The question in the title is just like our daily deep thoughts on "how far is the ideal". So, what standard should the ideal medical quality have? What is the measurement method? Professor Li Baoluo, Honorary Chairman of the Information Management Professional Committee of the China Hospital Association, gave a speech on the theme of "Medical Quality Measurement and Standardization of Medical Information" at the "Smart Medical Data Service Technology Seminar" held by Intel on November 15th The staff explained the progress of medical quality measurement in the United States and how far China is from the medical quality measurement.
Medical reform goals
Professor Li Baoluo said that the goals of medical reform in various countries are nothing more than the following three points: accessibility: medical insurance covers more people; efficiency: medical service providers provide services more efficiently; cost: effectively suppress the rapid growth of medical costs. And any new system design, if it will eventually lead to the stagnation of medical technology progress and decline in medical quality, it must be a failed reform.
Control of medical quality
How to best achieve the goal of medical reform? Control of medical quality is the most important way to solve problems. The best way is to pay the service based on medical quality (Payment for Performance), or at least as an important factor. That is realized: Pay for Service → Pay for DRG → Pay for PopulaTIon → Pay for Performance
So, how can scientific, authoritative, fair, transparent, convenient, and feasible evaluation of medical quality be made? Li Baoluo believes that the construction of the HIT industry is in full swing at this stage, and medical institutions' recognition of informatization is also increasing. But the development of HIT (EMR / EHR) is not an end in itself. Our purpose is to provide patients with more timely, efficient and high-quality services through the interconnection and interoperability of clinical information; reduce medical errors and improve medical quality; improve the efficiency of hospitals; improve the efficiency of doctors; in fact, The more direct purpose is to make it possible to supervise complex and free doctor behaviors, including diagnosis and treatment activities, quality, efficiency and charges.
New Progress in the Measurement of American Medical Quality
Professor Li Baoluo said that the United States has gone through the stage of pure theoretical discussion and policy research on the supervision of complex and free doctor behaviors, including diagnosis and treatment activities, quality, efficiency and charging. Relying on President Obama's tide of medical reform, the American CMS led the implementation of a measurement management system (The Measures Management System), and developed a mechanism and steps to achieve medical quality measurement. Its methods and paths are closely related to information technology, especially information standardization technology, including HL7. Although the effect of the final operation of the system is still unknown, it is undoubtedly worth learning by Chinese medical reform policy makers.
Roadmap for medical quality measurement
US EMR Implementation Roadmap
The direct driving force for the promotion and application of EMR / EHR in the United States is to achieve the financial incentive plan required by Meanful Use in stages and the punishment regulations for failing to meet the requirements in due time. These are based on bills passed by Congress. Measure Management System will become an important part of meeting EMR Meaningful Use conditions.
Five steps to achieve medical quality measurement
1. First, a medical management agency (NQF) published a series of clinical guidelines (Clinical guideline / Clinical Pathway). Quality measures are often derived from clinical guidelines and are designed to determine whether the appropriate care has been provided given a set of clinical criteria and an evidence base.
2. Develop a standard format that can express such specifications. This format should be uniform (unique), complete (can cover all specifications), and can be electronic (computer readable). NaTIonal Quality Forum (NQF) joined with HL7, AHIMA and consulTIng firm Alschuler Associates to develop a draft standard called Health Quality Measure Format (HQMF) which is a standard for represenTIng a health quality measure as an electronic document.
3. Express each diagnostic specification in a uniform format HQMF. NQF convert 113 NQF-endorsed measures from a paper-based format to an electronic “e-Measure†format.
4. The application developer extracts the necessary information from the EHR / EMR according to the requirements of quality measurement, namely the so-called e-Measure Standardization of document structure (eg sections), metadata (eg author, verifier), and definitions (eg "numerator" , “Initial patient populationâ€) enables a wide range of measures, currently existing in a variety of formats, to achieve at least a minimal level of consistency and readability, even if not fully machine processable.
5. Generate a standardized quality measurement report (QRDA) that meets the requirements of the medical management department. The Quality Reporting Document Architecture (QRDA) project is developing a standard for communicating health care quality measurement information. The standard will conform to the requirements of the Health Level Seven (HL7) Clinical Document Architecture Release 2.0 (CDA).
How far is China from medical quality measurement?
We have nearly 200 clinical pathways for diseases; failed to meet the exchangeable and shared electronic medical record standards; there is no formatted standard for expressing clinical pathway specifications; many HIS developers personally integrate the clinical pathway specifications into the doctor workstation system (CPOE) The requirements of the clinical path specification are applied, but there is no requirement for quantitative measurement of medical quality; there is no requirement for standardized quality measurement report. Therefore, combining these factors, perhaps we can predict how far China is from the medical quality measurement.
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