The National Quality Forum has endorsed 70 measures designed to increase the use of electronic data platforms to measure, report and improve quality of healthcare.

NQF, officials say the measures combine data from two or more common electronic sources such as administrative claims, pharmacy and laboratory systems and registries. Fifteen of the most robust endorsed measures use clinical data elements from personal health records, electronic health records or case management registries. The measures cover 16 conditions, including bone and joint conditions, cardiovascular disease, asthma and respiratory illness and diabetes.

The NQF has also recommended ways to harmonize physician-level performance measures used by different health plans.

The foundation's steering committee on clinically enriched administrative data sources, co-chaired by Charles Cutler, MD, an internist and former national medical director at Aetna, identified three levels of measures based on data source and complexity of methodology. They are:

• Level one measures, which collect data from a single, electronic administrative data source such as encounter or pharmacy claims. Many current quality improvement measures rely on administrative data like claims data that only provide one piece of information, such as a charge for a doctor's visit or an ordered lab test.
• Level two measures, which rely on merged data from multiple administrative data sources, such as laboratory, pharmacy, imaging or other claims data.
• Level three measures, which are constructed from common electronic administrative data sources enriched with clinical data such as laboratory results or blood-pressure values.

"By taking advantage of multiple sources of data, these measures can provide a more complete picture of the care provided," Cutler said. "These measures are also an important step down the path toward harmonized performance measures fully driven off of an electronic data platform."

The steering committee reviewed more than 200 measures currently used by private health plans to assess physician performance. Seventy were endorsed by the NQF, comprised of 55 level two and 15 level three measures. No level one measures satisfied NQF endorsement criteria. Many assessed similar aspects of performance but used slightly different measure specifications.

It is anticipated that NQF endorsement will encourage health plans to coordinate the use of these measures, reducing burden while ensuring greater consistency and understanding of performance information.

"The overarching goal is better ambulatory care," said Michael O'Toole, MD, co-chairman of the NQF's steering committee on clinically enriched administrative data sources and a cardiologist and chief information officer at Midwest Heart Specialists. "Clinically enhanced physician measures are a representation of quality. The more we can promote the use of electronic data, the more quality becomes part of routine clinical care, rather than a by-product or another form that needs to be filled out."

The steering committee said use of the more complex level-three measures will be limited, but will likely become widespread as more ambulatory practices invest in electronic health records and as participation in clinical registries becomes more prevalent.