NCQA Launches Coalition to Assess Bulk FHIR Data Quality
October 7, 2024 · Becky Kolinski
Although health care organizations are adopting FHIR® (Fast Healthcare Interoperability Resources) as the standard for exchanging health information, the quality of FHIR data has not been established for quality measurement.
To identify common gaps and challenges limiting organizations from fully utilizing FHIR data, NCQA has launched the Bulk FHIR Quality Coalition. The coalition will perform end-to-end testing of regulated FHIR data, using the real-world use case of digital HEDIS® measurement to assess the state of the industry regarding FHIR data quality.
“We’re excited to embark on this effort to prove that FHIR data can work for digital quality measurement and point the way toward more accurate, complete and useable data,” said Amol Vyas, Vice President, Interoperability at NCQA. “Our customers have been asking for real-world examples of how to leverage FHIR data, and that’s exactly what we’re doing with this coalition.”
How Does FHIR Work?
FHIR, developed by HL7 International, is a health care industry standard for exchanging patient health information. It enables a more connected health ecosystem.
- FHIR uses a set of resources representing data elements such as patients, encounters and claims.
- Implementation guides provide detailed instructions for using FHIR resources, ensuring standardization of data-sharing protocols across health care organizations.
- FHIR’s application programming interface (API) creates a full interoperability solution for health care.
What Is Bulk FHIR?
FHIR APIs typically exchange information for a single patient in real time. Bulk FHIR allows organizations to move large data sets involving thousands of patients asynchronously. A requesting organization can monitor the progress of its query using a link provided by the responding organization, and can retrieve the data output when it is complete.
Digital quality is a perfect use case for Bulk FHIR; for example, to plan outreach for closing gaps in care, a payer can obtain all patient records from a care delivery organization for a defined time period.
What Is the Bulk FHIR Quality Coalition?
The Bulk FHIR Quality Coalition is health care organizations working together to perform real-world testing of FHIR data exchange and share performance metrics. The coalition will have multiple cohorts—each comprising a health care payer and a care delivery organization—working at their own pace to create a FHIR data pipeline by sharing data directly or connecting through a health information exchange.
Representatives from CMS and the ASTP (formerly ONC) are also participating in the coalition as observers.
The Bulk FHIR Quality Coalition has three goals.
Goal #1: Real-world use case for digital quality.
The coalition will demonstrate that we have the necessary components to move to a fully digital state for quality measurement using interoperable data formats at scale. Each cohort will validate the clinical and administrative data collected using regulated APIs for three HEDIS measures in a fully digital format:
- Controlling High Blood Pressure
- Hemoglobin A1c Poor Control (>9%)
- Screening for Depression and Follow Up Plan
These measures are commonly used across many quality measurement programs, including CMS quality programs. NCQA will provide the digital HEDIS data model and measure specifications.
Goal #2: Evaluate the quality of FHIR data.
Cohorts will evaluate the quality of FHIR data on multiple levels:
- Conformance. Do the data match the required format and definitions?
- Completeness. Does the amount and type of data match what is expected?
- Plausibility. Are the data accurate, and do they mirror the data in the source system?
Cohorts will also use the digital HEDIS content to create sophisticated data validation checks and gain deeper insights into FHIR data quality. They can compare HEDIS results from existing reporting processes with new data obtained in the FHIR format to identify gaps or inconsistencies in the FHIR data.
This comprehensive assessment of FHIR data quality will inform the next steps toward full implementation of digital quality measurement.
Goal #3: Identify gaps and provide feedback to regulators/observers.
Several key regulations, including the 21st Century Cures Act and the CMS Interoperability and Patient Access Rule, recommend or require FHIR as the standard for health care data exchange. The coalition will provide feedback as regulators shape future standards for data exchange.
What’s Next?
NCQA anticipates sharing the progress and results of the Bulk FHIR Quality Coalition to help health care organizations advance their digital quality strategy. The first cohort should complete testing within 4–6 months.
Organizations can join the Bulk FHIR Quality Coalition here.
FHIR® is a registered trademark of Health Level Seven International. Its use does not constitute endorsement by HL7.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
The Bulk FHIR Quality Coalition requires HIPAA data-sharing agreements between cohort participants before creating data pipelines. No PHI or PII data are shared outside the production environment.
