Clinical data quality: Build a business use-case for data validation

Improving care quality and performance for value-based contracts is a powerful way to leverage FHIR and data validation initiatives.

By admin

May 2, 2022, 11:00 AM

As the clock ticks toward a year-end health IT interoperability deadline, the industry still struggles with data usability after it’s captured.

The Office of the National Coordinator (ONC) states that patient and provider access to electronic health information is “ready for primetime” through Fast Healthcare Interoperability Resources (FHIR) application programming interfaces (APIs). Health IT developers must provide customers with a certified FHIR API by Dec. 31, 2022. ONC’s Cures Act Final Rule specifies that certified APIs need to be accessible and usable “without special effort” through published, no-cost endpoints — specific internet locations that guide apps to health information on behalf of users.

Nonetheless, a larger challenge runs parallel to ONC’s mandate. “Conformance with FHIR doesn’t tell you the data are good,” explained Brad Ryan, chief product officer at the National Committee for Quality Assurance (NCQA), who leads the organization’s healthcare measurement, evaluation and improvement programs.

“There’s a misconception that interoperability is about formats for exchanging information,” Ryan continued. “It should be about organizations having the same meaning when trying to solve a business problem. Lack of a business case remains the root problem in clinical data quality. The data are inconsistent, incomplete and not trusted, and that causes problems downstream,” he added.

For example, when a physician enters an order into an electronic health record (EHR) system, chances are the order is typically non-standardized and institution specific. Additionally, results frequently lack connection to standards. This scenario leads to the back-end expense of attempting to retroactively apply the proper coding.

The suggested business case, according to Ryan, would be ensuring that data are usable for the purposes of value-based contracting and payment. A standard, independent framework would assess data quality on the front end to confer trust that organizations are being evaluated fairly and consistently on quality measures. “We need to give people visibility that if they make the investment, it will pay off for them financially,” he said. “Let’s tie it to things we all believe will be good outcomes — improving care quality and performance in value-based contracts.”

Putting data quality guidance into action

In December 2021, NCQA announced results of the first cohort of its Data Aggregator Validation program, which evaluates the accuracy of clinical data streams for use in quality reporting, value-based contracting, closing care gaps and other clinical decisions. The validated data came from more than 2,300 ingestion sites representing tens of millions of patients. The process traced data flowing from physician offices and other sources into EHRs. It also examined documentation practices; data capture, integrity checking and mapping; and workflow resilience. Several state- or regional-based health information networks validated their data streams through the program.

Ryan recommended that in coming months “organizations with leverage” — such as the Centers for Medicare and Medicaid Services, large payers and NCQA — align with the initial use cases for front-end data, clearly communicate the intended mapping target, and leverage incentives already in place for quality measurement.

Concurrently, healthcare organizations will be called upon to provide FHIR endpoint information to developers working on APIs. The endpoint resource should include the business name of the organization as well as contact information for addressing technical issues. The endpoint resource should be placed on the FHIR server to enable automatic downloading and ingestion, while information about the FHIR server should be made publicly available via the organization’s National Plan and Provider Enumeration System entry used to assign unique identifiers across healthcare.

By taking steps toward standardization and validation of clinical data, healthcare organizations can broaden the scope of use cases and discover how true interoperability closes existing gaps in care.

Frank Irving is a Philadelphia-based content writer and communications consultant specializing in healthcare, technology and sports.