NCQA Establishes Bulk FHIR Quality Coalition
To identify common gaps and challenges limiting organizations from fully using FHIR data, NCQA has launched the Bulk FHIR Coalition. The coalition will perform end-to-end testing of regulated FHIR data, using the real-world use case of digital HEDIS measurement to assess the state of the industry regarding FHIR data quality.
During a conference presentation a few years ago, Dana Gelb Safran, Sc.D., president and CEO of the National Quality Forum (NQF), said that the work done by the Office of the National Coordinator for Health IT on Bulk FHIR will eventually lead to new ways to use clinical data in the EHR for measurement, rather than having to rely on claims data.
FHIR offers a standardized way to transmit information about an individual patient from one provider to another or from a provider to a health plan. “Bulk FHIR allows us to do that on a population,” Safran explained, “so it really begins to open up the possibility of low-burden, high-fidelity ways of using data from the clinical record to source our measurement.”
As NCAQ explains it, FHIR APIs typically exchange information for a single patient in real time. Bulk FHIR allows organizations to move large data sets involving thousands of patients asynchronously. A requesting organization can monitor the progress of its query using a link provided by the responding organization, and can retrieve the data output when it is complete.
“We’re excited to embark on this effort to prove that FHIR data can work for digital quality measurement and point the way toward more accurate, complete and useable data,” said Amol Vyas, Vice President, Interoperability at NCQA, in a statement. “Our customers have been asking for real-world examples of how to leverage FHIR data, and that’s exactly what we’re doing with this coalition.”
The Bulk FHIR Quality Coalition will involve healthcare organizations working together to perform real-world testing of FHIR data exchange and share performance metrics. The coalition will have multiple cohorts—each comprising a payer and a care delivery organization—working at their own pace to create a FHIR data pipeline by sharing data directly or connecting through a health information exchange.
Representatives from CMS and the ASTP (formerly ONC) are also participating in the coalition as observers.
The Bulk FHIR Quality Coalition has three goals:
Goal #1: Real-world use case for digital quality.
The coalition will demonstrate that we have the necessary components to move to a fully digital state for quality measurement using interoperable data formats at scale. Each cohort will validate the clinical and administrative data collected using regulated APIs for three HEDIS measures in a fully digital format:
Controlling High Blood Pressure
Hemoglobin A1c Poor Control (>9%)
Screening for Depression and Follow Up Plan
These measures are commonly used across many quality measurement programs, including CMS quality programs. NCQA will provide the digital HEDIS data model and measure specifications.
Goal #2: Evaluate the quality of FHIR data.
Cohorts will evaluate the quality of FHIR data on multiple levels:
Conformance. Do the data match the required format and definitions?
Completeness. Does the amount and type of data match what is expected?
Plausibility. Are the data accurate, and do they mirror the data in the source system?
Cohorts will also use the digital HEDIS content to create sophisticated data validation checks and gain deeper insights into FHIR data quality. They can compare HEDIS results from existing reporting processes with new data obtained in the FHIR format to identify gaps or inconsistencies in the FHIR data.
This comprehensive assessment of FHIR data quality will inform the next steps toward full implementation of digital quality measurement.
Goal #3: Identify gaps and provide feedback to regulators/observers.
Several key regulations, including the 21st Century Cures Act and the CMS Interoperability and Patient Access Rule, recommend or require FHIR as the standard for healthcare data exchange. The coalition will provide feedback as regulators shape future standards for data exchange.
NCAQ notes that the Bulk FHIR Quality Coalition requires HIPAA data-sharing agreements between cohort participants before creating data pipelines. No PHI or PII data are shared outside the production environment.
