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AQA Invitational Meeting Summary

Report of the Data Sharing and Aggregation Workgroup

George Isham, Health Partners

George Isham opened his remarks by highlighting what the workgroup has accomplished to date:

  • Endorsement of data sharing and aggregation principles.
  • Development of a National Health Data Steward document.
  • Establishment of a health information technology workgroup.
  • Initiation of implementation efforts for the AQA pilot project in the six pilot sites.

He then turned to the workgroup's goals for the AQA meeting:

  • Review and endorse the National Health Data Steward document.
  • Review and endorse the Health Information Subcommittee report.
  • Receive an update on the status of the pilot projects.

National Health Data Stewardship Board

Isham noted that revisions to the National Health Data Steward document reflect the December 2005 publication of the Institute of Medicine (IOM) report, Performance Measurement: Accelerating Improvement. He said there was interest in the workgroup on focusing on the scope of work and potential existing entities that could fulfill this role.

Next, Isham noted that the workgroup is working to reach consensus on the mission, objectives, and scope of the work presented in the document. As a result, he said that by the end of 2006 he hoped the AQA would:

  • Recommend what new or existing entities could fulfill the precepts, responsibilities, and scope of work defined in the National Health Data Steward document.
  • Recommend if that entity should be included in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 definition of a standard-setting organization.
  • Recommend stakeholder communities, including Federal agencies that could serve a role and/or participate in the public/private entity. (Isham added that the stakeholder communities should represent a broad range of perspectives and have the expertise needed to address the scope of work.)

Finally, Isham said that the next steps also include working with key organizations to finalize the governance structure, and seeking Federal endorsements and short- and long-term funding. We must also develop a strategy to integrate aggregation activities in multiple health care settings, he said.

Following Isham's remarks, the discussion opened with a question about how to come up with an appropriate attribution model and whether there were alternative views about what would be analyzed under attribution. In response, Isham noted that the bullet on attribution states that the scope of work "should address at what specific level(s) data should be aggregated."

Another participant commended the workgroup for thinking through the relationship between the National Health Data Steward board and the IOM's report. He then asked: If the implementation plan suggests further consideration of existing or new entities, do you have any idea whether this process precludes or presupposes an outcome? The participant proposed that the plan, as outlined, suggest that the National Quality Forum (NQF) take over that role.

Isham responded that the objective was data aggregation, which isn't something that the NQF does. He noted that the language in paragraph two of "Initial Strategies and Objectives to Achieve Mission" addresses the need to support outreach to key stakeholders. Another participant, however, noted that the language in that section was somewhat outdated, since the pilot projects have been launched. She suggested that the workgroup incorporate language that notes that the AQA has embarked on a project to use uniform data. Isham agreed.

A participant representing the NQF said that the job ahead was to figure out which entity is best positioned to undertake data aggregation and related activities. She said that standard-setting activities were related and that it might make sense to look at the role of the NQF. Referring to a comment about funding, she encouraged the AQA to use its resources in the most efficient way possible, including using existing resources whenever possible.

In response to a question about how the pieces fit together, Isham said that the document sets up a proposal for a structure or framework that manages the important work that happened before. Another participant said that the proposed structure gives the AQA flexibility and a framework to incorporate a lot of other products.

One participant expressed concern about the bullet on data sharing and reporting (that it "should develop guiding principles for public reporting and reporting back information to clinicians. Screening processes to ensure valid reporting also should be addressed."). She said that having the reporting part coordinated by AQA (as proposed in a footnote) would set up another hurdle. In response, Isham said that the language was for placeholder purposes only. He also stressed that the document was a "concept document" that includes no presumptions about who is or isn't going to be involved.

How would this board's work relate to ongoing data releases by CMS and other groups? asked another participant. Isham replied that issue would need to be resolved. He stressed that the document only sets up a process, and that the workgroup wants to see a harmonization of efforts. This means meeting the needs of CMS and other major players.

Another participant then suggested operationalizing the principles through the pilot projects. In response, a participant from CMS urged caution. He stressed that adding additional functions to the existing pilots would require new resources (both in dollars and staff).

Motion: To adopt the National Health Data Steward document.

Result: The motion was adopted.

