Quality Measures

Quality measurement is a mechanism of assigning a quantity to quality of care by comparing it with certain criteria. It indicates whether providers meet certain performance standards by using the following ways:

• Compare data on what was actually done to what was supposed to be done.
• Define if appropriate procedures were conducted.

This contributes toward healthcare services improvement and stakeholders' awareness of the quality of care provided. This helps a Payer evaluate the quality of providers' work and distribute the payment between providers properly. Quality measures can be of three types: structural, process, and outcome. Structural measures evaluate the conditions in which care services are provided. Process measures define whether the procedures proven to benefit patients were performed and indicate what a provider has done to maintain or improve consumer's health. These measures can inform patients about medical care they might expect to receive for certain diseases or conditions, and can promote improved health outcomes. Outcome measures show the results of provider activities. They indicate whether the patient’s health improved and reflect the healthcare service's impact on the patient's health status. For more information on quality measures, see the Centers for Medicare & Medicaid Services (CMS) official web site.

XES Module for FHIR collects the patient-related resources (demographics, encounters, procedures, etc.) in real time to perform accurate up-to-date quality measures against a required provider. This helps the Payer to reduce chart reviews for calculating patient outcomes without having to buy or build expensive Quality Measure Engines. Each quality measure is specified by a unique CMS identification number (ID). Using the Measures page of XES Module for FHIR, you can get the necessary quality measures of the required practitioners. There are a lot of quality measures, and the following ones are implemented as an example. You can use the implemented quality measure engine that can be added to the system or implement you own quality measures.

• CMS 69 BMI - Body Mass Index
• CMS 122 - Hemoglobin Control
• CMS 125 - Breast Cancer Screening
• CMS 165 - High Blood Pressure

XES Module for FHIR calculates quality measures by the ratio of the numerator to the denominator, where the denominator is the selection of patients satisfying certain conditions. For example, for the CMS 165 quality measure has the following conditions:

1. The patient's age is between eighteen and eighty-five years.
2. An essential hypertension condition was diagnosed within the six months from the initial date.
3. An active pregnancy was not diagnosed.
4. An active renal disease was not diagnosed during the measurements period.
5. A kidney disease was not diagnosed.
6. A vascular access procedure was not performed.
7. A kidney transplantation was not performed.
8. A dialysis service was not provided.
9. Another dialysis service was not provided.
10. An education dialysis procedure was not performed.
11. ESRD (End Stage Renal Disease) was not diagnosed.
12. The following actions were carried out:

• An office visit
• An outpatient consultation
• Preventive Care Services (an initial office visit for patients older than eighteen years)
• Preventive care services (an established office visit for patients older than eighteen years)
• A face-to-face interaction
• Home healthcare services
• An annual wellness visit

For more details on other quality measures, see CMS 69 BMI, CMS 122, and CMS 125.