Decoding Digital Transformation

In this episode of Quality Matters, host Andy Reynolds is joined by Ed Yurcisin, Chief Technology Officer at NCQA, to break down the complexities of digital transformation in health care quality. Ed explains how NCQA’s push for digital measurement cuts through inefficiencies and inconsistencies in assessing quality. Traditionally, HEDIS® quality measures have existed as large, text-heavy PDFs, leaving room for misinterpretation. By digitalizing these measures into computer code—Clinical Quality Language (CQL)—NCQA removes ambiguity and standardizes interpretation. That makes it easier for health care organizations to implement and use quality measures. This shift reduces administrative burden and helps ensure that quality assessments are more accurate and actionable.

The conversation then shifts to FHIR® (Fast Healthcare Interoperability Resources), a standard designed to streamline health care data exchange. Ed explains that while FHIR might sound intimidating, it’s built on the basic web technologies that power everyday internet browsing. FHIR brings five essential components to the table—JSON files, Rest APIs, standardized value sets, a common data model and government-mandated data exchange. While the government requires organizations to “pitch” data (make data available), there’s no mandate to “catch” data (actually use the data). That means organizations that choose to use the data gain a competitive advantage.

The discussion ends by focusing on data quality, an issue that looms large over digital transformation efforts. Ed introduces the Bulk FHIR Quality Coalition, a collaborative initiative aimed at improving the reliability of data exchanged between health care providers and insurers. Using the analogy of water through pipes, Ed explains that current data-sharing efforts help ensure flow, but don’t always guarantee that data are “clean” enough to be useful. The coalition enhances existing provider–insurer relationships to test and improve large-scale data exchange methods. 

Ultimately, Ed underscores that digital transformation in health care is only as strong as the quality of the data being exchanged. Standardization, accessibility and interoperability are the foundations of progress, ensuring that technology-driven solutions improve enhance outcomes. Digital HEDIS, FHIR and the Bulk FHIR Quality Coalition are examples of how NCQA is reducing measurement burden to streamline measurement and improve quality.