Known originally in the 2011 Edition (Stage 1) as 170.304 (j) – and now 170.314 (c)(1), (2), and (3) - the requirements for supporting Clinical Quality Measures (CQMs) proved to be a sticking point for many vendors looking to certify.
Some of our clients who had certified under 2011 edition had done so successfully with the application popHealth for CQMs, a product targeted to Ambulatory (EP) providers, under Stage 1. But users had grown frustrated with the implementation process, one that included difficulty importing data, delayed updates for known issues and virtual machines for various Windows versions that were cumbersome to use.
This frustration was compounded by the 2013 government shutdown that lasted two and a half weeks and affected support and continuity for a host of Health IT-related programs. This put another layer of pressure on vendors facing certification deadlines.
When the 2014 edition of certification standards rolled around, popHealth was not yet certified and ultimately would transition to open source. While DHIT has been involved in open source projects at various, the time-sensitive nature of certification pressed the limits of using open source to build and maintain a certified software package.
PopHealth was built with Ruby on Rails and our development team felt we could harness technology more familiar to our clients (C#, MSSQL) to tackle CQMs. In CQMs, we saw an opportunity to challenge ourselves and embark on some cutting-edge development. We decided to jump in head first and build an what would come to be named CQMsolution.
Our goal from the outset was to create a browser based C# application to support the 93 CQMs (both Inpatient and Ambulatory). We would have to do it from scratch, but we had the development experience and potential clients looking for a new approach.
In contrast to the pitfalls of version stagnation that can sometimes occur in open source projects, CQMsolution is subject to an actively managed development cycle. Our team seeks to stay current on updates to Federal policy and quality measure updates across programs (MU, PQRS, IQR). We attend biweekly Tech Talks with Cypress to ensure our software validates with the very latest version of eCQMs and we engage in frequent testing, assisted by an ONC-sponsored tool called BONNIE (a web-based tool primarily for measure developers that allows users to load in quality measures and create test patients).
Where there have been challenges configuring and deploying homebrew CQM aggregators in multi-entity settings, we have worked to ensure that CQMsolution sits atop a stable back-end that runs with minimal client intervention and can be centrally-configured for multiple practices.
Our latest version of the application, which works with Cypress CQM validation software (v2.6.1), includes enhanced drill-down screens and the fruits of a testing process that has increased our coverage of many "border" cases. With BONNIE, Dynamic Health IT has now generated or shared in over a thousand patients to stress-test our application.
These efforts keep CQMsolution current for our clients and on pace with EHR certification and standards.
All of this is not to say that open source does not have its virtues. It most certainly does and often leads to breakthroughs in our industry. Many of us use or even contribute to open source applications on a daily basis. But there can be important differences, especially when dealing in subject matter that is time sensitive (CQMs, check) and frequently changing (double check).
Quality measure software must be updated regularly to accommodate both Cypress validation and CMS measure releases. Meaningful support also should be responsive to client submission deadlines and other potential needs related to reporting and displaying quality measures.
As always, let form follow function.
Stay tuned for a full breakdown of 2015 Certification Updates.