Question

• Evaluate the National Committee for Quality Assurance’s (NCQA) impact on health information systems.

Answer 1

The National Committee for Quality Assurance (NCQA) is an independent  nonprofit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. The National Committee for Quality Assurance operates on a formula of measure, analyze, and improve and it aims to build consensus across the industry by working with policymakers, employers, doctors, and patients, as well as health plans.

A national effort to reform primary care, known as the Patient-Centered Medical Home (PCMH), requires fulfillment of six standards determined by the National Committee for Quality Assurance to

• enhance access and continuity,
• identify and manage patient populations,
• plan and manage care,
• provide self-care and community support,
• track and coordinate care,
• measure and improve performance.

Information technologies play a vital role in the support of most, if not all, of these standards. However, given the newness of the PCMH, little is known on how health information technologies (HITs) have been employed to accomplish these objectives.

The utilization of HITs such as EHRs offer unique opportunities to track improvements in disease management resultant from process changes. Further, the EHR allows practice teams to use patient data to drive quality improvements, such as through the use of a monthly “run chart” to identify the effect of various clinical initiations (e.g., identifying the effect of giving nurses standing orders for the fu vaccine on rates of vaccine receipt). By implementing the role of care managers and other team members in chronic illness care for diabetes, among other quality improvements, practices are able to track changes in measures such as hemoglobin A1c, cholesterol, and blood pressure.Health information technologies offer primary care practices the opportunity to fulfill this NCQA standard by allowing for the tracking, follow-up, and coordination of patient tests, referrals, and outside care. The ability to coordinate patient care is particularly critical in team-based care approaches, where different members of the care team need access to the patient’s records and current measures both within and outside the primary care setting. For example, the ability to track eye exam referrals and other specialist referrals is a quality measure that is frequently challenging to follow-up. An EHR allows the opportunity to track the referral and whether the patient was evaluated by ophthalmology, diabetes education, or laboratory testing.NCQA standard requires primary care practices to assess patient and family self-management abilities and then work with them to develop a plan for self-care, providing tools and resources. Achieving this standard is likely the greatest challenge to primary care clinics, which infrequently have focused on care outside the clinic setting. However, it also offers a tremendous opportunity for HITs, which may be ideal to reach patients in real-world settings. For example, a patient portal may be utilized by a practice to assess their patients’ abilities to care for their noted health conditions, set self-management goals, and then direct them to appropriate resources and tools, either online or in person (e.g., local exercise programs, medications assistance programs). Group Health offers patients the opportunity to complete an EHR assessment and then enroll in peer-led self-management support workshops.By interfacing with systems that collect data from glucose meters and an EHR, computer-assisted decision support programs can integrate blood glucose values, medications, and laboratory values to generate recommendations to providers for further adjustments to improve diabetes control.For example, the use of web-based glucose uploading and resultant insulin titrating has been shown to improve hemoglobin A1c in type 2 diabetes.Telemedicine, the provision of health care services such as monitoring through information technology, also presents a HIT domain in need of further development.Diabetic eye care is an area that has been explored as a focus of telemedicine to meet evidence-based guidelines for care

National Committee for Quality Assurance Standards for a Patient-Centered Medical Home and Examples of Achieving These Standards through Health Information Technologies in Diabetes Care

Enhance access and continuity

Receives and processes electronic requests for follow-up visits and prescription refills via a patient portal

Identify and manage patient populations

Uses a patient registry to systematically and proactively remind patients and clinicians of needed services (e.g., urine microalbumin screening and eye exams)
Proactively identify high-risk patients (e.g., elevated hemoglobin A1c) not seen for 6 months with outreach call for a return visit

Plan and manage care

Electronically documents medication lists to facilitate ongoing medication reconciliation and monitor patient adherence.Decision support reminders to clinicians for overdue tests.Previsit screening of patients through questionnaires

Provide self-care and community support

Electronically documents self-management goals and available community resources (e.g., local exercise programs, medication assistance programs)

Track and coordinate care

Electronically tracks ophthalmology and other specialist referrals

Measure and improve performance

Electronically reports diabetes clinical quality measures to external entities (e.g., federal or state government, payers, and, ultimately, public reporting) to benchmark data to drive quality improvement.Identification of high utilization patients (e.g., frequent emergency department admissions) for targeted interventions