[Federal Register Volume 77, Number 140 (Friday, July 20, 2012)]
[Pages 42738-42740]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-17530]



Agency for Healthcare Research and Quality

Request for Information on Quality Measurement Enabled by Health 

AGENCY: Agency for Healthcare Research and Quality (AHRQ), Health and 
Human Services (HHS).

ACTION: Notice of Request for Information (RFI).


SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) requests 
information from the Public, including diversified stakeholders (health 
information technology (IT) system developers, including vendors; 
payers, quality measure developers, end-users, clinicians, health care 
consumers) regarding current successful strategies and challenges 
regarding quality measurement enabled by health IT. Quality 
measurement--the assessment of the timeliness, completeness and 
appropriateness of preventive services, diagnostic services, and 
treatment provided in health care--has been most generally conducted 
via paper chart information capture, manual chart abstraction, and the 
analysis of administrative claims data.

DATES: Submit comments on or before August 20, 2012.

ADDRESSES: Electronic responses are preferred and should be addressed 
to [email protected]. Non-electronic responses will also be 
accepted. Please send by mail to: Rebecca Roper, Agency for Healthcare 
Research and Quality, Attention: HIT-Enabled QM RFI Responses, 540 
Gaither Road, Room 6000, Rockville, MD 20850, Phone: 301-427-1535.

FOR FURTHER INFORMATION CONTACT: Please identify in the subject line of 
emails that you are inquiring about the ``Question about HIT-enabled QM 
RFI''. Contact Angela Nunley, email: [email protected], Phone: 
301-427-1505, or, Rebecca Roper, email: [email protected], 
Phone: 301-427-1535.



    Health information technology (IT), such as, electronic health 
records (EHR) which may include clinical decision support and health 
information exchange, has seen a tremendous increase in adoption in 
recent years. Some institutions have successfully used health IT to 
generate health IT-enabled quality measures which may be retooled 
versions of established paper-based or administrative data-driven 
quality measures or (preferably) they are ``de novo'' quality measures 
that were developed with the capabilities of health IT in mind. These 
new health IT-enabled quality measures seek to leverage the use of 
electronic clinical data capture, analysis and reporting to measure and 
report electronically enabled quality measures in order to facilitate 
improvements in the quality of care provided. AHRQ supports research to 
improve health care quality through enhancements in the safety, 
efficiency, and effectiveness of health care available to all 
Americans. Through this RFI, AHRQ is seeking information related to 
successful strategies and/or remaining challenges encountered regarding 
the development of health IT-enabled quality measure development and 
    Health IT has the potential to advance quality measurement and 
reporting through the use of efficient automated data collection, 
analysis, processing,

[[Page 42739]]

and its ability to facilitate information exchange among and across 
care settings, providers, and patients. Quality measurement enabled by 
health IT, referred to as health IT-enabled quality measurement, is an 
emerging field. There are numerous perspectives on how to achieve the 
future state of quality measurement. These varied perspectives 
sometimes include competing choices and challenges: (1) Underdeveloped 
or unavailable infrastructure (e.g., whether the measure set should be 
extensive or parsimonious); (2) incompleteness of the measure set 
(e.g., developing measures that matter to consumers, how to measure 
value); and (3) technology challenges (e.g., how might unstructured 
data be captured in the EHR to be used for measurement, if and how to 
integrate patient-generated and clinician-generated data).
    In preparation for the development of this RFI, AHRQ generated a 
high-level overview of the current state of quality measurement through 
health IT, challenges facing the advancement of quality measurement 
enabled by health IT, a partial catalog of current efforts seeking to 
address those challenges, and, possibilities for the next generation of 
health IT-enabled quality measurement. This report, ``An environmental 
snapshot--Quality Measurement Enabled by Health IT: Overview, 
Possibilities, and Challenges'' can be found at http://healthit.AHRQ.gov/HealthITEnabledQualityMeasurement/Snapshot.pdf.
    AHRQ is committed to garnering further insight in order to 
facilitate meaningful advancements in the next generation of quality 
measurement. Through this Request for Information AHRQ is seeking 
information on the building blocks of health IT-enabled quality 
measurement in terms of perspectives, practicalities, and priorities. 
Responses will be used in conjunction with deliberative activities to 
inform the development of a summary report to be released to the public 
approximately in summer 2013.
    Respondents should note that this Request for Information is 
completely voluntary; respondents are welcome to address as many of the 
questions posed as they wish. AHRQ would appreciate if you clearly 
indicate the number of the question area to which you are providing a 
response. This RFI is for planning purposes only.
    Responses to this are not offers, cannot be accepted by the 
Government to form a binding contract, and are not intended to 
influence regulation.

