administrative Task Force. The
task force has the following goals:
- Develop and explain
terminology that will be useful to the AQA and the pilot projects with
regard to the definition of administrative data.
- Review a draft data-mapping
schematic that aligns the correct data definitions and the data flow
- Discuss other approaches
and ideas to further clarify the term administrative data.
- Recommend to the Health IT
Subcommittee and the Data Sharing and Aggregation Workgroup how to best define
or explain administrative data.
Noting that the AHIC's Quality Workgroup is pursuing similar work, he
said that the AQA's Administrative Data Task Force is recommending that it
defer its own efforts and rely on AHIC to be the resource for this work.
Pilot Projects Update
Barry Straube, director and
chief clinical officer, CMS Office of Clinical Standards and Quality, provided
an update on the AQA pilot projects. Funding for the six pilot sites has come
from three principal sources: the Quality Improvement Organization program,
CMS, and AHRQ.
Straube noted that the
contracting process to get the sites up and running has been a challenge—but
that everyone has learned a lot about how to do this in the future. He said
that the project was sole-sourced to Delmarva Medical Foundation, which in turn
has established or will establish subcontracts with each of the six pilot
sites. He added that the structural challenges have been further complicated by
the fact that any CMS funding must be contingent on demonstrating a benefit to
Straube outlined where the
process stands for each of the sites:
- The Wisconsin and Minnesota sites have signed their subcontracts.
- The Indiana site is expected
to sign soon.
- The budget request for the
Massachusetts site has been approved, and the final contract language is
being worked out.
- There are some outstanding
contract issues regarding the Arizona and California sites, but Straube
expressed confidence that they could be worked out (the biggest challenges
are Arizona's request for an exemption from the Federal Acquisition
Regulation and California's budget problems).
Once the pilots are up and running, aggregation will be done either semiannually (Wisconsin, Indiana, Arizona) or annually (Minnesota, California, Massachusetts). Straube said he hoped to see the five initial measures based on administrative data reported on by May 1 with subsequent reporting on three additional measures that require lab data or chart review.
He concluded by saying that, with the subcontracting rigors now over, the effort to figure out how to aggregate claims data from multiple payers could begin.
National Health Data Stewardship Entity: Request for Information
Turning to the National
Health Data Stewardship Entity, George Isham noted that the AQA previously approved
a National Health Data Stewardship Entity document (which addresses its
mission, precepts, scope of work, and next steps), as well as a document that
sets forth the characteristics of the entity.
Isham explained that the Data Sharing and Aggregation Workgroup had set out to determine which entities might serve as the National Health Data Stewardship Entity. As the workgroup began its task, he said, it became clear that a more formal process was needed. As a result, Isham said that the workgroup opted to pursue the idea of a request for information (RFI) rather than a request for proposals, as an RFI is a nonbinding way to gather information. The aim, he stressed, is to reach as large an audience as possible. Isham noted that the AQA is working to identify the appropriate government agency to publish the RFI in the Federal Register.
Regarding the timeline, Isham indicated that the workgroup hoped to have the RFI finalized and published on February 1, 2007, with the comment period through April 1. The overall goal is to present the RFI summary and responses to the full AQA body at the next meeting.
Turning specifically to the draft RFI, Isham stressed that it was very much in draft form. He pointed out that supplementary information comes directly from documents previously approved by the AQA. Isham then asked participants both for specific comments on the Information Requested section and for broader comments on the process that has been established by the Data Sharing and Aggregation Workgroup so that comments can be reflected in the final draft rule.
Carolyn Clancy opened the discussion with a question about how the data would be aggregated: Do they go to a central database (which is what hospitals are doing) or will there be a distributed model, in which there is an entity that sets rules on what needs to be assessed but doesn't necessarily collect data itself? Is there consensus in the group for one model or the other?
Isham replied that there is a difference of opinion as to whether to adopt a so-called regional aggregation model or a centralized aggregation model. He indicated that it might also be possible to create a hybrid national/local model, adding that there was an opportunity for different specialty societies to discuss how they would interface with whatever system is adopted. Whatever model is adopted, there will still be a need for an entity that isn't in the data aggregation business to set standards on how data should be aggregated. Another member of the workgroup added that the workgroup has not focused on the model but rather on the need for standardization on how data are aggregated across various markets.
Several participants expressed support for the RFI approach, saying that it was important to solicit
broad input on the entire concept of a National Health Data Stewardship Entity.
One person asked about the need to make the data accessible by individual physicians.
Regarding a question about conflict of interest and the AQA's role in selecting an entity to serve as the National Health Data Stewardship Entity, Isham said that the workgroup has pledged to gather the information collected from RFI respondents and come back to the AQA with some recommendations as to which group might serve in that role, adding that a broad conversation on this is vital.
One participant asked how this work dovetails with that of other groups examining similar kinds of principles around national health information. In response, Isham stressed the need to coordinate activities with other groups, including AHIC's Quality Workgroup. Clancy added that AHIC would be discussing potential use cases for the information.
One participant said that the Information Requested section should be more specific as to what was being measured. Another participant said that more specificity was needed regarding confidentiality of data and data security—although clearly implied, it needs to be explicit.
In response to another question, Isham pointed out that the AQA's focus is no longer limited to ambulatory care but is now broader.
Finally, a participant recommended including a set of structured questions in the Information Requested section in order to get to the types of answers that the AQA was looking for.
Finally, Isham outlined the
Data Sharing and Aggregation Workgroup's goals for 2007:
- Determine which entities
could serve as the National Health Data Stewardship Entity (releasing the
- Work to clarify the
elements of administrative data (and cooperate with AHIC, which does this
work) and to develop clear terminology useful to the AQA and the pilot
- Test the health IT principles in
the selected pilot sites.
- Monitor the progress of
the AQA pilot projects as data collection and aggregation continue.
- Begin to think more
broadly about data aggregation models and how they might be established to
support the AQA's purpose.
Wrapping up the meeting,
Carolyn Clancy thanked everyone for their participation and reiterated that the
AQA Steering Committee would do the following:
- Address the issue of the AQA's
voting process (and bring a recommendation to the full AQA body).
- Think through and bring
forth recommendations about the AQA's strategic direction.
Finally Dr. Clancy noted that the AQA Steering Committee has held meetings with Care Focused Purchasing (an initiative to aggregate data across multiple private sector payers). She said the conversation with that entity came about because the AQA recognizes that its work cannot apply only to Medicare data and that AQA needs to reach out to others who are placing demands on physicians in order to harmonize our efforts.
The next AQA meeting is scheduled
for May 30, 2007.
AHRQ Publication No. 07-0044-EF
Current as of March 2007
AQA Invitational Meeting. Summary. AHRQ Publication No. 07-0044-EF, March 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/performance6/