How NCQA’s New HEDIS® Electronic Clinical Data System Reporting gives HIEs another way to deliver value to Health Plans

How NCQA’s New HEDIS® Electronic Clinical Data System Reporting gives HIEs another way to deliver value to Health Plans

HEDIS-ninja-universe

Health Information Exchanges (HIEs) offer a valuable, interoperable data source, and health plans now have the possibility of better leveraging that data as part of NCQA’s new HEDIS® reporting type, Electronic Clinical Data System (ECDS).

ECDS as a New Reporting Type

HEDIS measures are historically collected in one of three ways – Administrative, Hybrid and Survey, and now NCQA is exploring a new type: ECDS.

Administrative
Gathered from claims, encounter, enrollment and provider systems	Survey
Gathered from a survey
Hybrid
Gathered from administrative and medical record data	
ECDS
Gathered from claims, encounter, enrollment and provider systems, registries, case management

ECDS is an Evolution of Quality Measurement

ECDS measures are designed to inspire the innovative use of electronic clinical data to document high-quality care and provide a more holistic picture of services rendered to a population. NCQA’s ECDS reporting program contains all the data use and reporting rules that are designed to move the quality ecosystem forward to the next generation.

Data systems that may be eligible for ECDS reporting include, but are not limited to, HIEs, member eligibility files, EHRs, clinical registries, administrative claims, electronic laboratory reports, etc. There are 11 ECDS measures currently available. HEDIS Measurement Year 2020 will be the first year an ECDS measure, Prenatal Immunization Status, is publicly reported.

NCQA's HEDIS Electronic Clinical Data Systems (ECDS) Measures

When it comes to implementing ECDS measures, it is important to note that while ECDS measures at a high-level follow traditional HEDIS measure definitions, the specifications are expanded to make it more useful for today’s current “numerous data source” industry. Meaning, the logic required to calculate ECDS measures is much complex than more traditional HEDIS or Electronic Clinical Quality Measures (eCQM).  Think multiple numerators and denominators, with numerous stratifications.

In a previous blog, we discuss the benefit of HIEs that provide services that are both NCQA eCQM and HEDIS® Measure Certified to enable payers to develop a thorough understanding of their populations using claims and electronic quality measurement to make complex inferences, without the added burden. And today, yet again, we are discussing how HIEs can support health plans through HEDIS ECDS reporting. NCQA’s mission to advance quality measurement in support of interoperability and quality improvement is positioning HIEs to be a valuable resource for health plans in bringing this vision to fruition.

A HIE partner that is experienced in navigating the complex technical infrastructure of HIEs, understands nuanced quality requirements and implements complex measure definitions, can support the shared aims of advancing the industry toward improving health outcomes.


Renee Towne

About the Author
Renee Towne
Director of Quality Programs at KPI Ninja, Inc.
Renee provides operational leadership of quality initiatives at KPI Ninja. Towne has a background in occupational therapy, education and experience in operational excellence across a variety of healthcare domains. Based on prior experience as a clinician that drove outcomes patient by patient, she is leaving a larger footprint by improving health care more comprehensively, population by population.


About KPI Ninja
KPI Ninja is a data analytics company that helps healthcare organizations accelerate their quality, safety, and financial goals with a unique combination of software and service. We are differentiated by our signature mix of technology, performance management consulting and healthcare expertise. We don’t merely offer software solutions but work shoulder to shoulder with clients to help them draw on the power of analytics and continuous improvement methodologies to become more efficient. In harmony with our data-centered ethos, we truly believe that our success is strongly co-related with yours.

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