Providers and hospitals pursuing EHR incentives know about clinical quality measures (CQMs) and clinical decision support (CDS) in terms of reporting measures required under Stage 2 of meaningful use. What they may be aware of is that the Office of the National Coordinator for Health Information Technology is working to create standards that would align those two realms of modern medicine.

"Clinical quality measurement and clinical decision support are really two parts of the same point," explained Marc Hadley, principal software systems engineer at MITRE Corporation and a co-presenter at a HIMSS14 educational session on Tuesday. Hadley developed an open-source quality measure engine that uses an algorithm to compute CQMs and is designed to scale to large populations of patients.

"We take personal health information and activate it into practices and populations, where we can perform public health and clinical research," said Hadley. "That can provide clinical guidelines that drive public health policy and influence the creation of clinical quality measures and clinical decision support rules, which in turn help providers deliver care."

However, standards used for CQM and CDS have evolved in "separate stovepipes" until now, he said.

Co-presenter Julia Skapik, a board-certified internist and medical officer at ONC, said the integration of harmonized terminology into CQMs is part of an overarching quality improvement framework: Researchers would be able to focus on what is happening in their studies; guidelines would determine what should happen; CDS would be used in care settings to determine "Does the patient really need this?" and quality measures would reflect what actually happened.

"I'm a provider myself and recognize that probably a few of my colleagues would describe meaningful use and EHRs as reducing the burden on the way that they practice," said Skapik. "But as we start to standardize the process and make improvements, I think people will see that it's going to be easier for them to provide clinical care. They will have more information available at their fingertips, and they're going to be able to act on that in a meaningful way."