Quality Roadmap

Legend

Priority: H Essential Now M Essential Future L Nice to Have Prerequisites: List of applicable standards Coordination: Other domains to coordinate efforts with.

Strategy: CP Develop Content Profile IP Develop Integration Profile Res Research Applicable Standards Promote Promote Applicable Standards Development Efforts Year: Earliest Opportunity given prerequisites, priority and skills.

Roadmap

Topic	Pri	Standards/Prerequesites	Coord	Strategy	Year
Peer Review Peer review and feedback		ACR RadPeer program AMA/ABMS program using performance measures for peer review of physician hospital groups
Decision support for ordering and procedure approvals		Massachusetts program based on ACR appropriateness criteria (consult with Dr. Keith Dreyer/MGH) Generate justification data when needed (through use of QED?) AQA principles for developing measures of appropriateness ACC/AHA Appropriateness Criteria, decision support tools
Retrospective review of outcomes based on utilization of evolving technologies		NOPR (PET registry) ACRIN/CMS/Brown Univ.
Radiation dose Appropriate aggregation of dose information Minimization of dose to target patient population
Real-time documentation of continuing education and certification (point-of-care CME)		ACCME standards for award of physician CME ABMS MOC requirements Medbiquitous/SCORM
Patient assessment to prevent adverse events
Adverse event reporting		Joint commission requirements (per state) CDC has voluntary and mandatory reporting for some diseases
Measure Reporting Institutional (process) Physician (performance) Core Measure Reporting (AHA?/JCAHO?)		Measures developers (eg, AMA/PCPI, NCQA, ACC/AHA, JCAHO), endorsers, testers and implementers (eg, NQF, AQA)
Data registries Procedure-specific datasets (eg, ACC Carotid Artery Stent Registry) Intermediary point to aggregate date to share with CMS, other destination agencies Gathering quality data (peer review, patient safety, protocols in place and physician use of protocols) from various care settings		Disease management registries: STS, ACC NCDR, Tumor Registry, Trauma Registry, HDC Registry (HRSA) Immunization registries National Practitioner Database
Standardized reporting: develop standard formats for reports (eg, Echo, Cath Lab, Nuc Med) to ensure report has elements needed to collect quality data
Consumer aspects of quality reporting		PHR as record of repeat procedures Consumer view of provider quality information Patient self management Home health monitoring Informed patient consent
Harmonization with other initiatives a. Uniformity of measure import and export formats b. Measuring health delivery disparities across demographic segments (eg, race, gender, socioeconomic status) - AHA Health Research and Educational Trust, HRSA c. Care coordination efforts across disciplines - NQF, CMS d. Structural measures - different groups, data measures (eg, infection control) e. NCVHS hearings in July f. State/provincial/regional quality measures g. AHIC/ONC/HITSP Use Case on Quality i. Patient identity management/tracking of patients across settings h. Expected AHIC/ONC/HITSP Use Case on Adverse Events 3. Consumer aspects of quality reporting a. PHR as record of repeat procedures b. Consumer view of provider quality information c. Patient self management d. Home health monitoring e. Informed patient consent