Questions Regarding Quality Measurement Enabled by Health IT

    1. Briefly describe what motivates your interest in clinically-
informed quality measures through health information technology. To 
what extent is your interest informed by a particular role (e.g., 
provider, payer, government, vendor, quality measure developer, quality 
improvement organization, standards organization, consumer advocate) in 
this area?
    2. Whose voices are not being heard or effectively engaged at the 
crucial intersection of health IT and quality measurement? What non-
regulatory approaches could facilitate enhanced engagement of these 
    3. Some quality measures of interest have been more difficult to 
generate, such as measures of greater interest to consumers, measures 
to assess value, specialty-specific measures, measures across care 
settings (i.e., measures enabled by health information exchange), and 
measures that take into account variations in risk. Describe the 
infrastructure that would be needed to ensure development of such 
    4. What health IT-enabled quality measures, communication channels, 
and/or technologies are needed to better engage consumers either as 
contributors of quality information or as users of quality information?
    5. How do we motivate measure developers to create new health IT-
enabled quality measures (which are distinct from existing measures 
which were retooled into electronically-produced quality measures) that 
leverage the unique data available through health IT? Please provide 
examples of where this has been successfully. What new measures are in 
the pipeline to leverage data available through health IT?
    6. Describe how quality measurement and ``real-time'' reporting 
could inform clinical activity, and the extent to which it could be 
considered synonymous with clinical decision support.
    7. Among health IT-enabled quality measures you are seeking to 
generate in a reliable fashion, including the currently proposed 
Meaningful Use Stage 2 measure set, what types of advances and/or 
strategies for e-measure generation if pursued, would support more 
efficient generation of quality measures?
    8. Many EHR, HIE, and other health IT vendors are developing 
software code to support measures. Tools such as the Measure Authoring 
Tool (MAT) were created to improve efficiencies in the process of 
creating and implementing eMeasures. What additional approaches might 
be used to enable consistent, accurate, and efficient quality 
measurement when using health IT?
    9. How do you see the establishment and adoption of data standards 
impacting the future of health IT-enabled quality measurement? For what 
types of quality measures should a combination of natural language 
processing and structured data be considered?
    10. Much support has been voiced for the need of longitudinal data 
in quality measurement. What are the strengths and weaknesses of 
different information architectures and technologies to support health 
IT-enabled quality measurement across time and care settings? How can 
data reuse (capture once, use many times) be supported in different 
models? What examples might you provide of successful longitudinal 
health IT-enabled quality measurement (across time and/or across 
multiples care settings)?
    11. What are the most effective means by which to educate providers 
on the importance of health IT-enabled quality measurement and how 
clinical information is used to support health IT-enabled quality 
measurement and reporting? How can providers be better engaged in the 
health IT-enabled quality measurement process?
    12. What is the best way to facilitate bi-directional communication 
between vendors and measure developers to facilitate collaboration in 
health IT-enabled measure development?
    13. To what extent do you anticipate adopting payment models that 
use quality measurement informed by electronic clinical records (as 
opposed to exclusively using claims data)? What strategies are you 
pursuing to gain access to clinical data and test the reliability of 
health IT-enabled clinical outcome measures? How do you anticipate 
sharing quality measure results with consumers and other stakeholders?
    14. What tools, systems, and/or strategies has your organization 
been using to aggregate information from various EHRs and other health 
IT for use in quality measurement? What strategies is your organization 
pursuing to move toward greater automation in quality measurement?
    15. Please describe scalable programs, demonstrations, or solutions 
(domestic or internationally) that show material progress toward 
quality measurement enabled by health IT.

Reference Material

    Anderson KM, Marsh CA, Isenstein H, Flemming AC, Reynolds J. An 
Environmental Snapshot: Health IT-

[[Page 42740]]

enabled Quality Measurement: Efforts, Challenges, and Possibilities 
(Prepared by Booz Allen Hamilton, under Contract No. 
HHSA2902009000241.) AHRQ Publication No. 12-0061-EF. Rockville, MD: 
Agency for Healthcare Research and Quality. July 2012. See: http://

    Dated: July 13, 2012.
Carolyn M. Clancy,
AHRQ Director.
[FR Doc. 2012-17530 Filed 7-19-12; 8:45 am]