QMIR: Modernizing healthcare quality measures for enhanced user experience and adaptability

In 2014, Congress passed the Improving Post-Acute Care Transformation (IMPACT) Act. This law standardized the submission and reporting of quality measure data collected by Long-Term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs), Skilled Nursing Facilities (SNFs), and Home Health Agencies (HHAs). These data allow the Centers for Medicare & Medicaid Services (CMS) to track Meaningful Measures across Post-Acute Care (PAC) providers—high-priority aspects of care that CMS has determined need measurement and improvement. The Meaningful Measures initiative has a goal to improve health outcomes for patients, “empowering people to make informed care decisions while also reducing burden on clinics and hospitals.”

The technology and systems used to store, manage, and support these quality measures were, in some cases, out of date. Those processes reflected the technologies used to develop the software at the time, and some could be considered cumbersome and time consuming, thereby presenting challenges for post-acute care providers. Our charge was to step in and help CMS modernize these systems to create efficiencies in how CMS collects, computes, shares, and publicly displays quality measures data.

What are quality measures, and how are they used?

Per CMS, quality measures are “tools that help us measure or quantify healthcare processes, outcomes, perceptions, and organizational structures and/or systems that are associated with the ability to provide high-quality health care.” PAC providers submit patient assessment data from the point they are deemed in compliance with the ‘Conditions of Participation’ to participate in the Medicare program and can accept and provide care to program beneficiaries.

Quality measures have both internal and external applications. Internally, quality measures help CMS track overall trends in the quality of care its PAC providers deliver. Externally, quality measures are valuable to providers who want to receive feedback on their process improvement efforts and see how they stack up against other providers in their state or across the nation. Also, quality measures are publicly reported, allowing the public to view a provider's performance at a high level.

Assessment-based quality measures require collection, analysis, and calculation of raw data to create output. On the collection side, we partnered with CMS to develop the patient assessment and survey and certification data collection aspects of the Internet Quality Improvement and Evaluation System (iQIES), a cloud-based application that supports collection and storage of assessments and surveys. Through the Quality Measures Implementation and Reporting (QMIR) contract, we are modernizing the analysis and calculation aspects, making it easier for the federal government, states, providers, and other stakeholders to access the information in iQIES by increasing efficiencies and improving the user experience (UX).

New tools and strategies to implement quality measures

The iQIES project modernized the technology stack of the systems used to collect patient assessment data and manage the generation of the quality measures data, making it easier for both end users and developers working with the system. For example, users can now access iQIES anywhere via the web, from a computer or mobile device, rather than through the CMS network, reducing the burden on PAC providers who need to submit data and access reports.

As part of the iQIES program, the QMIR teams take advantage of modernization by shifting data processing and reporting into a cloud-based ecosystem. For instance, quality measures are currently transitioning to Apache Spark, which will significantly speed up the calculation of complex data transformations and analysis due to its design for parallel processing and faster computational capabilities. This helps our teams quickly process numerous assessment records and quality measures to generate a wide range of reports for users. Additionally, Spark uses a wide range of data libraries beyond SQL-like operations that make it versatile in integrating data from different sources such as the Centers for Disease Control and Prevention (CDC) and Medicare claims-based measure data for various processing and analytical tasks.

This range of tools gives our teams the flexibility to respond to rapid, complex, and sometimes unexpected events. PAC providers can request to the CMS policy teams to suppress their data in case they find evidence of errors. Additionally, policy decisions or, in rare cases, national disasters such as hurricanes, can affect how and when we report measure data. To better respond to these events, the iQIES program adheres to Scaled Agile practices to the extent possible in an effort to allow teams to pivot and execute changes quickly when necessary or warranted. This ensures users—including PAC providers and the public—have accurate information as quickly as possible.

Reimagining UX for quality measures

Building on the efficiencies facilitated by the iQIES program, the QMIR project seeks to improve the legacy applications’ reporting capabilities and overall user experience. The project incorporates human-centered design (HCD) processes such as semi-structured interviews, surveys, interactive prototyping, and usability testing to help deliver an optimal, intuitive platform for end users. Quality measures reports have been reimagined and redesigned to make better use of space while conveying more information.

Take one quality measure—the Transfer of Health Information (TOH)—as an example. CMS identified several healthcare priorities and goals, one of which relates to promoting effective communication and care coordination. As a result, TOH measures were developed to evaluate the timely transfer of health information, specifically the reconciled medication list, when a patient or resident is transferred to another healthcare provider or discharged to the community to ensure the new provider or patient/caregiver has the patient’s active medication list they need to reduce the risk of complications and medical errors. In iQIES, PAC providers are asked whether the reconciled medication list was transferred to the subsequent healthcare provider or the resident, family and/or caregiver, depending upon the discharge disposition location. Our system then processes the submitted assessment data and reports the measure results that are:

• available in an existing iQIES report for PAC providers to help them improve their patient care processes, which leads to better patient outcomes.
• going to be delivered to CMS for display on the Care Compare website, where patients, families, caregivers, clinicians, and other members of the public can compare and evaluate providers to make informed care decisions.

QMIR conducts this process for all four PAC settings (IRF, LTCH, HHA, and SNF), and reports can be run for organizations that administer more than one care setting.

Tap into ICF’s federal product management expertise

ICF’s successful partnership with CMS is rooted in our approach to product management, which bridges the gap between policy and technology. We have in-house experts who understand and closely monitor CMS’ policies regarding quality measure development and implementation. We pair those domain experts with technologists to create cross-cutting fusion teams. This ensures that we’re choosing the solutions to deliver mission impact—not building technology for technology’s sake.

To learn more about how ICF’s unique approach to product management can benefit federal agencies, read our iQIES case study.