Health Information Technology Subcommittee Report

Turning to the work of the Health Information Technology (HIT) subcommittee, Isham briefly outlined its mission and scope of activities. He said the mission was to "discuss how best to align and apply modern health information technology with the mission and goals of the AQA." He noted that the subcommittee would strive to ensure that its work is consistent with ongoing national HIT activities.

Regarding the scope of activities, Isham said that members had agreed that they would consider four key items:

  1. The attributes and characteristics of networks used to support the digital transmission of relevant clinical and financial information, and to share health data within and across health care communities.
  2. The standardization of software applications used to collect, store, manage, and transmit health care information used in measuring and reporting performance.
  3. The structure and content of digitalized data and data used for physician-level measures collection, aggregation, and reporting.
  4. The guidelines and practices used to ensure data validation and auditing of digitalized quality and performance data.

Isham added that the list did not preclude consideration of other items.

Following Isham's remarks, the first question addressed collaboration with other groups. In response, Isham said that, although the document does not expressly state it, the workgroup assumes that will happen.

A participant asked how the HIT subcommittee's work would complement other efforts, e.g. the American Health Information Community (AHIC). In response, Carolyn Clancy said that the intersection between quality and health information technology still needs fleshing out. She added that earlier discussions about having a separate workgroup for the AHIC on quality measurement concluded that the approach was not practical. Another participant noted that a lot of measures are currently being developed without electronic health records (EHRs) in mind.

Another participant said that it was important that the effort not just be "a slightly different perspective on reinventing the wheel." In response, Isham stressed that the workgroup had held a considerable discussion about not duplicating existing efforts. This subcommittee's aim is to plug into the broader AQA activities, he said.

Motion: To adopt the mission and scope of work of the Subcommittee on Health Information Technology.

Result: The motion was adopted with the understanding that the subcommittee would develop a bullet on patient-centeredness.

Principles for HIT and Measurement Aggregation

Next, Isham turned to the Principles for Health Information Technology and Measurement Aggregation. He said the principles were developed to guide the development and use of HIT systems and components that support performance measurement and reporting.

The proposed principles are as follows:

  1. System design, implementation, and use should minimize costs to consumers, physicians' practices, health plans, and data aggregators.
  2. Open networks, standards, and protocols should be promoted to ensure that compatibility, connectivity, and interoperability characterize the systems used for physician-level quality and performance measurement.
  3. Security and the protection of the privacy of personal health information are imperative.
  4. Software applications for care management (e.g., EHRs, practice management systems, registries) should make standardized quality, performance, and efficiency measurement the routine by-product of their use.
  5. Software applications for care management (e.g., EHRs, practice management systems and registries) should be designed to enable the merger of their data with others for the purpose of facilitating quality improvement efforts or the production of standardized quality, performance, and efficiency measurement.

Following Isham's remarks, one participant suggested substituting a for the in the phrase "the routine by-product of their use" in item No. 4. Another participant, however, thought that the item should stay as is. A third participant proposed deleting "and efficiency measurement" in items No. 4 and No. 5, saying that you need a lot more time when talking about efficiency. Referring to the first comment, Isham said the point is that routine software for other purposes should have this as a routine by-product. Referring to the second, he stressed that the current discussion was about information technology and software, not quality and efficiency.

There was also a question about whether to add a reference to HIPAA in item No. 3. In response, Isham said he felt that, as a principle, the item was very clear about the need to comply with all laws.

Finally, one participant asked whether it was the subcommittee's intent to focus on measurement at the individual level. No, replied Isham, the intent was merely to mirror the language contained in other AQA documents.

Motion: To change the to a in item No. 4 in the Principles for Health Information Technology and Measurement Aggregation to read, "a routine by-product of their use."

Result: The motion was adopted.

Motion: To adopt the AQA Data Sharing and Aggregation Subgroup on Health Information Technology Principles for Health Information Technology and Measurement Aggregation.

Result: The motion was adopted.

HIT Glossary

Isham turned participants' attention to the Health Information Technology Glossary. He said although the glossary was not comprehensive, it was intended to help everyone better understand the topic and the terms. The only comment was from a participant who suggested adding three terms: electronic medical record, electronic health record, and personal health record.

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