Methods for Developing the American College of Rheumatology's Electronic Clinical Quality Measures

The widespread use of electronic medical records (EMRs) is creating new opportunities to reimagine quality measurement and improvement in rheumatology. Previous quality measurement efforts have relied on analyses of administrative billing claims, such as the National Committee on Quality Assurance disease-modifying antirheumatic drug measure (1), or on manual chart review, such as the American Medical Association’s Physician Consortium for Performance Improvement’s (PCPI) Physician Quality Reporting System measures (2). While there is some evidence that these programs have resulted in quality improvement, many have argued that current performance assessments have limited utility and do not support building a continuously learning health care system, as envisioned by the Institute of Medicine (1–3). The limitations of current measurement approaches have led to calls for new systems to make quality measurement more efficient and meaningful. Rather than relying on retrospective assessments of care, newer measures should be fully integrated into clinical workflows and results available in realtime to clinicians (4). Performance information should be tailored to individual practices and health systems to allow flexibility and innovation in local quality improvement efforts. At the same time, aggregate data across practices should also be available to allow for benchmarking. The implementation of EMRs has created new infrastructure to begin to advance these goals. Electronic clinical quality measures (eCQMs) are a new approach to measurement that automatically extracts information from EMRs, potentially allowing timely generation of performance data and increasing the efficiency of data collection for quality improvement (5,6). In this paper, we discuss the methodologic approach recommended by the American College of Rheumatology (ACR) The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Supported by the American College of Rheumatology. Dr. Yazdany’s work was supported by the Robert L. Kroc Chair in Rheumatic and Connective Tissue Diseases (I) (AHRQ-R01-HS024412) and the Russell/Engleman Medical Research Center for Arthritis. Jinoos Yazdany, MD, MPH, Gabriela Schmajuk, MD, MS: University of California, San Francisco; Rachel Myslinski, MBA, Amy Miller, Melissa Francisco, MBA: American College of Rheumatology, Atlanta, Georgia; Sonali Desai, MD, MPH: Brigham & Women’s Hospital, Boston, Massachusetts; Diane Lacaille, MD, FRCPC, MHSc: Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada; Claire E. Barber, MD, PhD, FRCPC: University of Calgary, Calgary, Alberta, Canada; Catalina Orozco, MD: Rheumatology Associates, Dallas, Texas; Matthew Bunyard, MD: Cleveland Clinic, Cleveland, Ohio; Martin J. Bergman, MD: Drexel University College of Medicine, Philadelphia, Pennsylvania; Murray Passo, MD: Children’s Hospital, Medical University of South Carolina, Charleston; Eric L. Matteson, MD, MPH: Mayo Clinic College of Medicine, Rochester, Minnesota; Richard Olson, MD: Rockford Orthopedic Associates, Rockford, Illinois; Stuart Silverman, MD: Osteoporosis Medical Center, Beverly Hills, California; Robert Warren, MD, PhD, MPH: Medical University of South Carolina, Charleston; Kamala Nola, PharmD, MS: Lipscomb University College of Pharmacy, Nashville, Tennessee; Mark Robbins, MD, MPH: Harvard Vanguard Medical Associates, Atrius Health, Somerville, Massachusetts. Dr. Bergman has received consultant fees, speaking fees, and/or honoraria from Amgen, Iroko, BMS, Horizon, Johnson & Johnson, and Novartis (less than $10,000 each), and AbbVie, Celgene, Genentech, and Pfizer (more than $10,000 each), and holds stock or stock options in Merck, Johnson & Johnson, and Pfizer. Dr. Passo has received consultant fees, speaking fees, and/or honoraria from Pfizer and Cincinnati Children’s Hospital (less than $10,000 each). Dr. Matteson has received advisory fees from GlaxoSmithKline (less than $10,000). Address correspondence to Jinoos Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco, Box 0920, San Francisco, California 94143-0920. E-mail: jinoos.yazdany@ucsf.edu. Submitted for publication November 20, 2015; accepted in revised form June 29, 2016.