NQF Framework Aims to Improve Interoperability Measurement

The National Quality Forum (NQF) recently released a final report to assist in the measurement of healthcare interoperability meeting its definition under federal law.

The common measurement framework is designed to identify existing measures that effectively measure interoperability as well as gaps where improved or new measures are needed. “This interoperability framework aspires over time to meet the definition of interoperability described in the 21st Century Cures Act,” stated the report.

In accordance with the enacted bill, NFQ designed the framework to enable seamless, secure health data access, exchange, and use. The organization the measurement framework and measure concepts in response to a request from HHS to address current gaps in interoperability measurement.

To create the framework, NQF first interviewed key informants with knowledge about interoperability and conducted an environmental scan. Next, NQF convened a multi-stakeholder interoperability committee to gather feedback from healthcare experts and establish guiding principles for the framework.

The interoperability committee developed a set of guiding principles for the framework: 

• Interoperability is more than EHR to EHR, and all sources of data should be taken into consideration
• Various stakeholders with diverse needs are involved in the exchange and use of data, and the use of this framework and measure concepts will differ based on stakeholder perspectives.
• The term “electronically exchanged information” is more appropriate to completely fulfill the definition of interoperability, as it is more congruent with accepted definitions and aligns with the intent of the Shared Nationwide Interoperability Roadmap developed by ONC, which emphasizes bidirectional and multidirectional exchange among diverse information systems, and moves the framework closer to the goals described in the 21st Century Cures Act.
• Interoperability needs will differ depending on the care setting and maturity.
• All critical data elements should be included in the analysis of measures as interoperability increases access to information. 

The measurement framework spans several categories that address electronic health data exchange, usability of exchanged data, application of exchanged data, and the impact of interoperability.

Each category is further divided into subcategories discussing subjects including relevance, accessibility, care coordination, patient safety, and others.

Interviewed informants also made the following recommendations to operationalize the interoperability framework: 

• An evaluation of current outcomes and/or process measures considered for inclusion in the framework must commence to determine if the measure would benefit from interoperability.
• Current measures may not demonstrate the full spectrum that could benefit from an interoperable environment. When identifying gaps, it is best to assume that complete interoperability had been achieved as this would allow stakeholders to identify areas of measurement without the constraints of current implementation barriers.
• When evaluating both current measures and measure concepts, there is a need to create a test environment to validate interoperability sensitive measures and to determine the data sources that capture that information. The test framework would assist in prioritizing measures by identifying those that have the most impact on clinical quality, patient experience, and reduction in the costs of care.
• The framework needs to provide guidance on how to gather high-integrity data that will provide accurate, consistent, and timely information.
• The measurement of interoperability should show both the extent to which data exchange and use leads to better outcomes as well as reduced costs.

Beyond the framework, NFQ also developed measures and measure concepts.

The forum defines measure concepts as “an idea for a measure that includes a description of the measure, including a planned target and population.”

In addition to improving interoperability measurement, the interoperability framework and measure concepts are also intended to minimize provider burden whenever possible.

Similarly, ONC is in the process of convening several multistakeholder meetings to develop a standardized health data exchange framework in an effort to fulfill provisions in the Cures Act.

The trusted exchange framework and common agreement will utilize feedback from these meetings as well as several subsequent public comment periods to improve interoperability and interoperability measurement.