A version of this post, written by Mike Noshay, Rick Moore, and Michael Barr, was initially posted in the Resources section on the HIMSS website on March 9, 2023.

Value-based payment models (VBPMs) depend on differentiating and rewarding entities that demonstrate higher quality, more equitable care at a lower cost when compared to similar organizations. For VBPMs to succeed, quality and utilization measures need to assess and reflect the results of meaningful, actionable aspects of care and link variation in performance to variation in outcomes for people, utilization, and cost. This requires a high degree of clinical data usability.

Data Must Be Accessible, Usable, and High-Quality

Health plan executives know that “Dirty Data” is pervasive. A survey by Sage Growth Partners of 100 healthcare executives showed that only 20% of organizations fully trust their data; more than 50% indicate poor data quality has serious consequences; and 84% say creating and sharing high-quality data is a top strategic priority for the next 36 months. Deficiencies in data affect clinical, operational, and financial analyses that can influence how, where, and whether care is provided. Gaps in the quality of social determinants data make it challenging to identify and address health equity gaps due to misclassification and non-random, missing data. Systematic data issues can lead to biased analyses and misdirection of resources. A lack of confidence in the underlying data can lead clinical teams to question decision-support algorithms designed to nudge clinical teams towards guideline-concordant, cost-effective best practices.

The 21st Century Cures Act will facilitate secure access, exchange, and use of electronic health information through Health Level Seven (HL7®) Fast Healthcare Interoperable Resources (FHIR®) application programming interfaces (APIs) and reduce information blocking. But the usefulness of that data will only be as good as its quality. 

More Data Will Not Fix Poor Data

The need for more and better clinical data will continue to increase. The CMS National Quality Strategy (NQS) includes a commitment to transition to digital quality measurement, and the National Committee for Quality Assurance (NCQA) has also signaled its intent to digitalize HEDIS measures. The impetus for the shift to digital measures is primarily driven by the currently burdensome, expensive, underperforming, and under-differentiating performance measurement ecosystem. New digital quality measures will generate actionable insights for improving care by leveraging clinical data beyond what most health plans and healthcare organizations currently can obtain. Health plans, accountable care organizations, health systems, and other data-dependent entities need to focus on clinical data quality and usability now in anticipation of the need for more and better clinical quality data.

Take Steps Now

There are steps that healthcare organizations and health plans should start taking now to support better clinical data usability – including leveraging existing tools and validation programs. The post on the HIMSS site includes specific recommendations including to:

• Determine the current and future need for clinical data within your organization.
• Inventory current clinical data sources and whether those data can support your needs for internal and external reporting.
• Prepare your organization for FHIR API implementation, including assessing internal operations to consume and use clinical data.
• And several others…

Please read the complete set of recommendations and opportunities.

Avoid Drowning in a Sea of Dirty Data

Organizations that do not have an informed and forward-looking clinical data quality strategy could incur avoidable financial and reputational risk as public reporting of quality, health equity, and utilization become more heavily dependent on access to robust, high-quality, and usable clinical data.