The Challenges of Implementing Quality Measures in Healthcare

Quality measures have been a vital and important part of the 21st century revamp in productivity. This new and improved aspect of productivity and quality measures is also true for Quality Measures in Healthcare. However, there have been some challenges that the industry has faced. Two of these biggest challenges are Missing Data and Data integrity. Discussed below.

Missing Data

E-measures are calculated using only the structured data collected by the certified EHR technology (CEHRT). If an e-measure data element is not in the CEHRT, it can skew the accuracy of how the e-measure is calculated. For example, if the date and time a urinary catheter is inserted for an emergency department (ED) patient resides in the ED information system and not in the CEHRT, the EHR will be unable to accurately calculate the relevant Catheter-Associated Urinary Tract Infection (CAUTI) e-measures. To address the problem, healthcare providers may need to create or update several interfaces between the CEHRT and department or specialty modules. Alternatively, organizations using an enterprise data warehouse (EDW) may be able to leverage this tool to create the complete data sets needed to improve e-measure reporting accuracy.

Data Integrity

Another possible cause of e-measure inaccuracies is the integrity of the data. This accuracy is often caused by documentation, workflow variation or human error. Take, for example, a scenario in which the hospital EHR is set up to automatically capture a patient’s arrival time as they are being registered with the emergency department. This may seem like an efficient way to collect patient information from the registration workflow but what if the patient is triaged first and then registered? In this case, a change in the workflow produces an inaccurate ED arrival time, which affects the accuracy of any e-measures using this data.


But despite these problems, there are solutions that can and have been implemented. The following solutions can help mitigate some challenges of Quality Measures in Healthcare.



Prioritize measures that impact patient care

The number one goal of any healthcare organizations should be to always offer and continuously improve patient care and outcomes. Patient safety measure like surgical site infection and Central Line Associated Bloodstream Infection (CLABSI) should be part at the top of the priority list and part of the safety measures revisited frequently. Performing poorly on patient safety measures means not doing well by patients and leaving money that could have been earned on the table. So patient safety and patient harm measures should always be included in organizational scorecards, but care must be taken of how your internal goals align with benchmarks and thresholds identified in the pay-for-performance programs.

Have a line-of-sight to reimbursement

Financial considerations need to be monitored in addition to those related to quality and safety. When this is ignored the quality of care could start to decline because of lack of motivation. Doctors and nurses work long hours and work hard continuously when their reimbursements methods or even amount are ignored by the organization’s, there’s bound to be a drop in morale which will affect the quality of care. It’s important to look at the alignment of measures across programs, understand the reimbursement tied to each one, and then make informed decisions about which ones to support the most.

Having tools available to show not only clinical performance on quality measures but also the projected payment impact of that performance, allows an organization’s clinical and finance teams to work together to make informed decisions on prioritization of improvement efforts.Sometimes great clinical improvement work isn’t tied to any reported measures, but it still deserves financial recognition. Having this awareness and connection between quality reporting and reimbursement can help to then continually improve the existing pay-for-performance program.

Involve the right people

Always include financial and clinical leadership. Financial leadership plays the role of creating a budget based on performance in these programs, and clinical leadership plays the role of tracking monitoring performance and delivering the outcomes of improvement in work. This includes the department within an organization that is responsible for paying contractors as well. A strong connection with this team is critical to set measurable goals with commercial payers that align with the efforts required of government programs.