Thomas R. Barr, MBA
In 2011, the Medicare Electronic Health Record (EHR) Incentive Program began paying physicians and hospitals for the measurement and reporting of performance metrics through the utilization of certified electronic medical record (EMR) software. This epic program began in earnest the irrevocable shift in the provision of healthcare from an individual craft-based art to a structured, evidence-based system. The EHR Incentive Program has three specific phases that progressively build from data capture and reporting, through clinical process refinement, to the final goal of achieving measurably improved healthcare outcomes.1
Currently, we are in the first phase of this transition, and in oncology, trends are emerging about what metrics are important to three key groups—patients, payers, and providers. Each seeks improvements to quality and lower—or at least stable—costs for cancer care. The broad utilization of EMR technology has, for the first time in history, enabled systematic measures of care delivery on a broad scale.
While management of clinical care using modern information technology is important to providers and payers of oncology care, it is critical to those of us who have a cancer diagnosis in our family or in our future— and that is just about everyone. Providers must participate in the move to active measurement of clinical variables or become obsolete. They must also integrate reporting and measurement of important process measures into routine clinical management. Payers have a critical role in promoting this technology adoption. They are positioned to promote payment methodologies that support and reward clinical measurement. Without such support, innovative practices suffer economically as they push toward rational care. We all should expect basic quality process measures that are indicative of good clinical management of cancer care for our families and ourselves. Successful payers and providers will encourage patients to seek care where these quality indicators are available and exemplary.
Three visions of performance metrics in oncology were presented at the Cancer Center Business Summit held October 11-12, 2012, in Fort Worth, Texas. The theme of the conference was transitioning to value-based oncology, and most of the program content, including the full program that is summarized in this article, is available online.2
While the three perspectives are different, there were consistent themes throughout. All speakers endorsed the use of available data, keeping metrics simple, delivering measurements to the care providers who can affect the numerator, and showing these providers how they compare with peers. The speakers all understand that current payment methodology does not support process optimization, yet view that as a transitional barrier that will not persist.
Figure 1. Survey Data Showing Who Is Entering Information Into the EMR
Within your practice, who is primarily responsible for entering information for the following data fields?
I presented the three criteria that are generally accepted for choosing clinical performance measures.3
To be successful, measures must be important, scientifically sound, and feasible. Importance is measured by the relevance of the measure to patients and providers and the promise that being measured offers improvement. To be scientifically sound, there must be substantial, explicit evidence with validity, reliability, and sufficient specificity to patient factors to be clinically useful. Feasibility requires an explicit definition of the numerator and denominator needed for the measure from data that are available at low cost and with low administrative burden. Today, the fact is that payment drives process measurement, and most systematic data are about billing, not about medical care. The EHR Incentive Program, coupled with many providers and payers seeking a departure from fee for service, are factors driving oncology data feasibility toward important, scientifically sound measurements.