The Top Three Challenges in Transitioning to Digital Quality

August 30, 2024 · Becky Kolinski

NCQA is working with customers as they navigate the transition to digital quality measurement. We asked Allison Lance, NCQA’s Director, Digital Quality Community, to give us her insight into the challenges health care organizations are facing during the process.

Before joining NCQA, Lance worked for a large population health and EHR vendor, where she focused on the market strategy for interoperability and was a product manager for quality measurement programs. In those roles, she learned firsthand about the challenges of integrating FHIR^® (Fast Healthcare Interoperability Resources) data into business operations.

She brings that perspective to her role at NCQA, where she is responsible for building and sustaining the digital quality community. Here’s what she has to say about the transition.

What Are the Challenges in the Transition to Digital Quality Measurement?

We see three main challenges among our customers.

Challenge 1: Accessing Clinical Data

Traditionally, quality measures—such as NCQA’s HEDIS^® (Healthcare Effectiveness Data and Information Set)—are based on claims and other administrative data sources, with chart reviews to supplement the data. In a digital world, organizations that report HEDIS measures will obtain clinical data from EHRs. But accessing clinical data from EHRs is challenging:

• Organizations need permission from providers and health systems to access clinical data and share it with their vendors.
• Organizations must develop new processes to obtain data from EHR vendors.
• Because data are housed in multiple EHRs, this must be repeated multiple times.

How to Get Started: Create an inventory of your large providers and the EHRs they use. Prioritize high-volume vendors. Start with a pilot program to integrate data from one vendor and slowly add data from other vendors. Partner with an intermediary data aggregator to gain scale by accessing data from multiple providers and EHR vendors.

Challenge 2: Making FHIR Data Useable

EHR systems are built in one language, health plan and vendor systems are built in another. FHIR is a standard for exchanging health care information electronically among different systems. It acts as a bridge between these systems and allows them to talk to each other. But each side must translate their data into/out of the FHIR standard format. That’s where data mapping comes in. Mapping FHIR data is challenging:

• There are gaps in the data. The United States Core Data for Interoperability (USCDI) defines the clinical data elements that EHR vendors are required to provide, but not all the data elements needed for HEDIS reporting are included in USCDI.
• There are multiple data types. Organizations reporting HEDIS must include enrollment, claims and clinical data. All source data must be mapped to a standard FHIR format, such as USCDI for clinical data or CARIN Blue Button for claims data.

How to Get Started: Analyze your systems to create a current and future state so you can identify gaps. Engage your technical team in analyzing what’s required in the transition to FHIR. Talk to your data providers and vendors about the opportunity for pilot programs. And join NCQA’s Bulk FHIR Quality Coalition to participate in real-world testing.

Challenge 3: Building Infrastructure

The move to digital quality will improve accuracy and efficiency of quality measurement by leveraging standards-based, policy-driven clinical and claims data. Organizations will need to make an upfront financial and resource investment in infrastructure to achieve these benefits. But building infrastructure is challenging:

• Organizations and vendors have proprietary systems to calculate and report HEDIS measures.
• These systems will need to be replaced with Clinical Quality Language (CQL) engines to calculate measures.
• Organizations need to create pathways to incorporate data into their downstream systems for population health and quality improvement activities.

How to Get Started: Start formulating a transition strategy with your IT team and vendors. Ask vendors and trade associations about pilot programs for testing digital quality measures. Get involved in NCQA’s Digital Quality Implementers Community to find out how other organizations are handling the transition.

How Is NCQA Helping Organizations Navigate These Challenges?

It’s easy to get stuck in the planning phase. Our advice is to keep moving forward—whether that means joining a pilot project or providing FHIR or CQL training for your technical team. And know that no matter what challenges you face, other organizations are dealing with similar issues, and there is a community of digital quality adopters who can help.

NCQA’s Digital Quality Hub contains information and resources to support health care organizations in the transition to digital quality measurement. We’re committed to making digital quality measurement a reality.

Join us at NCQA’s Health Innovation Summit in Nashville, October 31–November 2. There’s even a learning track dedicated to digital quality!

Get quick responses to your questions and comments through My NCQA. Choose PCS, then select Digital Community as the Product/Program Type.